Roundups Sexuality

This Year in Sex: We’re Living in the Future

Martha Kempner

Between the high-tech sex toys, transplanted uteri, lab-grown penises, and perils of hookup apps, 2014 sometimes sounded like a science fiction novel. But we can't forget the news about IUDs and STIs that came out this year, either.

This Year in Sex takes a look back at the news and research related to sexual behavior, sexuality education, contraception, sexually transmitted infections, and other topics that captured our attention in 2014.

The HPV Vaccine Works, It Doesn’t Cause Promiscuity, and There’s an Even Better One Coming

HPV and its vaccine made headlines many times this year. The upsetting news is that two new studies came out suggesting that we had been underestimating the number of both HPV cases and cervical cancer, but as far as the vaccine itself was concerned, things were looking pretty good.

First, and most importantly, it appears to be working. A 2013 study found that despite the fact that only half of teen girls had gotten one dose of the vaccine—and fewer than a third had gotten the recommended three doses—the proportion of teen girls infected with the HPV strains that the vaccine addresses has dropped by 56 percent. This year, another study confirmed this success when it found that states with high rates of HPV vaccines have lower rates of cervical cancer, and vice versa.

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Additional research this year should (though probably won’t) also put to rest the idea that giving young people the HPV vaccine encourages them to engage in sexual behavior. One study found that young women do not change their attitudes or behaviors toward safer sex if they get the shot, and the other showed that girls with the vaccine are no more likely to get pregnant or be tested positive for a sexually transmitted infection than their unvaccinated peers.

More good news: Last week, the Food and Drug Administration (FDA) approved a new version of Gardasil, one of the two HPV vaccines on the market, which will protect against more strains of the virus. The original vaccine protected against strains 11 and 6, which cause most genital warts, and strains 16 and 18, which cause 70 percent of cervical cancer. The new vaccine, called Gardasil 9, will protect against these four strains in addition to five more cancer-causing strains—31, 33, 45, 52, and 58. Public health experts are hopeful that this added defense can prevent 90 percent of cervical, vulvar, vaginal, and anal cancers.

Wins and Losses for Those Who Want Condoms in Porn

Last year ended with a shutdown of filming—the third of its kind in 2013—in the porn industry after another actor was found to be HIV-positive. So it should be no surprise that this year included numerous rounds in the battle between producers who say no one wants to see condoms on film and public health experts who insist safer sex should start on set.

An effort to get California to pass a statewide law mandating condom use ultimately failed after facing a lot of opposition from porn company representatives, who threatened to take their business to a friendlier state, and porn stars who said it would force their industry underground and make their work more dangerous.

Defenders of the ban, however, did get an end-of-year victory this week when Measure B—a Los Angeles County ordinance requiring condoms on adult industry sets—was upheld by the Ninth Circuit Court of Appeals. A lower court had formerly upheld the measure, though it has yet to be systematically enforced.

The IUD Gains Supporters and Users

The intrauterine device (IUD) was once one of the more popular methods of birth control available. Then one model, the Dalkon Shield, came on the market with numerous design flaws that caused many users to become infertile, even resulting in several deaths. Though the dangers were unique to Dalkon Shield, women and physicians became suspicious of all IUDs; for many years, very few women—and only those who had already had children—would use them for contraception. In the last few years, however, IUDs have started getting more attention as providers and public health experts note the safety of newer models and the unparalleled efficacy rates.

This year, the IUD gained even more supporters, such as the American Academy of Pediatrics, which came out with a recommendation in October suggesting that IUDs be considered a first-line contraception for sexually active young people. Three months prior, research out of Colorado suggested that increasing the number of young women at Title X clinics using long-acting reversible contraceptives (which include both IUDs and implants) had led to lower than expected fertility rates among low-income women ages 15-to-24 in the state.

Other states, even conservative ones, decided this year that fixing the way Medicaid pays for IUDs—to make it possible to obtain one in a single visit, or even while still in the hospital after delivering a baby—could help prevent unintended pregnancies.

All of this support seems to be translating into increased use of the method. The National Survey of Family Growth found that 6.4 percent of contraceptive users were using an IUD in 2011-2013, compared to just 3.5 percent in the 2006-2010 survey.

Lab-Grown Penises and Transplanted Uteri

The future of reproductive health may include penises grown in a lab and babies born from transplanted uteri.

This year, the first baby to grow in a transplanted uterus was born to a 36-year-old Swedish woman whose name is being withheld. The woman, like the nine others who began the trial, had functioning fallopian tubes but was born without a uterus. After she received a donor organ from a friend of the family, doctors put her on anti-rejection drugs immediately. She became pregnant using IVF and had a relatively uncomplicated pregnancy, though the baby was delivered at 32 weeks when she showed signs of preeclampsia.

The medical team who undertook the trial hailed this as great news for assisted reproductive technologies, but others have expressed worry that the procedure is too invasive for both the donor and the recipient. Two of the nine women in the original study had to have their donor uteruses removed.

Meanwhile, no one has yet to be given a lab-grown penis, but new research on rabbits publicized in October suggests that it’s just a few years off. The process starts with a donor organ that is first stripped of its cells, then seeded with two different types from the genitals of the intended recipient. By making the penis out of the recipient’s own cells, scientist say they are reducing the chance of organ rejection. The procedure was tested on 12 rabbits; all successfully tried to mate using their engineered penis, eight were able to ejaculate, and four impregnated their bunny partner.

Truvada Dominates HIV-Prevention Discussion

Truvada is a combination of two antiretroviral drug used to treat individuals who have HIV. When used daily in HIV-negative individuals, these drugs have been shown to prevent transmission of the virus. The FDA approved the use of Truvada as a form of pre-exposure prophylaxis (PREP) in 2011 and it has been gaining popularity ever since.

This year, both the Centers for Disease Control and Prevention and the World Health Organization released guidelines suggesting that those at high risk of HIV infection—including injection users and men who have sex with men who are not in a monogamous relationship—consider using Truvada.

The method is highly effective. Studies have found that men who take it every day can reduce their risk of HIV infection by as much as 92 percent.

Still, some HIV advocates are concerned that those who choose Truvada—which can cost as much as $10,000 a year and needs to be taken every day—will stop using condoms, putting themselves and their partners at increased risk of other STIs, such as gonorrhea or syphilis.

The Dangers of Mixing Sex and Technology

The intersection between technology and sex got a little tricky this year as officials pointed to a dating app, Grindr, as being at least partially responsible for a syphilis outbreak; meanwhile, a jury in California found that an STI dating site called PositiveSingles had been sharing private information.

Grindr uses global positioning technology to help users meet other users nearby who are interested in getting together, presumably for sex. Grindr is marketed to men who have sex with men, but similar apps exist for heterosexual couples and women who have sex with women. This March, the popular app was at the center of an outbreak of syphilis in Onondaga County, New York.

A few months later, research in Los Angeles found that men who have sex with men who met partners on apps like Grindr had a 25 percent greater incidence of chlamydia and a 37 percent greater incidence of gonorrhea than those who met men in person at a bar, club, gym, private sex party, or even an online dating site. There was no difference in HIV rates or syphilis rates based on where men met.

The online dating sites, however, might pose another problem, at least according to a California jury that awarded 16.5 million dollars last month to a man who says the dating website PositiveSingles—which advertises itself as a place where people can meet other people living with STIs—violated consumer law and committed fraud by sharing information among many other niche websites owned by the same company. As the plaintiff’s attorney put it: “[my client] is not Black, gay, Christian or HIV positive and was unaware that [the] defendant was creating websites that focused on such traits that would include his profile, thus indicating that he was all of these things and more.”

Always a New Sex Toy

Finally, lest anyone worry that we will get bored heading into the new year, we take a look at the sex toys that emerged in the public eye in 2014. There’s the Svakom Gaga, a new vibrator introduced by a Chinese company that comes equipped with a camera and a USB port—plug it into your computer and star in your very own vulva video.

Of course, if you’re not ready for your close-up or you live far from your partner, you could instead turned to the OhMiBod, a vibrator that can be controlled from an iPhone via Bluetooth.

And, for the fitness buffs who aren’t satisfied knowing that they took their 10,000 steps a day, there is the kGoal, a U-shaped device that counts kegels. Women put one side of the device inside their vagina and the hook the other to their phones and are able to know exactly how many times they squeezed their pelvic floor muscles. Known as kegels, these exercises have been shown to help during childbirth, prevent or control urinary incontinence, and improve orgasms.

Roundups Sexual Health

This Week in Sex: The Sexually Transmitted Infections Edition

Martha Kempner

A new Zika case suggests the virus can be transmitted from an infected woman to a male partner. And, in other news, HPV-related cancers are on the rise, and an experimental chlamydia vaccine shows signs of promise.

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

Zika May Have Been Sexually Transmitted From a Woman to Her Male Partner

A new case suggests that males may be infected with the Zika virus through unprotected sex with female partners. Researchers have known for a while that men can infect their partners through penetrative sexual intercourse, but this is the first suspected case of sexual transmission from a woman.

The case involves a New York City woman who is in her early 20s and traveled to a country with high rates of the mosquito-borne virus (her name and the specific country where she traveled have not been released). The woman, who experienced stomach cramps and a headache while waiting for her flight back to New York, reported one act of sexual intercourse without a condom the day she returned from her trip. The following day, her symptoms became worse and included fever, fatigue, a rash, and tingling in her hands and feet. Two days later, she visited her primary-care provider and tests confirmed she had the Zika virus.

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A few days after that (seven days after intercourse), her male partner, also in his 20s, began feeling similar symptoms. He had a rash, a fever, and also conjunctivitis (pink eye). He, too, was diagnosed with Zika. After meeting with him, public health officials in the New York City confirmed that he had not traveled out of the country nor had he been recently bit by a mosquito. This leaves sexual transmission from his partner as the most likely cause of his infection, though further tests are being done.

The Centers for Disease Control and Prevention (CDC)’s recommendations for preventing Zika have been based on the assumption that virus was spread from a male to a receptive partner. Therefore the recommendations had been that pregnant women whose male partners had traveled or lived in a place where Zika virus is spreading use condoms or abstain from sex during the pregnancy. For those couples for whom pregnancy is not an issue, the CDC recommended that men who had traveled to countries with Zika outbreaks and had symptoms of the virus, use condoms or abstain from sex for six months after their trip. It also suggested that men who traveled but don’t have symptoms use condoms for at least eight weeks.

Based on this case—the first to suggest female-to-male transmission—the CDC may extend these recommendations to couples in which a female traveled to a country with an outbreak.

More Signs of Gonorrhea’s Growing Antibiotic Resistance

Last week, the CDC released new data on gonorrhea and warned once again that the bacteria that causes this common sexually transmitted infection (STI) is becoming resistant to the antibiotics used to treat it.

There are about 350,000 cases of gonorrhea reported each year, but it is estimated that 800,000 cases really occur with many going undiagnosed and untreated. Once easily treatable with antibiotics, the bacteria Neisseria gonorrhoeae has steadily gained resistance to whole classes of antibiotics over the decades. By the 1980s, penicillin no longer worked to treat it, and in 2007 the CDC stopped recommending the use of fluoroquinolones. Now, cephalosporins are the only class of drugs that work. The recommended treatment involves a combination of ceftriaxone (an injectable cephalosporin) and azithromycin (an oral antibiotic).

Unfortunately, the data released last week—which comes from analysis of more than 5,000 samples of gonorrhea (called isolates) collected from STI clinics across the country—shows that the bacteria is developing resistance to these drugs as well. In fact, the percentage of gonorrhea isolates with decreased susceptibility to azithromycin increased more than 300 percent between 2013 and 2014 (from 0.6 percent to 2.5 percent).

Though no cases of treatment failure has been reported in the United States, this is a troubling sign of what may be coming. Dr. Gail Bolan, director of CDC’s Division of STD Prevention, said in a press release: “It is unclear how long the combination therapy of azithromycin and ceftriaxone will be effective if the increases in resistance persists. We need to push forward on multiple fronts to ensure we can continue offering successful treatment to those who need it.”

HPV-Related Cancers Up Despite Vaccine 

The CDC also released new data this month showing an increase in HPV-associated cancers between 2008 and 2012 compared with the previous five-year period. HPV or human papillomavirus is an extremely common sexually transmitted infection. In fact, HPV is so common that the CDC believes most sexually active adults will get it at some point in their lives. Many cases of HPV clear spontaneously with no medical intervention, but certain types of the virus cause cancer of the cervix, vulva, penis, anus, mouth, and neck.

The CDC’s new data suggests that an average of 38,793 HPV-associated cancers were diagnosed each year between 2008 and 2012. This is a 17 percent increase from about 33,000 each year between 2004 and 2008. This is a particularly unfortunate trend given that the newest available vaccine—Gardasil 9—can prevent the types of HPV most often linked to cancer. In fact, researchers estimated that the majority of cancers found in the recent data (about 28,000 each year) were caused by types of the virus that could be prevented by the vaccine.

Unfortunately, as Rewire has reported, the vaccine is often mired in controversy and far fewer young people have received it than get most other recommended vaccines. In 2014, only 40 percent of girls and 22 percent of boys ages 13 to 17 had received all three recommended doses of the vaccine. In comparison, nearly 80 percent of young people in this age group had received the vaccine that protects against meningitis.

In response to the newest data, Dr. Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center, told HealthDay:

In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer. Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe.

Making Inroads Toward a Chlamydia Vaccine

An article published in the journal Vaccine shows that researchers have made progress with a new vaccine to prevent chlamydia. According to lead researcher David Bulir of the M. G. DeGroote Institute for Infectious Disease Research at Canada’s McMaster University, efforts to create a vaccine have been underway for decades, but this is the first formulation to show success.

In 2014, there were 1.4 million reported cases of chlamydia in the United States. While this bacterial infection can be easily treated with antibiotics, it often goes undiagnosed because many people show no symptoms. Untreated chlamydia can lead to pelvic inflammatory disease, which can leave scar tissue in the fallopian tubes or uterus and ultimately result in infertility.

The experimental vaccine was created by Canadian researchers who used pieces of the bacteria that causes chlamydia to form an antigen they called BD584. The hope was that the antigen could prompt the body’s immune system to fight the chlamydia bacteria if exposed to it.

Researchers gave BD584 to mice using a nasal spray, and then exposed them to chlamydia. The results were very promising. The mice who received the spray cleared the infection faster than the mice who did not. Moreover, the mice given the nasal spray were less likely to show symptoms of infection, such as bacterial shedding from the vagina or fluid blockages of the fallopian tubes.

There are many steps to go before this vaccine could become available. The researchers need to test it on other strains of the bacteria and in other animals before testing it in humans. And, of course, experience with the HPV vaccine shows that there’s work to be done to make sure people get vaccines that prevent STIs even after they’re invented. Nonetheless, a vaccine to prevent chlamydia would be a great victory in our ongoing fight against STIs and their health consequences, and we here at This Week in Sex are happy to end on a bit of a positive note.

Analysis Abortion

Legislators Have Introduced 445 Provisions to Restrict Abortion So Far This Year

Elizabeth Nash & Rachel Benson Gold

So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.

So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. Of these, 35 percent (445 provisions) sought to restrict access to abortion services. By midyear, 17 states had passed 46 new abortion restrictions.

Including these new restrictions, states have adopted 334 abortion restrictions since 2010, constituting 30 percent of all abortion restrictions enacted by states since the U.S. Supreme Court decision in Roe v. Wade in 1973. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.

Mid year state restrictions


Signs of Progress

The first half of the year ended on a high note, with the U.S. Supreme Court handing down the most significant abortion decision in a generation. The Court’s ruling in Whole Woman’s Health v. Hellerstedt struck down abortion restrictions in Texas requiring abortion facilities in the state to convert to the equivalent of ambulatory surgical centers and mandating that abortion providers have admitting privileges at a local hospital; these two restrictions had greatly diminished access to services throughout the state (see Lessons from Texas: Widespread Consequences of Assaults on Abortion Access). Five other states (Michigan, Missouri, Pennsylvania, Tennessee, and Virginia) have similar facility requirements, and the Texas decision makes it less likely that these laws would be able to withstand judicial scrutiny (see Targeted Regulation of Abortion Providers). Nineteen other states have abortion facility requirements that are less onerous than the ones in Texas; the fate of these laws in the wake of the Court’s decision remains unclear. 

Ten states in addition to Texas had adopted hospital admitting privileges requirements. The day after handing down the Texas decision, the Court declined to review lower court decisions that have kept such requirements in Mississippi and Wisconsin from going into effect, and Alabama Gov. Robert Bentley (R) announced that he would not enforce the state’s law. As a result of separate litigation, enforcement of admitting privileges requirements in Kansas, Louisiana, and Oklahoma is currently blocked. That leaves admitting privileges in effect in Missouri, North Dakota, Tennessee and Utah; as with facility requirements, the Texas decision will clearly make it harder for these laws to survive if challenged.

More broadly, the Court’s decision clarified the legal standard for evaluating abortion restrictions. In its 1992 decision in Planned Parenthood of Southeastern Pennsylvania v. Casey, the Court had said that abortion restrictions could not impose an undue burden on a woman seeking to terminate her pregnancy. In Whole Woman’s Health, the Court stressed the importance of using evidence to evaluate the extent to which an abortion restriction imposes a burden on women, and made clear that a restriction’s burdens cannot outweigh its benefits, an analysis that will give the Texas decision a reach well beyond the specific restrictions at issue in the case.

As important as the Whole Woman’s Health decision is and will be going forward, it is far from the only good news so far this year. Legislators in 19 states introduced a bevy of measures aimed at expanding insurance coverage for contraceptive services. In 13 of these states, the proposed measures seek to bolster the existing federal contraceptive coverage requirement by, for example, requiring coverage of all U.S. Food and Drug Administration approved methods and banning the use of techniques such as medical management and prior authorization, through which insurers may limit coverage. But some proposals go further and plow new ground by mandating coverage of sterilization (generally for both men and women), allowing a woman to obtain an extended supply of her contraceptive method (generally up to 12 months), and/or requiring that insurance cover over-the-counter contraceptive methods. By July 1, both Maryland and Vermont had enacted comprehensive measures, and similar legislation was pending before Illinois Gov. Bruce Rauner (R). And, in early July, Hawaii Gov. David Ige (D) signed a measure into law allowing women to obtain a year’s supply of their contraceptive method.


But the Assault Continues

Even as these positive developments unfolded, the long-standing assault on sexual and reproductive health and rights continued apace. Much of this attention focused on the release a year ago of a string of deceptively edited videos designed to discredit Planned Parenthood. The campaign these videos spawned initially focused on defunding Planned Parenthood and has grown into an effort to defund family planning providers more broadly, especially those who have any connection to abortion services. Since last July, 24 states have moved to restrict eligibility for funding in several ways:

  • Seventeen states have moved to limit family planning providers’ eligibility for reimbursement under Medicaid, the program that accounts for about three-fourths of all public dollars spent on family planning. In some cases, states have tried to exclude Planned Parenthood entirely from such funding. These attacks have come via both administrative and legislative means. For instance, the Florida legislature included a defunding provision in an omnibus abortion bill passed in March. As the controversy grew, the Centers for Medicare and Medicaid Services, the federal agency that administers Medicaid, sent a letter to state officials reiterating that federal law prohibits them from discriminating against family planning providers because they either offer abortion services or are affiliated with an abortion provider (see CMS Provides New Clarity For Family Planning Under Medicaid). Most of these state attempts have been blocked through legal challenges. However, a funding ban went into effect in Mississippi on July 1, and similar measures are awaiting implementation in three other states.
  • Fourteen states have moved to restrict family planning funds controlled by the state, with laws enacted in four states. The law in Kansas limits funding to publicly run programs, while the law in Louisiana bars funding to providers who are associated with abortion services. A law enacted in Wisconsin directs the state to apply for federal Title X funding and specifies that if this funding is obtained, it may not be distributed to family planning providers affiliated with abortion services. (In 2015, New Hampshire moved to deny Title X funds to Planned Parenthood affiliates; the state reversed the decision in 2016.) Finally, the budget adopted in Michigan reenacts a provision that bars the allocation of family planning funds to organizations associated with abortion. Notably, however, Virginia Gov. Terry McAuliffe (D) vetoed a similar measure.
  • Ten states have attempted to bar family planning providers’ eligibility for related funding, including monies for sexually transmitted infection testing and treatment, prevention of interpersonal violence, and prevention of breast and cervical cancer. In three of these states, the bans are the result of legislative action; in Utah, the ban resulted from action by the governor. Such a ban is in effect in North Carolina; the Louisiana measure is set to go into effect in August. Implementation of bans in Ohio and Utah has been blocked as a result of legal action.


The first half of 2016 was also noteworthy for a raft of attempts to ban some or all abortions. These measures fell into four distinct categories:

  • By the end of June, four states enacted legislation to ban the most common method used to perform abortions during the second trimester. The Mississippi and West Virginia laws are in effect; the other two have been challenged in court. (Similar provisions enacted last year in Kansas and Oklahoma are also blocked pending legal action.)
  • South Carolina and North Dakota both enacted measures banning abortion at or beyond 20 weeks post-fertilization, which is equivalent to 22 weeks after the woman’s last menstrual period. This brings to 16 the number of states with these laws in effect (see State Policies on Later Abortions).
  • Indiana and Louisiana adopted provisions banning abortions under specific circumstances. The Louisiana law banned abortions at or after 20 weeks post-fertilization in cases of diagnosed genetic anomaly; the law is slated to go into effect on August 1. Indiana adopted a groundbreaking measure to ban abortion for purposes of race or sex selection, in cases of a genetic anomaly, or because of the fetus’ “color, national origin, or ancestry”; enforcement of the measure is blocked pending the outcome of a legal challenge.
  • Oklahoma Gov. Mary Fallin (R) vetoed a sweeping measure that would have banned all abortions except those necessary to protect the woman’s life.


In addition, 14 states (Alaska, Arizona, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Maryland, South Carolina, South Dakota, Tennessee and Utah) enacted other types of abortion restrictions during the first half of the year, including measures to impose or extend waiting periods, restrict access to medication abortion, and establish regulations on abortion clinics.

Zohra Ansari-Thomas, Olivia Cappello, and Lizamarie Mohammed all contributed to this analysis.