Roundups Sexual Health

Sexual Health Roundup: Arousal Helps Us Forget that Sex Can be Gross

Martha Kempner

A new survey shows women underestimate their risk of pregnancy and don't know enough about contraception; research out of the Netherlands finds arousal helps us get past the "ickiness" factor in sex; and schools in Texas broaden their approach to sex ed. 

Women Don’t Know Everything They Should About Contraception

A new survey suggests that women are not as well informed about birth control methods—even the ones they are using—as they should be. The study was sponsored by Teva Women’s Health, a manufacturer of contraceptive methods. A nationally representative sample of 1,000 women ages 18 to 44 were asked about their birth control choices and pregnancy experiences, as well as their knowledge and attitudes about certain methods. The survey also asked questions of 200 physicians, including Obstetricians/Gynecologists and family practitioners. It found:

  • 31 percent of all women ages 18 to 49 report having experienced an unintended pregnancy.
  • 47 percent of all women who have experienced an unintended pregnancy blame birth control failure.
  • Among women currently using birth control, 31 percent of women ages 18 to 24 reported birth control failure, as did 7 percent of women ages 25 to 39, and 4 percent of women ages 40 to 49.
  • Only 7 percent of sexually active women who were not trying to get pregnant and not sterilized say that they are at high risk for an unintended pregnancy.
  • Among women at risk of pregnancy (which excludes women who are currently pregnant, trying to get pregnant, sterilized, had a hysterectomy, or whose partner has been sterilized), 31 percent of those ages 25 to 29, 48 percent of those ages 35 to 39, 49 percent of those ages 40 to 44, and 64 percent of those ages 45 to 49 are not using a form of contraception.
  • 91 percent of women had heard of emergency contraception (EC), but among those many did not know how it worked. For example, 40 percent of women who had heard of EC incorrectly believed that it worked by terminating an existing pregnancy.
  • While most women reported talking to their physician about contraception, 61 percent of women who had talked to their health care provider said they had to start the conversation.

The survey confirms what we’ve known for a long time—there are many gaps in women’s knowledge and understanding of birth control, and health care providers are missing opportunities to discuss these topics. As the authors note: “Overall, women do not understand the mechanisms through which various forms of contraception work and are also under-informed about contraceptive methods.” The study shows that women are not only underestimating their own risk of pregnancy, they are also underestimating their own role in contraceptive failure. For example, many women suggested they experienced birth control failure of the pill, but admitted that they often or sometimes forgot to take their pill. As the authors point out: “Incorrect usage of birth control methods may lead to birth control failures and accidental pregnancy.”

This study makes it clear that we need to provide more education about how birth control methods work and what steps women (and men) need to take in order to make sure that their method of contraception is as effective as possible. Moreover, it suggests that we need to remind women that, with few exceptions, if you don’t want to get pregnant you have to use birth control. It still amazes me how many grown women are willing to just take their chances when it comes to pregnancy.

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Why We Don’t Notice that Sex is Kind of Gross

On television and in movies, sex is beautiful; two people with perfect bodies, wearing fabulous lingerie, fall gently onto a well-made bed, then, lit by a soothing blue glow and surrounded by quiet music, they glide around each other gracefully until the “after shot” when they are glistening, smiling, and neatly wrapped in a sheet. In contrast, real-life sex is kind of messy. People sweat, they smell, they fart, they burp, and that’s even before the body fluids (which are sticky and have their own distinct scents) get involved.  And yet, almost all of us not only do it, we seek it out. It does make one wonder, why don’t we think sex is gross?

Researchers in the Netherlands attempted to answer this question in a study of 90 women. The women were randomly assigned to three groups and shown different videos; a “female-friendly” erotic video, a high-adrenaline sports video that depicted activities like skydiving or rafting, or a clip of a train. The researchers then asked women to perform tasks that would be considered gross, like drinking from a cup with a (fake) bug in it, wiping their hands with a used tissue, eating a cookie that was next to a live worm, or putting their finger in a tray of “used” condoms. It turned out that women who had watched the erotic video were more likely to complete these tasks and to rate them as less disgusting than those who watched either of the other videos.

The researchers concluded that “…both the impact of heightened sexual arousal on subjective disgust and also on disgust-induced avoidance … act in a way to facilitate the engagement in pleasurable sex.” They go on to suggest that these findings could explain some sexual dysfunction because if women are not sufficiently aroused they might find sex disgusting and then begin to avoid it in the future.

The researchers recommend a large-scale study on this issue.

School Systems in Texas Expanding Sex Ed

When it comes to sex education, Texas is usually thought of as being pretty strict in its abstinence-only-until-marriage approach. In fact, it was one of the first to have a state-wide abstinence-only program. Called the Lone Star Leaders, the program was started by then-Governor George W. Bush to “help young people make right choices about drugs and alcohol, tobacco, sex, crime, civic involvement and school.” The State Board of Education has also engaged in bitter debates over textbooks in an effort to make sure the books were exclusively focused on abstinence and contained no information about other methods of protection against STDs or unintended pregnancy.

Now, though, many school systems in Texas are steering away from this strict abstinence-until-marriage approach and adopting broader sexuality education curricula. This week, the Spring Branch and Cypress-Fairbanks Independent School District, which is in the Houston area, adopted an “abstinence-plus” program created by the University of Texas Prevention Research Center which includes 12 lessons designed to teach seventh graders about contraception, unplanned pregnancy, and condom use.

The director of the University of Texas (UT) program who developed the lessons explained: “The misperception is that by talking about condoms and contraception and talking about sex, kids are going to increase their sexual activity; we know definitely that is not true.” UT received a $15 million grant from the U.S. Department of Health and Human Services to develop and test the curriculum. Thus far it has been used in five Houston schools and been taught to about 20,000 students.

Not all parents, however, welcomed the change. At an information session for parents in the Cypress-Fairbanks ISD some said the new program was “against their ‘moral fiber’ and a ‘bad choice’ for students and school districts.” That said, according to a district administrator, 200 parents attended the meeting and fewer than 10 had doubts about the program.

The district joins 10 schools in Harris County, the KIPP charter school system, and districts in Austin, Corpus Christi, San Antonio, and Plano in having broader sex- education programs.

Commentary Contraception

Hillary Clinton Played a Critical Role in Making Emergency Contraception More Accessible

Susan Wood

Today, women are able to access emergency contraception, a safe, second-chance option for preventing unintended pregnancy in a timely manner without a prescription. Clinton helped make this happen, and I can tell the story from having watched it unfold.

In the midst of election-year talk and debates about political controversies, we often forget examples of candidates’ past leadership. But we must not overlook the ways in which Hillary Clinton demonstrated her commitment to women’s health before she became the Democratic presidential nominee. In early 2008, I wrote the following article for Rewirewhich has been lightly edited—from my perspective as a former official at the U.S. Food and Drug Administration (FDA) about the critical role that Clinton, then a senator, had played in making the emergency contraception method Plan B available over the counter. She demanded that reproductive health benefits and the best available science drive decisions at the FDA, not politics. She challenged the Bush administration and pushed the Democratic-controlled Senate to protect the FDA’s decision making from political interference in order to help women get access to EC.

Since that time, Plan B and other emergency contraception pills have become fully over the counter with no age or ID requirements. Despite all the controversy, women at risk of unintended pregnancy finally can get timely access to another method of contraception if they need it—such as in cases of condom failure or sexual assault. By 2010, according to National Center for Health Statistics data, 11 percent of all sexually experienced women ages 15 to 44 had ever used EC, compared with only 4 percent in 2002. Indeed, nearly one-quarter of all women ages 20 to 24 had used emergency contraception by 2010.

As I stated in 2008, “All those who benefited from this decision should know it may not have happened were it not for Hillary Clinton.”

Now, there are new emergency contraceptive pills (Ella) available by prescription, women have access to insurance coverage of contraception without cost-sharing, and there is progress in making some regular contraceptive pills available over the counter, without prescription. Yet extreme calls for defunding Planned Parenthood, the costs and lack of coverage of over-the-counter EC, and refusals by some pharmacies to stock emergency contraception clearly demonstrate that politicization of science and limits to our access to contraception remain a serious problem.

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Today, women are able to access emergency contraception, a safe, second chance option for preventing unintended pregnancy in a timely manner without a prescription. Sen. Hillary Clinton (D-NY) helped make this happen, and I can tell the story from having watched it unfold.

Although stories about reproductive health and politicization of science have made headlines recently, stories of how these problems are solved are less often told. On August 31, 2005 I resigned my position as assistant commissioner for women’s health at the Food and Drug Administration (FDA) because the agency was not allowed to make its decisions based on the science or in the best interests of the public’s health. While my resignation was widely covered by the media, it would have been a hollow gesture were there not leaders in Congress who stepped in and demanded more accountability from the FDA.

I have been working to improve health care for women and families in the United States for nearly 20 years. In 2000, I became the director of women’s health for the FDA. I was rather quietly doing my job when the debate began in 2003 over whether or not emergency contraception should be provided over the counter (OTC). As a scientist, I knew the facts showed that this medication, which can be used after a rape or other emergency situations, prevents an unwanted pregnancy. It does not cause an abortion, but can help prevent the need for one. But it only works if used within 72 hours, and sooner is even better. Since it is completely safe, and many women find it impossible to get a doctor’s appointment within two to three days, making emergency contraception available to women without a prescription was simply the right thing to do. As an FDA employee, I knew it should have been a routine approval within the agency.

Plan B emergency contraception is just like birth control pills—it is not the “abortion pill,” RU-486, and most people in the United States don’t think access to safe and effective contraception is controversial. Sadly, in Congress and in the White House, there are many people who do oppose birth control. And although this may surprise you, this false “controversy” not only has affected emergency contraception, but also caused the recent dramatic increase in the cost of birth control pills on college campuses, and limited family planning services across the country.  The reality is that having more options for contraception helps each of us make our own decisions in planning our families and preventing unwanted pregnancies. This is something we can all agree on.

Meanwhile, inside the walls of the FDA in 2003 and 2004, the Bush administration continued to throw roadblocks at efforts to approve emergency contraception over the counter. When this struggle became public, I was struck by the leadership that Hillary Clinton displayed. She used the tools of a U.S. senator and fought ardently to preserve the FDA’s independent scientific decision-making authority. Many other senators and congressmen agreed, but she was the one who took the lead, saying she simply wanted the FDA to be able to make decisions based on its public health mission and on the medical evidence.

When it became clear that FDA scientists would continue to be overruled for non-scientific reasons, I resigned in protest in late 2005. I was interviewed by news media for months and traveled around the country hoping that many would stand up and demand that FDA do its job properly. But, although it can help, all the media in the world can’t make Congress or a president do the right thing.

Sen. Clinton made the difference. The FDA suddenly announced it would approve emergency contraception for use without a prescription for women ages 18 and older—one day before FDA officials were to face a determined Sen. Clinton and her colleague Sen. Murray (D-WA) at a Senate hearing in 2006. No one was more surprised than I was. All those who benefited from this decision should know it may not have happened were it not for Hillary Clinton.

Sometimes these success stories get lost in the “horse-race stories” about political campaigns and the exposes of taxpayer-funded bridges to nowhere, and who said what to whom. This story of emergency contraception at the FDA is just one story of many. Sen. Clinton saw a problem that affected people’s lives. She then stood up to the challenge and worked to solve it.

The challenges we face in health care, our economy, global climate change, and issues of war and peace, need to be tackled with experience, skills and the commitment to using the best available science and evidence to make the best possible policy.  This will benefit us all.

Analysis Law and Policy

Federal Court Says Trans Worker Can Be Fired Based on Owner’s Religious Beliefs

Jessica Mason Pieklo

“Plain and simple, this is just discrimination against a person because of who she is,” said John Knight, the director of the LGBT and HIV Project of the American Civil Liberties Union of Illinois, in an interview with Rewire.

When the U.S. Supreme Court ruled in 2014 in Burwell v. Hobby Lobby that the owners of secular for-profit businesses could challenge laws they believed infringed on their religious liberties, civil rights advocates warned that the decision was just the start of a new wave of litigation. On Thursday, those predictions came true: A federal district judge in Michigan ruled that a funeral home owner could fire a transgender worker simply for being transgender.

The language of the opinion is sweeping, even if the immediate effect of the decision is limited to the worker, Aimee Stephens, and her boss. And that has some court-watchers concerned.

“Plain and simple, this is just discrimination against a person because of who she is,” said John Knight, the director of the LGBT and HIV Project of the American Civil Liberties Union of Illinois, in an interview with Rewire.

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According to court documents, Stephens, an employee at Detroit’s R.G. & G.R. Funeral Homes, gave her boss—the business’ owner—a letter in 2013 explaining she was undergoing a gender transition. As part of her transition, she told her employer that she would soon start to present as a woman, including dressing in appropriate business attire at work that was consistent both with her identity and the company’s sex-segregated dress code policy.

Two weeks later, Stephens was fired after being told by her boss that what she was “proposing to do” was unacceptable and offensive to his religious beliefs.

In September 2014, the Equal Employment Opportunity Commission (EEOC) filed a lawsuit on behalf of Stephens, arguing the funeral home had violated Title VII of the federal Civil Rights Act, which prohibits employment discrimination. According to the EEOC, Stephens was unlawfully fired in violation of Title VII “because she is transgender, because she was transitioning from male to female, and/or because she did not conform to the employer’s gender-based expectations, preferences, or stereotypes.”

Title VII of the Civil Rights Act allows those employees who have been discriminated against in the workplace to collect money, known as civil damages. Those damages usually come in the form of lost wages, back pay, and funds to make up for—to some degree—the abuse the employee faced on the job. They are also designed to make employers more vigilant about their workplace culture. Losing an employment discrimination case for an employer can be expensive.

But attorneys representing Stephens’ employer argued that the Religious Freedom Restoration Act (RFRA) protected their client from legal liability for firing Stephens. On Thursday, a federal court agreed. It said that paying such damages for unlawfully discriminating against an employee could amount to a substantial burden on an employer’s religious beliefs. 

According to the court, despite the fact that Stephens’ boss admitted he fired her for transitioning, and despite the fact that the court found this admission to be direct evidence of employment discrimination, RFRA can be a defense against that direct discrimination. To use that defense, the court concluded, all the funeral home owner had to do was assert that his religious beliefs embraced LGBTQ discrimination. The funeral home had “met its initial burden of showing that enforcement of Title VII, and the body of sex-stereotyping case law that has developed under it, would impose a substantial burden on its ability to conduct business in accordance with its sincerely-held religious beliefs,” the court wrote.

In other words, Hobby Lobby provides employers a defense to discriminating against LGBTQ people on the basis of religious beliefs.

“The RFRA analysis is extremely troubling, and the implications of it [are] as well,” said Knight. “I believe this is the first case applying RFRA to a Title VII claim with respect to nonministerial employees.”

If the scope of the opinion were broader, Knight continued, “this would allow [employers in general] to evade and refuse to comply with uniform nondiscrimination law because of their religious views.”

This, Knight said, is what advocates were afraid of in the wake of Hobby Lobby: “It is the concern raised by all of the liberal justices in the dissent in Hobby Lobby, and it is what the majority in Hobby Lobby said the decision did not mean. [That majority] said it did not mean the end of enforcement of nondiscrimination laws.”

And yet that is exactly what we are seeing in this decision, Knight said.

According to court documents, Stephens’ boss has been a Christian for more than 65 years and testified that he believes “the Bible teaches that God creates people male or female,” that “the Bible teaches that a person’s sex is an immutable God-given gift, and that people should not deny or attempt to change their sex.” For Stephens’ former boss, Stephens’ transition to a woman was “denying” her sex. Stephens had to be fired, her boss testified, so that he would not be directly complicit in supporting the idea that “sex is a changeable social construct rather than an immutable God-given gift.”

If the “complicit in denying God’s will” sounds familiar, it should. It has been the exact argument used by businesses challenging the birth control benefit of the Affordable Care Act. Those business owners believe contraception is contrary to God’s will and that complying with federal law, which says birth control should be treated in insurance policies as any other preventive service, makes them complicit in sin. Thursday’s decision cites Hobby Lobby directly to support the court’s conclusion that complying with federal nondiscrimination law can be avoided by asserting a religious objection.

Think of the implications, should other courts follow this lead. Conservatives have, in the past, launched religious objections to child labor laws, the minimum wage, interracial marriage, and renting housing to single parents—to name a few. Those early legal challenges were unsuccessful, in part because they were based on constitutional claims. Hobby Lobby changed all that, opening the door for religious conservatives to launch all kinds of protests against laws they disagree with.

And though the complaint may be framed as religious objections to birth control, to LGBTQ people generally, and whatever other social issue that rankles conservatives, these cases are so much more than that. They are about corporate interests trying to evade regulations that both advance social equity and punish financially those businesses that refuse to follow the law. Thursday’s opinion represents the next, troubling evolution of that litigation.

CORRECTION: This article has been updated to clarify John Knight’s position with the American Civil Liberties Union of Illinois.

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