Roundups Sexual Health

Sexual Health Roundup: Parents Still Have Heads in the Sand on Teen Sex

Martha Kempner

A new book examines parents attitudes about their own teens sexual behavior; the New York Times looks at the life of Mary Fisher, an HIV-positive mother of two who spoke passionately at the RNC convention in 1992; and scientists look at a new immune deficiency syndrome that is not contagious.

Parents Still Burying Their Heads in the Sand When it comes to Teens and Sex

Back in 2004, Sinikka Elliot, a parent and sociology professor at the University of North Carolina, watched a heated controversy over sexuality education play out at the Texas School Board and wondered whether this polarized debate truly represented the views of parents who weren’t so entrenched in the issue. After interviewing parents on all points along the political spectrum, Elliot determined that it did not and published her finding in a book called, “Not My Kid: What Parents Believe About the Sex Lives of Their Teenagers.”  In an interview with Salon.com, Elliot talked about what she learned interviewing these parents who all resided in an “unnamed red state.” 

She found that parents tend to think of their children as less mature and less sexual than they really were: 

“What I see happening is that parents are constructing their kids in this way, as little and young, to think about them as not being interested in sex. Parents don’t want to think of their kids as sexual beings.” 

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Parents were, however, were willing to believe that other kids were having sex.  She points to the way society talks about teen sex as the culprit in this contradiction: 

“Parents aren’t hearing anything positive about teen sexuality, they’re hearing about the profound physical, psychological and social consequences of sex. So of course when they look at their teens they don’t want to imagine their kid encountering those risks.”

Elliot also writes about the sex education debate in this country and argues that both In both sides of the debate over sexuality education treated teen sex the same way and operatedwithin a “danger discourse.” She points out that those on either side of the spectrum base their arguments on the same thing—the possibility of STDs, HIV, or teen pregnancy—they just have different ideas of how teens should avoid these.  She argues that, “we can and should shift the discourse, but we need to start talking about the evidence there is that teens are actually being quite responsible when it comes to sex.” 

I agree with her whole-heartedly that teens often behave very responsibly when it comes to teen sex, that we have to give them credit for it, and that we have to start talking about something other than the dangers of teens sex (I’ve said all of these things before), but I think there is another layer to the argument over sex ed. While both sides often reduce their argument to one about preventing the dangers of teens sex I think this is because public health issues tend to sway those who are not, as Elliot puts it, deeply entrenched in the issue. But I belive that there is a fundamental philosophical difference underlying the arguments with one side believing that teen sex (or sex outside of marriage) is morally wrong and the other that sex can be a natural and healthy part of a teen’s life. (In the interest of full disclosure, I have not read her whole book and Elliot may delve deeper into this topic in the book and touch on this point as well.)

Her ultimate suggestion, however, that we need to change the way we talk about teen sex in this country, is one that I can definitely get behind and one that makes me eager to read the whole book.   

New York Times Looks Back at Mary Fisher’s 1992 RNC Speech

A few weeks ago, while Republicans took the stage in Tampa, the New York Times looked back at the RNC’s 1992 convention when Mary Fisher, a member of a prominent Michigan Republican family, took the stage to discuss HIV. Fisher, who herself worked in Gerald Ford’s White House, is the daughter of a Republican advisor who worked “with every president from Nixon to George W. Bush on Israel and Jewish affairs” and was serving as the honorary chairman of Bush-Quayle’s finance committee. Fisher was invited to speak because of her connection and, as the Times points out, because the Republicans needed their own Elizabeth Glaser who had spoken eloquently about HIV at the Democratic National Convention a month earlier.

Fisher became infected with HIV in 1991 (her ex-husband who she had already divorced by the time she was diagnosed died of the disease in 1993) and as far as anyone knew at the time was facing a certain death sentence when she took the stage and said:

“Tonight, I represent an AIDS community whose members have been reluctantly drafted from every segment of American society. I am one with a black infant struggling with tubes in a Philadelphia hospital.  I am one with the lonely gay man sheltering a flickering candle from the cold wind of his family’s rejection.”

The speech made a list of the top 100 speeches 1900-1999, a list which includes Martin Luther King’s “I Have a Dream.” As Stephen Lucas, a professor in the department of communication arts at the University of Wisconsin and co-editor of the list, explained:

“She is dealing with a really gritty subject that revolves around a sexually transmitted disease and people dying horrible deaths, and the language is uplifting.  And then she delivers it in this pristine, clarion kind of way in which her voice cuts through the convention, cuts through the myths and stereotypes regarding AIDS. She has what she sees as a profound truth, and she wants to bring it to the audience.”

The speech also launched Fisher into a career as an AIDS activist who served as a special representative for the United Nations global task force and Ambassador to UNAIDS.

Today Fisher is 64. She says she is “sad that we are still here” when it comes to the AIDS epidemic and frustrated with the perception that AIDS has been cured. She describes her sixth book, Messenger: A Self Portrait, which will be published this month as:  “…my second memoir. The one I had to write because I did not die.” 

Fisher told the Times that she admires Hilary Clinton and Barack Obama but says that she has stayed a Republican, though, she added: “What does Republican mean anymore?” I’m a Gerry Ford Republican, and my party’s gone someplace else. I feel like I want to stay a Republican because they might listen to me.”

New Study Looks at AIDS-Like Virus That is Not Contagious

A recent report in the New England Journal of Medicine looks over 200 cases of patients with AIDS-like symptoms none of whom were infected with HIV. AIDS—Acquired Immune Deficiency Syndrome—is caused by HIV, a virus that attacks T-cells, which are one of the body’s first defenses against germs, leaving infected individuals unable to fight off infections. Scientists are calling this new find Adult-Onset Immunodeficiency Syndrome because it develops in individuals around age 50 but scientists do not know why. The disease does not run in families which makes it unlikely that a single gene is responsible for it though thus far nearly all patients have been Asian or Asian-born suggesting that there may be a genetic or environment factor.

Unlike HIV, the disease does not attack T-cell. Instead, most of those with the disease make substances called auto-antibodies that block interferon-gamma, a chemical signal that helps the body clear infections.“Blocking that signal leaves people like those with AIDS—vulnerable to viruses, fungal infections and parasites, but especially micobacteria, a group of germs similar to tuberculosis that can cause severe lung damage.” As Sarah Browne, the author of the current study, said: “Fundamentally, we do not know what’s causing them to make these antibodies.” The disease itself is not contagious but scientists do not yet know if some type of infection serves as a trigger.  

Browne has studied 200 people since the disease was first documented in 2004 but believes there are many more including people who have likely been misdiagnosed as having tuberculosis.

Roundups Sexual Health

This Week in Sex: A Nursing Home With a Healthy Attitude Toward Sex

Martha Kempner

A nursing home understands that its elderly residents are still sexual beings; New York City is amping up its youth sexual health outreach with emojis of eggplants and monkeys; and if forced to choose between eating and sex, a good number of people pick food.

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

Sex Is Not Just for the Young

The New York Times recently profiled a nursing home with a sex-positive attitude for its residents. The Hebrew Home at Riverdale adopted its “sexual expression policy” in 1995 after a nurse walked in on two residents having sex. She asked her boss, Daniel Reingold, what she should do. He said, “Tiptoe out and close the door.”

Reingold, the president of RiverSpring Health (which runs the nursing home), said that aging includes a lot of loss—from the loss of spouses and friends to the loss of independence and mobility. But he believes the loss of physical touch and intimacy does not have to be part of getting older.

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The policy acknowledges that residents have the right to seek out and engage in consensual acts of sexual expression with other residents or with visitors. The policy ensures that staff understand that their role is not to prevent sexual contact. In fact, some of the staff like to play cupid for residents. Audrey Davison, an 85-year-old resident, said that the staff let her sleep in her boyfriend’s room, and one aide even made them a “Do Not Disturb” sign for his door. She added: “I enjoyed it and he was a very good lover.”

Still, there are complicating factors to dating in nursing homes or assisted-living facilities. Some residents may be married to people who don’t live in the facility, and others may be suffering from memory loss, dementia, or Alzheimer’s, which can raise issues of consent. Hebrew Home’s policy states that Alzheimer’s patients can give consent under certain circumstances.

Though not all nursing homes have formal policies about sex, many acknowledge that their residents are or want to be sexually active and are working to help residents have a safe and consensual experience. Dr. Cheryl Phillips, a senior vice president at LeadingAge, an organization which represents nursing homes and others who provide elder care, also told the New York Times that this generation of older adults is different: “They’ve been having sex—that’s part of who they are—and just because they’re moving into a nursing home doesn’t mean they’re going to stop having sex.”

Of course, not all residents are lucky in love when they move in. Hebrew Home says that about 40 of its 870 residents are in relationships. Staff are trying to help the others. They set up happy hours, a prom, and have started a dating service called G-Date (for “Grandparent Date”). So far it hasn’t been too successful in making matches, but the staff is convinced that someday their efforts will pay off with a wedding.

Can Emojis Connect Youth to Sexual Health Services?

New York City’s public hospital system, known as Health & Hospitals, provides confidential sexual health services—including pregnancy tests, contraception, and tests for sexually transmitted diseases (STDs)—for young people 12 and older regardless of their ability to pay, immigration status, or sexual orientation. Health & Hospitals served 152,000 patients last year, but its leaders think it could do even more if more young people were aware of the services offered.

As a way to speak the language of young people, Health & Hospitals launched a campaign starring emojis in July.

The emojis are expected to reach 2.4 million young people in New York City through social media including Facebook and Instagram. The emojis include an eggplant, a monkey covering his eyes, and, of course, some birds and bees. The online ads read, “Need someone to talk to about ‘it’?”

When young people click on the emojis, they will be taken to the Health & Hospitals youth website, which explains available services and how to find accessible providers.

Dr. Ram Raju, president and CEO of NYC Health & Hospitals, said in a press release that the organization provides nonjudgmental services to youth: “Whether it’s birth control, pregnancy testing, emergency contraception or depression screening, the public health system has affordable services in local community health centers, where we speak your language, understand your culture and respect your privacy.”

But some worry that these emojis are confusing. Elizabeth Schroeder, a sex educator and trainer, told the New York Times that while she applauded the effort, she questioned if the images chosen were the best to convey the message.

We here at This Week in Sex have to agree and admit the images confuse us as well. The monkey is cute, but what does it have to do with STDs?

Choosing Between Appetites, Many Pick Food

Good food or good sex? These two sources of pleasure are rarely at odds with each other, but if they ever are, which would you choose?

A new survey, by advertising agency Havas Worldwide, posed this very question to almost 12,000 adults in 37 countries across the globe. The results show that about half of adults (46 percent of men and 51 percent of women) believe that food can be as pleasurable as sex. And one-third would choose a great dinner at a restaurant rather than sex; women were more likely to make this choice (42 percent compared with 26 percent of men).

Millennials were also more likely to make this choice than those slightly older Gen-Xers (35 percent to 30 percent). Of course, it’s hard to tell whether this says more about their sex lives or their eating habits.

 

Analysis Sexual Health

Centering Disabled People in Conversations About Menstruation

s.e. smith

It is not a surprise that disabled people have a spectrum of feelings about menstruation, as do nondisabled people. Too often, however, disabled people tend to be among the last of those consulted about policy and best practice recommendations when it comes to their reproductive health and rights—starting as early as their adolescent years.

For Dee, who works with a disability nonprofit in New York state, menstruation is a frustrating balancing act, especially after an injury that limited her mobility. Dee, who asked that Rewire not use her last name, must coordinate with her personal care attendant to put on underwear and a pad before transferring to her wheelchair and adjusting them. The perennial struggle with keeping pads in place can come at a high cost to undergarments, clothes, and wheelchair cushions.

“I hate it. If I could make it stop, I would gladly do so. I have told my family and health-care providers that if I ever need to be anesthetized again, I would prefer they perform a hysterectomy while I’m knocked out,” Dee told Rewire.

Meanwhile, Alice Wong, a disability rights activist and organizer who lives in San Francisco, says that “menstruation is a nice reminder that something is ‘working normally’ in my body when there are so many other aspects to my body that are not.” She has limited hand strength and dexterity, paired with elbow contractures that make it impossible for her to use the toilet independently. Her parents, who act as her caregivers, assist her with her bathroom needs as well as use of menstruation supplies. For her, menstruation can present some personal care challenges, and she noted that pads in particular can pose problems because they tend to dislodge while she’s transferring in and out of her chair or moving around during the course of the day.

Wong came up with an innovative solution that would allow her to menstruate in comfort: “As I got older and stopped caring what other people thought, I went with disposable briefs instead of pads. That’s right—disposable briefs that are used for incontinence! There’s better coverage and absorption. And they’re a lot easier to pull on.”

These experiences serve to reinforce the fact that in discussions about menstruation and disability, disabled people themselves need to be centered. It is not a surprise that they have a spectrum of feelings about menstruation, as do nondisabled people. Too often, however, disabled people tend to be among the last of those consulted about policy and best practice recommendations when it comes to their reproductive health and rights—starting as early as their adolescent years.

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So when the American Academy of Pediatrics came out with updated guidelines on the subject of menstrual management among disabled teens in June, some disability activists worried that the document could be yet another iteration of policy about disability that didn’t consult disabled people themselves.

The document turned out to be a pleasant surprise, though, and an indication that the AAP is continuing to lead a progressive turnaround on thinking about both adolescent health and disability. When it comes to disability and medical practice, conversations often center the convenience and desires of caregivers, parents, and guardians. Instead, this document focused on issues of relevance to the disability community, particularly with regard to the abuse of menstrual suppression, which doctors sometimes recommend to disabled patients and their caregivers.

Advocates for menstrual suppression in disabled people, by both hormonal and surgical means, argue that it’s necessary in cases of “severe” disability where people might experience hardship with their periods. This can include the challenges of managing menstruation when people have limited mobility and rely on caregivers for assistance with activities of daily living, including toileting. They also assert that menstruation can be “traumatic” for people with intellectual, cognitive, or developmental disabilities. Furthermore, they claim, people who menstruate can get pregnant—often seen by nondisabled people as undesirable, though it can disturbingly be the first and only sign of sexual abuse.

These arguments primarily focus on the convenience and preference of caregivers who don’t want to deal with menstruation, and they strip disabled people of autonomy. Many people have very complex, intimate, and personal relationships with their period. Letting disabled people speak in their own words about their experiences with menstruation should be central to any conversation about menstrual suppression, especially extreme measures like the so-called Ashley Treatment, in which the uterus and breast buds are removed and children are medicated to attenuate their growth, ensuring that they remain small and light. Though it is overwhelmingly rare, parents say the treatment makes their children easier to handle, reducing the risk that they have to surrender their children to care facilities.

The AAP guidelines, hearteningly, center the patient from the very first line, stressing that they must be involved in discussions about such a sensitive issue. The organization states clearly that menstrual suppression shouldn’t be done for the wrong reasons: “When the stated reasons for suppression are an inability of caregivers to deal with menses or fear of abuse or pregnancy, further investigation into the patient’s circumstances and safety is warranted. If the issue is mainly to get assistance at school, then health care providers can help families to address the student’s needs with the school.”

The document stresses that physicians should fully evaluate the medical and social needs of their disabled patients—including interest in sexual activity—before making a menstrual management recommendation that suits their circumstances. The authors discuss a variety of hormonal and nonhormonal birth control options and some of their implications for disabled people, but do not make specific recommendations.

This focus on choice, again, reflects disabled people’s wide variety of experience with menstruation. Wong, for example, said while she has “options to suppress menstruation whether via an IUD or oral contraceptives” and “considered it in an effort to simplify my life and personal care needs,” she ultimately decided against it.

For her, the challenges are worth it: Taking control of her period by using pads and disposable briefs is an assertion of her independence.

Sam de Leve, an athlete from Southern California who also spoke to Rewire about their relationship with menstruation, experiences relatively light periods thanks to an IUD and finds that this provides some conveniences—but they aren’t using the IUD for menstrual suppression and aren’t sure they’d actively seek it out for that purpose.

When it comes to the loaded politics of the Ashley Treatment, de Leve commented, “It seems a little convenient that they target the most gendered parts of the body (breasts, uterus) when deciding what to remove. They’d make transfers easier if they removed arms or legs, but Lord knows they don’t do that! So I don’t believe that these are solely practical considerations or even primarily motivated by practical considerations. I think some of these families have this innocent ‘pillow angel’ mental image of their child, and this aspect of these procedures is about maintaining that image, not just the functional argument many of these care providers make to justify the Ashley Treatment. This is consistent with the desexualization of people with intellectual disabilities, or thought to have intellectual disabilities.”

Their comments echo concerns of those in the larger disability community who worry that practices like menstrual suppression serve to desexualize disabled people, but don’t actually offer concrete benefits. This is something the AAP itself also discusses, commenting that disabled youth are sexually active, but also experience higher rates of sexual abuse, adding, “It is important to discuss that any menstrual suppression does not change the risk of abuse or sexually transmitted infections.”

In their discussion of the Ashley Treatment, which was sharply condemned by a working group after its development, the authors also include stern warnings about the history of coerced sterilization in disabled people, and they caution that such procedures have “clear ethical and legal implications.”

Disabled youth are often given inadequate sexual health education, including education about menstruation, and they’re ill-prepared for the onset of menarche. Guardians, parents, and caregivers are sometimes under the impression that they’re doing their charges a favor by suppressing menstruation without consulting them, but they’re not turning to adults who menstruate to ask them about their own experiences. If they did, they might find that disabled individuals would like to be able to make that choice for themselves. In a culture where disabled people are both figuratively and literally desexualized, hiding menstruation doesn’t resolve issues like the abuse and dehumanization of disabled people—it just sweeps these problems under the carpet.

These guidelines may serve as a wakeup call to pediatricians that it’s wise to discuss concerns about menstruation before its onset with patients and their parents. A conversation about what to expect and the options available can encourage people to think about their needs and wants ahead of time. Disabled youth tend to be very isolated from the rest of the disability community, and encouraging parents to connect their children with adult disabled mentors who can help them navigate menstruation and other matters can be rewarding for all parties, including parents who may feel at sea when it comes to caring for their children.

In recent years, the AAP has distinguished itself with common-sense, but still radical, policy proposals, like its recent recommendation to use long-acting reversible contraceptives to prevent teen pregnancy, and explicit discussion of disabled patients using contraceptives, reminding pediatricians and the public that disabled youth have sex. The organization is presenting factual, evidence-based information to its members when it comes to youth sexual health, and raising the prospect that teens will be empowered to take charge of their own fertility and choices, regardless of disability status and sexual history.

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