tag:theconversation.com,2011:/africa/topics/sexual-health-1927/articlesSexual health – The Conversation2024-02-08T19:04:25Ztag:theconversation.com,2011:article/2225532024-02-08T19:04:25Z2024-02-08T19:04:25ZErections: what we learned from mice could help with sexual health in men<figure><img src="https://images.theconversation.com/files/573745/original/file-20240206-24-zl3t51.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5463%2C3628&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pots-different-cacti-on-blue-background-2193845671">HenadziPechan/Shutterstock</a></span></figcaption></figure><p>Have you ever wondered how penile erection works but never dared to ask? Well, imagine a dry sponge in a condom. Now pour water on the sponge (that’s the blood flowing in). There you have it.</p>
<p>This penis “sponge” is scientifically termed corpora cavernosa. Erections depend on the influx and trapping of blood. Smooth muscle cells regulate the blood flow into the sponge and its subsequent firmness. In a <a href="https://doi.org/10.1126/science.ade8064">recent study</a>, my colleague and I delved into the role of penile fibroblasts, the most abundant cells in the human penis, about which little was previously known.</p>
<p>We discovered that penile fibroblasts help smooth muscle cells to relax. Using a technique to render cells light-sensitive enabled us to activate fibroblasts by shining blue light from outside onto the penises of mice. </p>
<p>We found that light-induced activation of fibroblasts relaxed smooth muscle cells and increased blood flow. The effectiveness of this relaxation-support depends on the number of fibroblasts. More fibroblasts led to easier relaxation and increased blood flow.</p>
<p>We also learned that the number of fibroblasts is not static and identified the signalling molecules regulating the number of fibroblasts in the penis. By deleting or over-expressing the relevant molecules, we could increase or decrease the number of fibroblasts and in response see the corresponding changes in penile blood flow. </p>
<p>But we quickly learned that too many fibroblasts has negative consequences. Mice with very high numbers of penile fibroblasts showed erections that lasted for several hours. In men, this corresponds to a painful pathological condition termed <a href="https://www.nhs.uk/conditions/priapism-painful-erections/">priapism</a>, which demands a visit to the hospital. </p>
<p>Can penile erection be trained? In humans, much of the “erectile training” occurs naturally during sleep, with men experiencing three to five erections a night, known as “nocturnal penile tumescence”. </p>
<p>To test the importance of training, we artificially changed the frequency of erections in mice by targeting the brain region responsible for initiating an erection. This technique allowed us to turn erections on and off by simply administrating a designer drug that specifically activated the responsible nerve cells in the mouse brain. </p>
<h2>More fibroblasts, more blood flow</h2>
<p>Surprisingly, we found that the number of penile fibroblasts changed in relation to the frequency of erections. The more frequent the erections, the more fibroblasts were present and the better the blood flow. This implies that it becomes easier to initiate and maintain an erection with increased erection frequency.</p>
<p>It is known that the unconscious “training” during sleep declines with increasing age. Ageing is one of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5540144/">major risk factors</a> for erectile dysfunction in men. </p>
<p>Studying penises of aged mice, we found that they possessed a lower number of fibroblasts compared with young mice. When reducing the number of recurrent erections in young animals for a longer time, we found a decrease in the number of fibroblasts and lower penile blood flow. </p>
<p>One interpretation could be that reduced training negatively affects the number of fibroblasts and consequently, it becomes less efficient to initiate an erection. </p>
<p>While the spontaneous occurrence of erections during sleep is certainly convenient, our study does not suggest any differences between involuntary and actively evoked erections regarding the number of penile fibroblasts. So, an age-related decline of nocturnal penile tumescence could be a potential target for future treatment of erectile dysfunction or compensated for by actively achieving an erection. </p>
<p>Our research unveils a mechanism for controlling penile erections, opening the door for further exploration to understand and improve sexual health.</p><img src="https://counter.theconversation.com/content/222553/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christian Goeritz receives funding from: Bertil Hållsten Foundation, Knut and Alice Wallenberg Foundation, Swedish Research Council, Swedish Brain Foundation, Ming Wai Lau Centre for Reparative Medicine, Wings for Life Foundation, Swedish Cancer Foundation, the Government of Canada’s New Frontiers in Research Fund (NFRF), and the Strategic Network for Stem cells and Regenerative Medicine (STRATREGEN) at Karolinska Institutet.</span></em></p>Regular erections help to maintain the potency suggests a new study in mice.Christian Göritz, Associate Professor, Department of Cell and Molecular Biology, Karolinska InstitutetLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2213732024-02-07T12:32:53Z2024-02-07T12:32:53ZSome women enjoy anal sex – it shouldn’t be a guilty pleasure<figure><img src="https://images.theconversation.com/files/572879/original/file-20240201-17-o5ikwl.jpeg?ixlib=rb-1.1.0&rect=3%2C0%2C2049%2C1671&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Shaming women for enjoying anal sex is damaging to their health, wellbeing and sexual autonomy</span> <span class="attribution"><a class="source" href="https://www.gettyimages.co.uk/detail/news-photo/woman-lying-on-bed-with-arms-raised-portrait-elevated-view-news-photo/82144239?adppopup=true">Archive Photos / Stringer</a></span></figcaption></figure><p>What first comes to mind when you think of anal sex? Do you think of pain, fear, coercion? Do you think that anal sex is obscene, hardcore, adventurous, taboo, and perhaps dirtier than other forms of sex? Do you think of sex between gay men? Or do you think of pleasure, romance, love, connection, intimacy, trust and joy? </p>
<p><a href="https://www.tandfonline.com/doi/full/10.1080/13691058.2022.2037020">Research suggests</a> that it is common to associate anal sex with stigma, shame, and suspicion, <a href="https://www.bmj.com/content/378/bmj.o2323">with negative perceptions</a> dominating understanding of anal sex behaviour. </p>
<p>Where anal sex is depicted as occurring between men and women, both <a href="https://www.bmj.com/content/378/bmj.o1975">medical research</a> and popular culture tend to see <a href="https://journals.sagepub.com/doi/10.1177/10778012211045716">men as the penetrators</a>, <a href="https://www.marieclaire.com/sex-love/a5489/rise-in-anal-sex-statistics/">women as the receivers</a>, anal sex as a <a href="https://www.theguardian.com/society/2022/aug/11/rise-in-popularity-of-anal-sex-has-led-to-health-problems-for-women">riskier sexual activity</a>, and as <a href="https://metro.co.uk/2017/07/18/teenage-girls-pressured-into-painful-and-coercive-anal-sex-because-of-porn-6788524/">having a coercive element</a>. </p>
<p>For example, in the <a href="https://www.etonline.com/tv/160691_sex_and_the_city_creator_darren_star_up_the_butt_scene">US series Sex and the City</a>, one of the lead characters Charlotte York was disturbed and distressed because her male partner wanted to have anal sex. “I don’t want to be the up-the-butt girl, because I mean … Men don’t marry up-the-butt girl. Whoever heard of Mrs. Up-The-Butt?” she laments to her friends.</p>
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<figcaption><span class="caption">Charlotte is troubled by her boyfriend’s request for anal sex in the first series of Sex and the City (Series 1, episode 4, 1998)</span></figcaption>
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<p>And of course, there’s the infamous Fleabag scene which depicts Phoebe Waller-Bridge’s character acquiescing to anal sex with “Arsehole Guy”, while stating to camera:</p>
<blockquote>
<p>After some pretty standard bouncing, you realise, he’s edging towards your arsehole, but you’re drunk, and he did make the effort to come all the way here, so you let him. He’s thrilled.</p>
</blockquote>
<p>As well as the episode of US comedy series <a href="https://www.newyorker.com/video/watch/the-new-yorker-festival-mindy-kaling-on-the-sexual-nature-of-the-mindy-project">The Mindy Project</a> dedicated to <a href="https://www.glamour.com/story/the-mindy-project-explores-acc">“accidental” anal sex</a>.</p>
<p>These depictions both <a href="https://www.mumsnet.com/talk/telly_addicts/3553942-Fleabag-Im-disappointed">shock viewers</a> and <a href="https://link.springer.com/article/10.1007/s12147-020-09250-7">put men’s pleasure</a> and desire above women’s. Women are rarely viewed as the active instigators or penetrators of anal sex, especially between female same-sex partners, and are almost never seen as <a href="https://www.vogue.com/article/is-anal-sex-no-longer-taboo-breathless-karley-sciortino">anal enthusiasts</a>.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/bSVdebRTkJY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Acclaimed TV series Fleabag opened with a scene about anal sex (Series 1, episode 1, 2016)</span></figcaption>
</figure>
<p>Our research team conducted a series of focus groups with 20 participants aged between 19 and 56 years of age. They included sexual health practitioners and those with a vested interest in sexual health, such as youth workers, and young people. The purpose of the study was to explore perceptions of anal sex, exploring questions such as: What is anal sex? Who is involved and for what reasons? </p>
<p>In our focus groups, anal sex was immediately assumed to be a male sexual preference before women’s pleasure was considered. <a href="https://journalofpositivesexuality.org/wp-content/uploads/2023/07/10.51681.1.912_Perceptions-of-Young-Women-Who-Engage-in-Anal-Sex_Pickles-Hirst-Froggatt-Kenny.pdf">Participants</a> expressed that women who desire anal sex are culturally perceived as adventurous, sexually experimental, or “out there” in some way.</p>
<p>Imagine meeting a woman who is open about how much she enjoys pegging her boyfriend (where she’s the giver rather than the receiver) every other night. Would she be seen as edgy? Wild? Kinky? Would she experience bias on the basis of her sexual preferences? Would she be judged? </p>
<p>Our research strongly suggests that she would. Perhaps these negative attitudes are unsurprising – after all, even <a href="https://www.bmj.com/content/378/bmj.o2323">some doctors are reluctant</a> to discuss anal sex with women, <a href="https://www.bmj.com/content/378/bmj.o1975">causing a potential risk to health</a>. </p>
<h2>Anal sex is commonplace – despite the stigma</h2>
<p><a href="https://journalofpositivesexuality.org/wp-content/uploads/2023/07/10.51681.1.912_Perceptions-of-Young-Women-Who-Engage-in-Anal-Sex_Pickles-Hirst-Froggatt-Kenny.pdf">Our research</a> highlights the concerns of some sexual health practitioners that women may be <a href="https://researchspace.auckland.ac.nz/bitstream/handle/2292/63866/Carvalho%20Pinto%20Faustino-2022-thesis.pdf?sequence=4">influenced by their male partner</a> to engage in anal sex or may make decisions to participate in anal sex without being fully informed. These concerns then raise questions about whether women are consenting to their own sexual desires and behaviour or men’s. </p>
<p>Most of our participants thought that <a href="https://www.bmj.com/company/newsroom/doctors-reluctance-to-discuss-anal-sex-is-letting-down-young-women/">anal sex was a neglected area</a> of relationships and sex education. And definitely <a href="https://www.glamour.com/story/anal-sex-guilt">not taught as something pleasurable</a>.</p>
<p>It is difficult to estimate how many people generally, and women specifically, are engaging in anal sex. Many people are not comfortable speaking openly about their sex lives due to geographic, contextual and intersectional factors such as race, religion, gender and sexuality. </p>
<p>There is also no clear consensus over what constitutes anal sex, whether it’s rimming, pegging, fingering, penile-anal intercourse, anal massage, or other activities. But <a href="https://www.sciencedirect.com/science/article/abs/pii/S1743609515341801?via%3Dihub">some estimates</a> show that just over <a href="https://journals.lww.com/stdjournal/fulltext/2023/11000/changes_in_oral_and_anal_sex_with_opposite_sex.3.aspx">one-third of US women</a> have had heterosexual penile-anal sex. </p>
<p>Other scholars have argued that more adults and adolescents are engaging in anal sex <a href="https://journals.lww.com/stdjournal/Fulltext/2018/12000/Anal_Sex_Is_More_Common_Than_Having_a_Twitter.2.aspx">than have an account with X</a> (formerly Twitter). </p>
<p>Contrary to immediate negative biases of – and concerns over – anal sex, these estimates suggest that it is a <a href="https://www.refinery29.com/en-us/2015/08/93122/anal-sex-statistics">relatively common practice for women</a> to engage in anal sex as part of their wider sexual repertoire. </p>
<p>How then, given the immediate negative biases and potentially overzealous concerns over male-led coercion of women and young girls, should anal sex be discussed appropriately?</p>
<h2>Foregrounding women’s safety and pleasure</h2>
<p>A focus on women’s sexual pleasure is strikingly lacking from conversations in sex and relationships education, and within sexual health clinical practice. In our research <a href="https://journalofpositivesexuality.org/wp-content/uploads/2023/07/10.51681.1.912_Perceptions-of-Young-Women-Who-Engage-in-Anal-Sex_Pickles-Hirst-Froggatt-Kenny.pdf">we argue</a> that anal sex must be included in sexual health education as part of a wider repertoire of sexual pleasure. </p>
<p>What should be concerning is not engagement with anal sex per se – <a href="https://www.glamourmagazine.co.uk/article/anal-sex-safety">women are having anal</a> whether we want to acknowledge it or not – but the <a href="https://bmjopen.bmj.com/content/4/8/e004996.short">lack of education around anal sex</a> that, if included in relationships and sex education, could increase the <a href="https://www.tandfonline.com/doi/full/10.1080/14681810802433929">sexual literacy of women and young girls</a>. </p>
<p>We are not encouraging anyone to engage in anal sex if they do not wish to, but our research does emphasise that if young women are to have anal sex, they are entitled to the self-knowledge that will allow this to occur safely, consensually, pleasurably and positively. </p>
<p>Our research has highlighted implicit assumptions that must be challenged and destigmatised These involve what anal sex actually is, who the primary instigator is, and whether women are active participants who want to engage in anal sex for their own pleasure. </p>
<p>Providing knowledge on anal sex that centres women’s pleasure allows for a higher degree of choice to engage in sexual practices that feel right for all women involved.</p><img src="https://counter.theconversation.com/content/221373/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The stigma around anal sex is damaging for women – and diminishes their sexual autonomyJames Pickles, Senior Lecturer in Criminology, School of Humanities and Social Science, University of BrightonChloe Froggatt, Associate Lecturer in Sociology and Public Health, Sheffield Hallam UniversityJulia Hirst, Professor of Sexualities & Sexual Health, Sheffield Hallam UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2212192024-01-18T18:59:14Z2024-01-18T18:59:14ZCheck your ‘fun parts’: what a new sexual health campaign for young Aussies gets right and wrong<figure><img src="https://images.theconversation.com/files/569984/original/file-20240118-27-awurl6.jpg?ixlib=rb-1.1.0&rect=0%2C10%2C7008%2C4647&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-smiling-woman-wearing-glasses-holding-2250703231">insta_photos/Shutterstock</a></span></figcaption></figure><p>The Australian government recently launched a new campaign, <a href="https://www.health.gov.au/sti">Beforeplay</a>, to promote better sexual health among young people.</p>
<p>Beforeplay is focused on encouraging people aged 20 to 34 to seek frequent STI tests, and to use barrier methods (such as condoms and dental dams) to protect against the transmission of STIs.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/8CTkGukKcFo?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A video from the Beforeplay campaign.</span></figcaption>
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<p>The national campaign began on January 14 and will run for nine weeks, with content <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/new-sexual-health-campaign-to-combat-rising-rates-of-stis">to appear</a> on social media and online, on dating apps such as Tinder and Grindr, and around universities, bars and clubs.</p>
<p>The campaign material includes <a href="https://www.health.gov.au/sti/prevention">links to information and resources</a> as well as three videos and several posters, carrying messages including “it’s the test part, before the best part” and “it’s checking your fun parts, before the fun starts”. </p>
<p>The campaign message is simple and direct. Getting tested, as well as using condoms and dental dams to prevent the spread of STIs, will create a more fun and safe sexual encounter. But does the campaign get everything right?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sex-ed-needs-to-talk-about-pleasure-and-fun-safe-sex-depends-on-it-and-condom-use-rises-176572">Sex ed needs to talk about pleasure and fun. Safe sex depends on it and condom use rises</a>
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<h2>Beforeplay aims to combat increasing rates of STIs</h2>
<p>A recent annual surveillance report on <a href="https://www.kirby.unsw.edu.au/research/reports/asr2023">STIs in Australia</a> found in 2022, young people made up the majority of chlamydia and syphilis diagnoses. </p>
<p>For chlamydia, 69% of diagnoses occurred among people between 15 and 29, with an almost even split between men and women. </p>
<p>For infectious syphilis, notification rates were highest among people aged 25 to 29 (58.1 cases per 100,000 people), 30 to 39 (55.7 per 100,000), and 20 to 24 (38.2 per 100,000). More than 80% of all syphilis infections were among men. </p>
<p>Although the report highlighted increasing rates of STIs (syphilis notifications, for example, <a href="https://www.abc.net.au/news/2023-12-19/australia-syphilis-cases-kirby-institute-report-/103237700">have tripled</a> over the past decade) testing rates were lower than usual. The authors suggested this may be an effect of the COVID pandemic, but highlights a need for more STI testing, particularly among young people. </p>
<figure class="align-center ">
<img alt="A poster from Beforeplay with an image of a couple and the message 'It's checking your fun parts, before the fun starts'." src="https://images.theconversation.com/files/569973/original/file-20240118-25-h4ovvh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/569973/original/file-20240118-25-h4ovvh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=901&fit=crop&dpr=1 600w, https://images.theconversation.com/files/569973/original/file-20240118-25-h4ovvh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=901&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/569973/original/file-20240118-25-h4ovvh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=901&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/569973/original/file-20240118-25-h4ovvh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1133&fit=crop&dpr=1 754w, https://images.theconversation.com/files/569973/original/file-20240118-25-h4ovvh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1133&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/569973/original/file-20240118-25-h4ovvh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1133&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">One of the posters from the campaign.</span>
<span class="attribution"><a class="source" href="https://www.health.gov.au/sti/resources">Australian Government, Department of Health and Aged Care</a></span>
</figcaption>
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<h2>Young people already know to get tested</h2>
<p>The Beforeplay campaign appears to be premised on the idea that young people lack knowledge about adequate STI testing and don’t feel barrier methods are important.</p>
<p>Research, however, suggests this isn’t the case. A recent <a href="https://www.latrobe.edu.au/arcshs/work/national-survey-of-secondary-students-and-sexual-health-2022">national survey</a> of Australian high school students found 94% of those surveyed felt condom use was important. Some 75% of respondents said condoms were available during their most recent sexual experience, but less than 49% used them.</p>
<p>Similar results were seen with STI testing – more than 72% of participants believed young people should be tested for STIs. But less than 13% thought it was a common practice among their age group. And only 26% believed STI testing was easily accessible.</p>
<p>A <a href="https://www.publish.csiro.au/SH/SH22122">2023 study</a> of young adults in Australia aged 15 to 29 also showed STI testing and condom use remains low among this group.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/around-half-of-17-year-olds-have-had-sex-and-theyre-more-responsible-than-you-think-118337">Around half of 17-year-olds have had sex and they're more responsible than you think</a>
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<p>There could be a variety of reasons young people may not use condoms. For example, research has shown <a href="https://theconversation.com/why-do-women-still-get-judged-so-harshly-for-having-casual-sex-160583">gendered norms</a> in heterosexual couples mean women continue to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6115298/">carry the burden</a> of contraceptive responsibility, including having to ask men to wear condoms. Men may refuse these requests or engage in <a href="https://theconversation.com/case-in-victoria-could-set-new-legal-precedent-for-stealthing-or-removing-condom-during-sex-118343">stealthing</a>, the removal of a condom during sex without consent. </p>
<p>Meanwhile, long-standing <a href="https://theconversation.com/sex-ed-needs-to-talk-about-pleasure-and-fun-safe-sex-depends-on-it-and-condom-use-rises-176572">social taboos</a> and shame surround young people engaging in sexual activity, which can make it difficult for them to access sexual health services for STI testing. This can be particularly significant for LGBTQA+ young people, those living in rural and remote areas, and young people from religious, cultural and ethnic backgrounds where sex outside marriage may be discouraged. </p>
<p>As access to sexual health clinics can be difficult, including links and resources for <a href="https://www.qld.gov.au/health/staying-healthy/sexual-health/chlamydia-test">at-home screening kits</a> where available could be effective in encouraging more people to test. </p>
<p>More clarity in the posters and videos as to how often the campaign is recommending testing – whether before every sexual encounter with a new partner, or just general frequent testing as good sexual health practice – would also be helpful.</p>
<h2>A diverse campaign?</h2>
<p>Beforeplay’s content depicts couples of different genders, orientations and ethnicities to promote inclusivity. </p>
<p>I would argue there is an undercurrent of <a href="https://theconversation.com/queerphobic-hate-is-on-the-rise-and-lgbtq-communities-in-canada-need-more-support-214932">queerphobia</a> and discomfort with queer sex in the campaign videos, despite the attempts for inclusion. </p>
<p>The two videos featuring a heterosexual couple show more physical intimacy and engagement, such as kissing and bodies touching. The video featuring the queer couple, however, only shows them holding hands, with their bodies appearing further apart. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/t0HP_sQuGuw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A video from the Beforeplay campaign.</span></figcaption>
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<p>In contrast, queer sexual health campaigns designed by and for queer people, such as <a href="https://www.thedramadownunder.info/">The Drama Downunder</a> and <a href="https://downandirty.org/warning/?redirect=%2F">Down an’ Dirty</a> (note, this one is not suitable for work) promote sexual intimacy between queer partners through sexualised imagery and intimate representation. </p>
<p>Content will also be adapted and translated for multicultural and First Nations audiences. However, there are already sexual health campaigns designed by and for Aboriginal and Torres Strait Islander communities. <a href="https://youngdeadlyfree.org.au/about-us/the-syphilis-campaign/">YoungDeadlyFree</a> and <a href="https://takeblaktion.playsafe.health.nsw.gov.au/">Take Blaktion</a> are just two of these. They meet the needs of their audience through community consultation, and use of local language, humour, cultural references, and representation.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/teaching-young-people-about-sex-is-too-important-to-get-wrong-here-are-5-videos-that-actually-hit-the-mark-159438">Teaching young people about sex is too important to get wrong. Here are 5 videos that actually hit the mark</a>
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<h2>The focus on pleasure is a plus</h2>
<p>Despite these criticisms, the focus on pleasure and having a good time is a strong positive for this campaign when young people still sometimes experience shame and stigma around sex. </p>
<p>We know <a href="https://healthequitymatters.org.au/article/saved-lives-gay-community-australian-response-aids/">historic campaigns</a> around HIV/AIDs that were sex and pleasure-positive (as opposed to negative and fear-mongering) were much more effective in reducing the transmission of HIV among gay and bisexual men. </p>
<p>Advocating for STI testing and the use of appropriate protection while emphasising fun and enjoyment is a progressive step towards recognising and affirming young people’s sexual rights and agency.</p><img src="https://counter.theconversation.com/content/221219/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrea Waling receives funding from the Australian Research Council and the Commonwealth Department of Health. </span></em></p>A new campaign encourages young Australians to get tested for STIs more frequently and to take other measures to improve their sexual health.Andrea Waling, ARC DECRA Senior Research Fellow in Sex & Sexuality, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2161142023-11-19T18:59:58Z2023-11-19T18:59:58ZTikTok has a startling amount of sexual content – and it’s way too easy for children to access<p>Explicit content has long been a feature of the internet and social media, and young people’s exposure to it has been a persistent concern.</p>
<p>This issue has taken centre stage again with the meteoric rise of TikTok. Despite efforts to moderate content, it seems TikTok’s primary focus remains <a href="https://www.theverge.com/2021/12/6/22820305/tiktok-algorithm-explained-leak-how-it-works">on maximising user engagement and traffic</a>, rather than creating a safe environment for users.</p>
<p>As the top <a href="https://www.pewresearch.org/internet/2022/08/10/teens-social-media-and-technology-2022/">social media app used by teens</a>, the presence of explicit content on TikTok can put young users in harm’s way. And while TikTok and regulators scramble to catch up with moderation needs, it’s ultimately up to parents and users to navigate these harms online.</p>
<h2>TikTok’s content moderation maze</h2>
<p>TikTok relies on both <a href="https://www.tiktok.com/transparency/en-us/content-moderation/">automated and human moderation</a> to identify and remove content violating its community guidelines. <a href="https://www.tiktok.com/community-guidelines/en/safety-civility/#5">This includes</a> nudity, pornography, sexually explicit content, non-consensual sexual acts, the sharing of non-consensual intimate imagery and sexual solicitation. TikTok’s community guidelines say:</p>
<blockquote>
<p>We do not allow seductive performances or allusions to sexual activity by young people, or the use of sexually explicit narratives by anyone.</p>
</blockquote>
<p>However, Tiktok’s automated moderation system isn’t always precise. This means beneficial material such as LGBTQ+ content and healthy <a href="https://mashable.com/article/tiktok-sex-education-content-removal">sex education content may be incorrectly removed</a> while explicit, harmful content <a href="https://www.instagram.com/p/Cwr4gvXIncI/?hl=en">slips through the cracks</a>.</p>
<p>Although TikTok has a human review process to compensate for algorithmic shortcomings, this is slow and time-consuming, which causes delays. Young people may be exposed to <a href="https://www.theguardian.com/australia-news/2022/feb/08/most-australian-teens-have-viewed-harmful-content-online-but-parents-in-dark-safer-internet-day">explicit and harmful content</a> before it is removed. </p>
<p>Content moderation is further complicated by user tactics such as “<a href="https://www.9news.com.au/national/tiktok-explained-algospeak-shadowbanning-everything-to-know/24ea8123-7e4b-4d3c-9efc-48ea375d048b">algospeak</a>”, which is used to avoid triggering algorithmic filters put in place to detect inappropriate content. In this case, algospeak may involve using internet slang, codes, euphemisms or emojis to replace words and phrases commonly associated with explicit content. </p>
<p>Many users also resort to algospeak because they feel TikTok’s algorithmic moderation is biased and unfair to marginalised communities. Users have reported on <a href="https://journals.sagepub.com/doi/10.1177/20563051231194586#bibr25-20563051231194586">a double standard</a>, wherein TikTok has suppressed educational content related to the LGBTQ+ community, while allowing harmful content to remain visible. </p>
<h2>Harmful content slips through the cracks</h2>
<p><a href="https://support.tiktok.com/community-guidelines#30">TikTok’s guidelines</a> on sexually explicit stories and sexualised posing are ambiguous. And its age-verification process relies on self-reported age, which users can easily bypass. </p>
<p>Many TikTok creators, including creators of pornography, use the platform to promote themselves and their content on other platforms such as PornHub or OnlyFans. For example, creator @jennyxrated posts suggestive and hypersexual content. She calls herself a “daddy’s girl” and presents as younger than she is.</p>
<p>Such content is popular on TikTok. It promotes unhealthy attitudes to sex and consent and perpetuates harmful gender stereotypes, such as suggesting women should be submissive to men.</p>
<p>Young boys struggling with mental health issues and loneliness are particularly vulnerable to <a href="https://www.theguardian.com/commentisfree/2021/aug/17/incel-movement-extremism-internet-community-misogyny">“incel” rhetoric and misogynistic views</a> amplified through TikTok. Controversial figures such as Andrew Tate and <a href="https://www.intheknow.com/post/problematic-tiktok-dating-coach-branded-as-misogynist-of-the-year/">Russell Hartley</a> continue to be promoted by algorithms, driving traffic and supporting TikTok’s commercial interests. </p>
<p><a href="https://www.insider.com/andrew-tate-tiktok-ban-fanpages-misogynistic-content-circulating-2022-8">According to Business Insider</a>, videos featuring Tate had been viewed more than 13 billion times as of August 2022. This content <a href="https://www.theguardian.com/technology/2022/nov/06/tiktok-still-hosting-toxic-posts-of-banned-influencer-andrew-tate">continues to circulate</a> even though Tate has been banned. </p>
<p>Self-proclaimed men’s rights advocates centre their content on anti-feminist discourse, hyper-masculinity and hierarchical gender roles. What may seem like memes and “entertainment” can <a href="https://link.springer.com/article/10.1007/s10610-023-09559-5">desensitise young boys</a> to rape culture, domestic violence and toxic masculinity. </p>
<p>TikTok’s promotion of idealistic and sexualised content is also harmful for the self-perception of young women and queer youth. This content portrays unrealistic body standards, which leads to comparison, <a href="https://newsroom.unsw.edu.au/news/health/tiktok-and-body-image-idealistic-content-may-be-detrimental-mental-health">increased body dissatisfaction</a> and a higher risk of developing eating disorders.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/anorexia-coach-sexual-predators-online-are-targeting-teens-wanting-to-lose-weight-platforms-are-looking-the-other-way-162938">'Anorexia coach': sexual predators online are targeting teens wanting to lose weight. Platforms are looking the other way</a>
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</em>
</p>
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<h2>Empowering sex education</h2>
<p>Due to its popularity, TikTok offers a unique opportunity to <a href="https://www.them.us/story/tiktok-sex-education-lgbtq-sexuality-online">help spread educational</a> content about sex. Doctors and gynaecologists use hashtags such as #obgyn to share content about sexual health, including topics such as consent, contraception and stigmas around sex. </p>
<p><a href="https://www.tiktok.com/@alirodmd">Dr Ali</a>, for instance, educates young women about periods and birth control, and is an advocate for women of colour. <a href="https://www.tiktok.com/@sexedu">Sriha Srinivasan</a> promotes sex education for high-school students and discusses sex myths, consent, STIs, periods and reproductive justice. </p>
<p><div data-react-class="TiktokEmbed" data-react-props="{"url":"https://www.tiktok.com/@sexedu/video/7013923045874126086?is_from_webapp=1\u0026sender_device=pc\u0026web_id=7247360749801375234"}"></div></p>
<p><a href="https://www.tiktok.com/@itsmillyevans">Milly Evans</a> is a queer, non-binary, autistic sex-ed content creator who uses TikTok to advocate for inclusive sex education. They cover topics such as domestic abuse, consent in queer relationships, gender and sexual identities, body-safe sex toys and trans and non-binary rights.</p>
<p>These are just some examples of how TikTok can be a space for informative, inclusive and sex-positive content. However, such content may not receive the same engagement as more lewd and attention-grabbing videos since, like most social media apps, TikTok is optimised for engagement.</p>
<p><div data-react-class="TiktokEmbed" data-react-props="{"url":"https://www.tiktok.com/@itsmillyevans/video/7231574247104138523?is_from_webapp=1\u0026sender_device=pc\u0026web_id=7247360749801375234"}"></div></p>
<h2>A bird’s eye view</h2>
<p>Social media platforms face significant challenges in moderating harmful content effectively. Relying on platforms to self-regulate isn’t enough, so regulatory bodies need to step in.</p>
<p>Australia’s eSafety Commissioner has taken an active role by providing guidelines and resources for parents and users, and by pressuring platforms such as <a href="https://www.smh.com.au/technology/cyber-bullying-content-targeting-children-pulled-from-tiktok-20200713-p55bjt.html">TikTok to remove harmful content</a>. They’re also leading the way in addressing <a href="https://www.reuters.com/technology/tiktok-snapchat-others-sign-pledge-tackle-ai-generated-child-sex-abuse-images-2023-10-30/">AI-generated child sex abuse material</a> on social media.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australia-has-fined-x-australia-over-child-sex-abuse-material-concerns-how-severe-is-the-issue-and-what-happens-now-215696">Australia has fined X Australia over child sex abuse material concerns. How severe is the issue – and what happens now?</a>
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</em>
</p>
<hr>
<p>When it comes to TikTok, our efforts should be poured into equipping young users with media literacy skills that can help keep them safe.</p>
<p>For children under 13, it’s up to parents to decide whether they allow access. It’s worth noting TikTok itself has an age limit of 13 years, and Common Sense Media <a href="https://www.commonsensemedia.org/articles/parents-ultimate-guide-to-tiktok">doesn’t encourage</a> use by children under 15. If parents do decide to allow access for a child under 13, they should actively monitor the child’s activity.</p>
<p>While restricting apps’ use might seem like a quick fix, <a href="https://journals.sagepub.com/doi/abs/10.1177/1329878X211046396">our research</a> has found social media restrictions can strain parent-child relationships. Parents are better off taking proactive steps such as having open discussions, building trust, and educating themselves and their children about online risk.</p>
<hr>
<p><em>The Conversation reached out to TikTok for comment but did not receive a response before the deadline.</em></p><img src="https://counter.theconversation.com/content/216114/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Milovan Savic receives funding from the Australian Research Council. </span></em></p><p class="fine-print"><em><span>Sonja Petrovic does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many TikTok creators, including creators of pornography, use the platform to promote themselves and their explicit content on other platforms.Sonja Petrovic, Assistant Lecturer in Media and Communications, The University of MelbourneMilovan Savic, Research Fellow, ARC Centre of Excellence for Automated Decision-Making and Society, Swinburne University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2076542023-09-01T15:11:36Z2023-09-01T15:11:36ZWomen’s sexual desire often goes undiscussed – yet it’s one of their most common health concerns<figure><img src="https://images.theconversation.com/files/545488/original/file-20230830-15-rnyx9u.jpg?ixlib=rb-1.1.0&rect=0%2C9%2C6016%2C3998&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many women are afraid to voice concerns about low desire to their doctors.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-doctor-sits-her-desk-chats-1679462020">Lordn/ Shutterstock</a></span></figcaption></figure><p>Female sexual desire is frequently misunderstood. Despite desire (also known as libido or sex drive) being the <a href="https://academic.oup.com/jsm/article-abstract/13/2/144/6940252">most common sexual health concern</a> for women, most women aren’t really taught about it growing up. And if they are, the information is <a href="https://www.tandfonline.com/doi/abs/10.1080/00224490609552322">often inaccurate</a>. </p>
<p>This lack of education not only perpetuates misinformation, <a href="https://doi.org/10.1080/09589236.2016.1150818">stigma</a> and shame about female sexual desire, it can also have a major effect on <a href="https://journals.sagepub.com/doi/full/10.2217/WHE.11.54">wellbeing</a> and <a href="https://www.tandfonline.com/doi/abs/10.1080/14681994.2014.957498">perceptions of satisfaction</a> in intimate relationships. </p>
<p>Discrepancies in sexual desire and satisfaction are often reported as key reasons for <a href="https://www.tandfonline.com/doi/abs/10.1080/00224499.2018.1437592">relationship difficulties</a>. Low sexual desire also has a negative impact on <a href="https://www.liebertpub.com/doi/abs/10.1089/jwh.2014.4743">body image and self-confidence</a>.</p>
<p>But it’s never too late to understand desire and the many ways it can change – not just each day, but throughout life. </p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"></span>
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</figure>
<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/the-orgasm-gap-and-why-women-climax-less-than-men-208614">The orgasm gap and why women climax less than men</a></em></p>
<p><em><a href="https://theconversation.com/how-tracking-menopause-symptoms-can-give-women-more-control-over-their-health-209004">How tracking menopause symptoms can give women more control over their health</a></em></p>
<p><em><a href="https://theconversation.com/women-still-feel-like-they-arent-listened-to-when-they-give-birth-heres-what-could-help-change-things-206815">Women still feel like they aren’t listened to when they give birth – here’s what could help change things</a></em></p>
<hr>
<h2>Desire is constantly changing</h2>
<p>Sexual desire is best understood as a transient state. This means it can be affected by an <a href="https://bookshelftocouch.com/wp-content/uploads/2019/12/Maintaining-sexual-desire-in-long-term-Mark_Lasslo_2018.pdf">array of factors</a> – including stress, hormones, physical and mental health, certain medications, lifestyle and the <a href="https://link.springer.com/article/10.1007/s10879-012-9207-7">balance of intimacy and eroticism</a> in a relationship.</p>
<p>Desire is also a <a href="https://doi.org/10.1007/s10508-017-0959-8">multifaceted response</a>, which can either follow or occur at the same time as pleasure or arousal. This means feeling “in the mood” may not happen until after a woman is aroused. <a href="https://doi.org/10.1007/s10508-016-0895-z">Desire can also occur</a> with or without a partner and will vary in frequency and intensity. Sexual desire can also be affected by many <a href="https://www.tandfonline.com/doi/abs/10.1080/00224490902747768">environmental factors</a>, which helps explain why it may wane during periods of stress or in longer term relationships.</p>
<p>Even factors such as <a href="https://link.springer.com/article/10.1007/s10508-016-0895-z">gender roles and norms</a> are thought to cause low sexual desire for women in heterosexual relationships. <a href="https://link.springer.com/article/10.1007/s10508-016-0895-z">One study</a> proposes that the inequities in the division of household labour, the objectification of women and gender norms surrounding sexual initiation (in which men are presumed to be the primary instigators of sex while women are presumed coy), all result in low sexual desire for women. </p>
<p>Understanding that desire is a transient and multifaceted response can help women to see that low desire isn’t a problem with our bodies – and that treating it may be a matter of addressing problems in other parts of their lives. It also helps to understand that it’s normal for desire to change and fluctuate, even on a daily basis, depending on what’s going on in a person’s life. </p>
<h2>Certain life transitions can have a major effect</h2>
<p><a href="https://www.ingentaconnect.com/content/sbp/sbp/2003/00000031/00000006/art00008">Pregnancy</a>, the <a href="https://academic.oup.com/smr/article-abstract/8/1/38/6812656#google_vignette">post-partum period</a>, <a href="https://nyaspubs.onlinelibrary.wiley.com/doi/abs/10.1111/j.1749-6632.2009.04982.x">perimenopause</a> and <a href="https://www.sciencedirect.com/science/article/abs/pii/S0378512209001108">menopause</a> are all significant transitional periods in women’s lives that can also have a major impact on sexual desire. </p>
<p>There are a number of reasons why this may be. For example, body changes that may happen during these transitional periods can affect <a href="https://www.tandfonline.com/doi/abs/10.1080/08952841.2018.1510247">body image and self-esteem</a>, which in turn affects desire. <a href="https://journals.lww.com/menopausejournal/Abstract/2004/11010/The_impact_of_hormones_on_menopausal_sexuality__a.20.aspx">Hormone changes</a> can affect mood, and may also result in physical changes – such as <a href="https://link.springer.com/article/10.1007/s13167-019-00164-3">vaginal dryness</a> and <a href="https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.14518">dyspareunia</a> (genital pain that occurs before, during or after sex), which are known to affect desire.</p>
<p><a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2648.2010.05428.x">Perineal trauma</a> (damage to the perineum during birth) can cause pain which may make women desire sex less. Experiences of <a href="https://link.springer.com/article/10.1007/s11930-008-0009-6">pregnancy loss</a> and <a href="https://academic.oup.com/jsm/article-abstract/12/4/985/6980224">infertility</a> are also shown to lower sexual desire.</p>
<p>Importantly, these life transitions also affect <a href="https://academic.oup.com/smr/article-abstract/8/1/38/6812656#google_vignette">other areas of our lives</a> – and may lead to stress, fatigue, changes in relationship roles and less time for intimacy. This can all, in turn, lead to lower sexual desire.</p>
<figure class="align-center ">
<img alt="A woman stands in a nursery while holding her baby." src="https://images.theconversation.com/files/545494/original/file-20230830-27-q0sbr1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/545494/original/file-20230830-27-q0sbr1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/545494/original/file-20230830-27-q0sbr1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/545494/original/file-20230830-27-q0sbr1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/545494/original/file-20230830-27-q0sbr1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/545494/original/file-20230830-27-q0sbr1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/545494/original/file-20230830-27-q0sbr1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It’s normal for desire to be affected during big transitional periods, such as after having a baby.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-holding-newborn-baby-son-nursery-624519530">Monkey Business Images/ Shutterstock</a></span>
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<p>Expecting that sexual desire may change or decrease during these periods can be helpful, as it may reduce self-blame and shame.</p>
<h2>Desire can be cultivated</h2>
<p>Desire can be cultivated at any stage of life. Recent <a href="https://med-fom-brotto.sites.olt.ubc.ca/files/2014/11/Brotto-2017-Evidenced-based-treatments-for-low-sexual-desire-in-women-4743.pdf">psychosocial approaches</a> to addressing low sexual desire emphasise the importance of balancing <a href="https://www.tandfonline.com/doi/abs/10.1080/14681994.2014.957498">intimacy</a> and <a href="https://www.scirp.org/journal/paperinformation.aspx?paperid=67908">eroticism</a>, which is a focus on sensuality and pleasure over arousal and orgasm. Research indicates that, while intimacy is essential in healthy partnered sexuality, eroticism helps <a href="https://link.springer.com/article/10.1007/s10879-012-9207-7">increase desire</a> by promoting mystery and sexual excitement. </p>
<p>Sexual desire experts also suggest <a href="https://www.sciencedirect.com/science/article/abs/pii/S0091302217300079">good strategies</a> for cultivating desire including regularly communicating what feels good and what doesn’t with your partner, planning for sexual activity and finding ways to reduce distraction so you can focus on your body during sex. </p>
<p>Evidence-based treatments for low desire include <a href="https://www.sciencedirect.com/science/article/pii/S0005796714000497">mindfulness therapy</a>, which can help women reduce distraction, increase focus on the sensations, thoughts and emotions they’re experiencing in the moment and help target negative self-judgment. Another treatment, <a href="https://www.sciencedirect.com/science/article/abs/pii/S1743609522009602">sensate focus touch</a>, which involves using non-sexual touch to promote more open sexual communication among couples, has also been shown to increase desire. </p>
<p>Sexual desire is <a href="https://www.tandfonline.com/doi/abs/10.1080/14681994.2014.957498">unique to each person</a>. If women were taught what sexual desire is and what to expect across our lives, they would be less likely to suffer the ill effects of this misunderstanding. Sexual desire is not a problem to be solved – but a skill to be learned and cultivated throughout life.</p><img src="https://counter.theconversation.com/content/207654/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Áine Aventin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s normal for desire to change and fluctuate – even on a daily basis.Áine Aventin, Lecturer, School of Nursing and Midwifery, Queen's University BelfastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2105942023-08-16T20:10:23Z2023-08-16T20:10:23ZIt is not just heat waves — climate change is also a crisis of disconnection<figure><img src="https://images.theconversation.com/files/542024/original/file-20230809-28-ur0cq8.jpg?ixlib=rb-1.1.0&rect=42%2C0%2C4755%2C3160&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Political tribalism has severely hampered genuine action on climate change and developing more environmentally just practices and standards.</span> <span class="attribution"><span class="source">(AP Photo/Robert F. Bukaty)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/it-is-not-just-heat-waves-climate-change-is-also-a-crisis-of-disconnection" width="100%" height="400"></iframe>
<p>Climate change is widely recognized by the scientific community as “<a href="https://doi.org/10.1016/S0140-6736(09)60922-3">the biggest global health threat of the 21st century</a>.” </p>
<p>However, climate change isn’t just about greenhouse gas emissions. At its core, it is both a symptom and a cause for the centuries-long trend in declining social connection and community cohesion.</p>
<h2>A modern atomized life</h2>
<p>Consider this: If <a href="https://doi.org/10.1038/nature.2017.22114">human history</a> was summarized in 100 minutes, modern life would only take shape in the last 30 or so seconds. </p>
<p>In these last 30 seconds, human beings began <a href="https://doi.org/10.1038/nature01019">domesticating plants and animals</a>, <a href="https://doi.org/10.1038/scientificamerican0965-40">built cities</a>, <a href="https://books.google.ca/books?hl=en&lr=&id=vgbJbZi00bQC&oi=fnd&pg=PA1&dq=history+of+the+factory&ots=9UAgXOExlf&sig=5-Xc1cKNB8lOOguT21xyv8j7tPE&redir_esc=y#v=onepage&q=history%20of%20the%20factory&f=false">invented factories</a> and began harnessing <a href="https://dx.doi.org/10.2139/ssrn.2876929">electric power</a>. These novelties <a href="https://www.jstor.org/stable/3631212">totally revolutionized how we relate to each other</a> and <a href="https://www.jstor.org/stable/24690565">the world around us</a>. </p>
<p>Prior to the modern age, <a href="https://doi.org/10.1016/j.jhevol.2019.03.005">most humans lived in small collective bands</a>, surrounded by extended family, <a href="https://www.jstor.org/stable/43050800">and hardly ever ventured far</a> from home. These traditional lifestyles are increasingly rare <a href="https://www.jstor.org/stable/10.5749/j.ctv6q52rv">as the pressures of capitalism and colonialism homogenize our lives</a>.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/541767/original/file-20230808-27-i8u8og.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An Indigenous community on the boundaries of a clear-cutting operation." src="https://images.theconversation.com/files/541767/original/file-20230808-27-i8u8og.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/541767/original/file-20230808-27-i8u8og.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541767/original/file-20230808-27-i8u8og.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541767/original/file-20230808-27-i8u8og.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541767/original/file-20230808-27-i8u8og.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541767/original/file-20230808-27-i8u8og.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541767/original/file-20230808-27-i8u8og.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Clear-cutting operations in Brazil reveal with particular clarity the exponential growth of our demands upon this planet, in stark contrast to our ever shrinking social networks and communities.</span>
<span class="attribution"><span class="source">(AP Photo/Andre Penner)</span></span>
</figcaption>
</figure>
<p>Across the globe, people <a href="https://www.worldbank.org/en/topic/urbandevelopment/overview">increasingly live in cities</a> and are forced to abandon traditional lifestyles. <a href="https://www.americansurveycenter.org/why-mens-social-circles-are-shrinking/">Social networks have divided and grown smaller and smaller</a>. Despite efforts to resist declining social connection, we increasingly <a href="https://doi.org/10.1007/s13524-015-0440-z/%22%22">organize ourselves into disconnected and competing family units</a>. As a result, rates of loneliness <a href="https://doi.org/10.1136/bmj-2021-067068">are elevated</a> <a href="https://doi.org/10.1016/j.adolescence.2021.06.006">and increasing</a> in nearly every global region and <a href="https://doi.org/10.1177/2167696820962599">our attachments to one another are becoming less and less secure</a>.</p>
<h2>Consequences for our planet</h2>
<p>The consequences of modern life don’t end with <a href="https://www.hhs.gov/about/news/2023/05/03/new-surgeon-general-advisory-raises-alarm-about-devastating-impact-epidemic-loneliness-isolation-united-states.html">growing rates of loneliness and social disconnection</a>. Indeed, in the same fraction of time that we revolutionized human social life, we have also dramatically increased our demand on the world around us — <a href="https://doi.org/10.1079/9781780642031.0005">clearing billions of acres of forests</a>, releasing <a href="https://doi.org/10.5194/gmd-10-2057-2017">billions of tons of greenhouse gases into the atmosphere</a> and <a>imposing vast infrastructure upon this planet and its non-human inhabitants</a>. Moreover, <a href="https://link.springer.com/article/10.1007/s10745-021-00237-w">we are losing traditional ecological knowledge needed to protect our environments</a>. These atomized lifestyle changes have been costly to the environment.</p>
<figure class="align-center ">
<img alt="A baby in a pram stares at a phone on a subway carriage." src="https://images.theconversation.com/files/541963/original/file-20230809-16-tydw85.jpg?ixlib=rb-1.1.0&rect=48%2C0%2C5400%2C3564&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541963/original/file-20230809-16-tydw85.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541963/original/file-20230809-16-tydw85.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541963/original/file-20230809-16-tydw85.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541963/original/file-20230809-16-tydw85.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541963/original/file-20230809-16-tydw85.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541963/original/file-20230809-16-tydw85.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Climate change is as much a crisis of disconnection with ourselves and our planet as it is a failure of policy.</span>
<span class="attribution"><span class="source">(AP Photo/Mark Lennihan)</span></span>
</figcaption>
</figure>
<p>In addition to the more environmentally intensive lifestyles we now lead, our increasingly individualistic culture has emerged as a <a href="https://doi.org/10.1016/j.ancene.2019.100198/%22%22">key driver of environmental degradation</a>. Studies suggest that tribalism and polarization are stifling our ability <a href="https://doi.org/10.1186/s40665-016-0018-z%22%22">to respond to the environmental threats we are increasingly facing</a>. </p>
<h2>A vicious feedback cycle</h2>
<p>Perhaps of greatest concern, it is apparent that there is a vicious feedback cycle between climate change and poor social cohesion. In fact, there is a growing body of research showing that climate change will not just be worsened by our social disconnectedness, but will itself contribute to greater disconnection. Climate change and our modern social ills are linked.</p>
<p>As exemplified by recent <a href="https://www.nytimes.com/2023/03/31/style/modern-love-relationship-climate-change.html">media reports</a>, <a href="https://doi.org/10.3389/fpsyg.2021.623757">even close families and friends experience conflict over climate change</a>. Such conflicts may arise from disagreements about <a href="https://theethicalist.com/partner-does-not-care-climate-change/">how to live our lives in an environmentally conscious way</a> and this potential is increased by <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4168583">important gender differences in climate anxiety</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/eco-anxiety-climate-change-affects-our-mental-health-heres-how-to-cope-202477">Eco-anxiety: climate change affects our mental health – here's how to cope</a>
</strong>
</em>
</p>
<hr>
<p>Couples worried about the future may therefore experience conflicts over <a href="https://doi.org/10.1186/s12889-023-15674-z">whether to have kids</a>. For other couples, climate change may <a href="https://doi.org/10.1007/s13524-018-0690-7">reduce intimacy</a>, <a href="https://doi.org/10.1001/jamapsychiatry.2023.1958">increase intimate partner violence</a> and threaten <a href="https://womendeliver.org/wp-content/uploads/2021/02/Climate-Change-Report.pdf">sexual and reproductive wellbeing</a>. Indeed, there is compelling evidence that <a href="https://doi.org/10.1007/s13524-018-0690-7">unseasonably warm weather is associated with a decline in births</a> nine months later, which suggests that changes in the climate could impact intimacy between partners. Climate change is a wedge issue that has the potential to drive us further and further apart.</p>
<p>While the <a href="https://doi.org/10.1007/978-3-030-91611-4">decision to not have kids may have many environmental benefits</a>, living and ageing without children can have its own difficulties – including <a href="https://doi.org/10.1017/S0144686X22000824">increased risk for loneliness and isolation</a>. The feedback cycle goes both directions.</p>
<p>Moreover, at the population level, these impacts are compounded. Extreme weather effects can increase the rate of interpersonal violence. Declining birth rates lead to considerable economic impact. And mass migration creates cultural challenges such as those driving the re-emergence of extreme-right parties in Europe.</p>
<h2>The way out</h2>
<p>Put simply, human life has changed at a breakneck pace and our <a href="https://doi.org/10.1016/j.ijpp.2022.12.005">biology, ecology and psychology have failed to keep up</a>. </p>
<p>As <a href="https://doi.org/10.3390/ijerph182111303">Indigenous peoples have taught for centuries</a>, it’s time we recognize that all things are interconnected. If we don’t act, climate change will worsen our social bonds, which will only reduce our capacity to respond to the environmental threats that lie ahead. The climate will worsen and the cycle will continue.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fearmongering-about-people-fleeing-disasters-is-a-dangerous-and-faulty-narrative-200894">Fearmongering about people fleeing disasters is a dangerous and faulty narrative</a>
</strong>
</em>
</p>
<hr>
<p>However, there is a way out of this vicious feedback loop: we can reverse the centuries-long trend in disconnection by treating social and environmental health on par with physical and mental health. </p>
<p>Our own research suggests that <a href="https://doi.org/10.5281/zenodo.8226568">promoting social connection is key to reducing the harmful effects of climate change, including its effect on mental health</a>. Other studies also show that the <a href="https://doi.org/10.1177/09636625211020661">more connected we are, the better we will be able to discuss</a> and <a href="https://doi.org/10.1080%2F08941920.2019.1709002">respond to</a> climate change. </p>
<p>Of course, if the last few decades are any indication, we must acknowledge that social connection and cohesion is difficult to achieve. If modern life were conducive to healthy social lives, we would not be where we are today. </p>
<p>This is exactly why we need renewed public and philanthropic investments in social cohesion and community life. For example, <a href="https://www.friendshipbenchzimbabwe.org/">friendship benches in Zimbabwe</a> provide a leading example for how relying on and strengthening community <a href="https://doi.org/10.1186/s12913-022-08767-9">can help people live happier and healthier lives</a>. We must learn from communities leading the way across the globe if we are to survive and thrive in the midst of environmental change. Indeed, climate change requires us to come together.</p><img src="https://counter.theconversation.com/content/210594/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kiffer George Card has received funding from the Social Sciences and Humanities Research Council, Health Research British Columbia, Canadian Red Cross, Public Health Agency of Canada, Government of British Columbia, and Canadian Institutes of Health Research. </span></em></p><p class="fine-print"><em><span>Kalysha Closson receives funding from the Canadian Institutes of Health Research Banting Postdoctoral Fellowship program.</span></em></p>Dealing with climate change requires us to address not just our carbon emissions but also the disconnection with ourselves and our planet which fuels ecological destruction.Kiffer George Card, Assistant Professor in Health Sciences, Faculty of Health Sciences, Simon Fraser UniversityKalysha Closson, Adjunct Professor and Post Doctoral Fellow, Faculty of Health SciencesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2075722023-08-15T09:14:08Z2023-08-15T09:14:08ZFive old contraception methods that show why the pill was a medical breakthrough<figure><img src="https://images.theconversation.com/files/532664/original/file-20230619-15-aihcw9.jpg?ixlib=rb-1.1.0&rect=2%2C13%2C1531%2C1004&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The wishbone pessary didn't look comfortable </span> <span class="attribution"><a class="source" href="https://collection.sciencemuseumgroup.org.uk/objects/co96426/wishbone-%20stem-pessary-intracervical-device-europe-1880-1940-intra-uterine-device">Science Museum Group Collection</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>If you have access to it, it’s easy to take today’s contraception for granted. But key discoveries over the last century or so changed the lives of women. </p>
<p>Before the invention of modern intra-uterine devices (IUDs) or hormonal contraception, most products had low effectiveness, and were more useful for delaying pregnancy than preventing it. </p>
<p>When the contraceptive pill became available in the early 1960s, it marked a turning point. Its very low failure rate of <a href="https://www.nhs.uk/conditions/contraception/how-effective-contraception/">less than 1%</a> when used properly, helped put control of contraception firmly in women’s hands. </p>
<p>While the pill can have some serious side-effects, for many women it still provides a much less uncomfortable experience than many of the methods that preceded it.</p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/science-experiments-traditionally-only-used-male-mice-heres-why-thats-a-problem-for-womens-health-205963">Science experiments traditionally only used male mice – here’s why that’s a problem for women’s health</a></em></p>
<p><em><a href="https://theconversation.com/the-orgasm-gap-and-why-women-climax-less-than-men-208614">The orgasm gap and why women climax less than men</a></em></p>
<hr>
<h2>1. Reusable condoms</h2>
<p>People have used sheaths since at least the 17th century, mostly to prevent sexually transmitted infections. Initially these were made of <a href="https://wellcomecollection.org/articles/W88vXBIAAOEyzwO_">natural material such as animal intestines or linen</a>.</p>
<p>Just a few years after the <a href="https://www.pbs.org/wgbh/theymadeamerica/whomade/goodyear_hi.html#:%7E:text=A%20dogged%20experimenter%20with%20no,%2D%2D%20a%20key%20industrial%20substance.&text=Charles%20Goodyear%20and%20his%20family,viable%20as%20an%20industrial%20material">invention of synthetic rubber</a> (1844), the rubber condom was created. It was <a href="https://daily.jstor.org/short-history-of-the-condom/">designed to be rinsed and re-used</a>, but as a result it was thicker and less comfortable than today’s male condoms. </p>
<p>The <a href="https://daily.jstor.org/short-history-of-the-condom">disposable latex condom</a> was not invented until the 1930s. These were thinner, more comfortable and, of course, used only once. Later that decade, US courts overturned a ban on the sale of “immoral goods”, which helped make condom use more widespread.</p>
<h1>2. Acid-soaked sponges</h1>
<p>Since acid kills sperm, one traditional home-made method of contraception <a href="https://artsci.case.edu/dittrick/online-exhibits/history-of-birth-control/contraception-in-america-1900-1950/condoms-and-sponges/">involved inserting a vinegar-soaked sponge</a> into the vagina. Purpose-designed sponges became <a href="https://collection.sciencemuseumgroup.org.uk/objects/co96354/contraceptive-sponge-united-kingdom-1901-1930-contraceptive-sponge">commercially available</a> at the beginning of the 20th century and contained chemical spermicide. </p>
<p><a href="https://youtu.be/VrwpX1EgQck">Variations of the spermicidal sponge</a> are still available. However, less than <a href="https://digital.nhs.uk/data-and-information/publications/statistical/sexual-and-reproductive-health-services/2021-22/data-tables">1% of women in the UK</a> use the sponge today. </p>
<p>The typical failure rate, particularly for young women, is about <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3638209/">12%-24% per year</a>. In general, younger women are more likely to get pregnant while using less effective methods because they are more fertile than older women. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/532682/original/file-20230619-15-yqy28y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Large orange sponge in a net" src="https://images.theconversation.com/files/532682/original/file-20230619-15-yqy28y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/532682/original/file-20230619-15-yqy28y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532682/original/file-20230619-15-yqy28y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532682/original/file-20230619-15-yqy28y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532682/original/file-20230619-15-yqy28y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532682/original/file-20230619-15-yqy28y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532682/original/file-20230619-15-yqy28y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Contraceptive sponge, 1901-1930.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/m4smgwfy">Science Museum, London</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>3. Diaphragms and caps</h2>
<p>Diaphragms and their <a href="https://pubmed.ncbi.nlm.nih.gov/7099129/">smaller cousins, called caps</a>, were invented in the early 19th century. Like condoms, they work as physical barriers to sperm, and like sponges are also used with chemical spermicide. They are inserted before sex into the vagina and should stay in place for a least six hours afterwards to <a href="https://www.nhs.uk/conditions/contraception/contraceptive-diaphragm-or-cap/">allow the spermicide to kill sperm</a>. </p>
<p>The cap and diaphragm were widely used in the US and Europe before the second world war. But the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3638209/">typical failure rate for young women</a> using these methods is about 12%. Partly as a result, <a href="https://www.un.org/development/desa/pd/data/world-contraceptive-use">less than 1% of women worldwide</a> use them today. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/532684/original/file-20230619-21-isechv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Thick rubber cap with pull cord" src="https://images.theconversation.com/files/532684/original/file-20230619-21-isechv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/532684/original/file-20230619-21-isechv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532684/original/file-20230619-21-isechv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532684/original/file-20230619-21-isechv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532684/original/file-20230619-21-isechv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532684/original/file-20230619-21-isechv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532684/original/file-20230619-21-isechv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Rubber cervical cap.</span>
<span class="attribution"><a class="source" href="https://iiif.wellcomecollection.org/image/L0065292/full/760%2C/0/default.jpg">Science Museum, London</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The high failure rates of barrier methods are partly because they don’t stop women ovulating. If sperm manage to get through the barrier, the chances of fertilisation are high. The other drawback is that they are difficult to fit and must be in place before sex, at a time the woman would probably prefer to be thinking of other things.</p>
<h2>4. Douching with antiseptic</h2>
<p>Rinsing the vagina after intercourse, often with antiseptic solution, was used as <a href="https://artsci.case.edu/dittrick/online-exhibits/history-of-birth-control/contraception-in-america-1900-1950/douching-and-spermicides/">contraception in the early 20th century</a>. Douching does not affect sperm which has already started on its journey through the cervix. So the efficacy of vaginal douching was very low. </p>
<p>Today health professionals <a href="https://www.womenshealth.gov/a-z-topics/douching">strongly discourage</a> douching because of the harm it does to vaginal flora (the natural protective bacteria in the vagina), which can lead to vaginal irritation and infection. </p>
<h2>5. Silkworm gut IUDs</h2>
<p>Intra-uterine devices (IUDs) <a href="https://digital.nhs.uk/data-and-information/publications/statistical/sexual-and-reproductive-health-services">remain popular</a> but they didn’t always work the same way as modern products.</p>
<p>Early intrauterine methods worked on the (partially correct) belief that any device sitting inside the womb is likely to stop a fertilised egg from implanting and developing in the womb. In the 19th century, wishbone pessaries (so called because of their shape) were used to prevent pregnancy. </p>
<p>These devices had two arms which protruded through the cervix into the vagina, and a button ending which covered the cervix. It is hard to imagine <a href="https://collection.sciencemuseumgroup.org.uk/objects/co96426/wishbone-%20stem-pessary-intracervical-device-europe-1880-1940-intra-uterine-device">that these were comfortable</a>. </p>
<p>Polish gynaecologist Richard Richter <a href="https://pubmed.ncbi.nlm.nih.gov/1093589/#:%7E:text=PIP%3A%20The%20first%20published%20p">published a paper in 1909</a> about how he inserted a ring of silkworm gut into a patient’s womb, with two protruding strings to allow removal. At the time a lot of gynaecologists were discreetly using their own versions of such devices, because of <a href="https://www.mtsu.edu/first-amendment/article/983/birth-control">laws against promoting contraception</a> in many countries.</p>
<p>The Graefenberg ring replaced the silkworm gut with a metal alloy ring in the 1920s. German gynaecologist Ernst Graefenberg first tried pure silver, but the body <a href="https://www.reproductiveaccess.org/2013/01/a-history-the-iud/">absorbed it</a> and turned the women’s gums blue. </p>
<p>All kinds of <a href="https://artsci.case.edu/dittrick/online-exhibits/history-of-birth-control/contraception-in-america-1950-present-day/intrauterine-device-iud/">materials and shapes of IUDs</a>, from leaf shapes to spirals, were used throughout the fifties, sixties and seventies until researchers realised copper improved the effectiveness of the devices. By the 1970s there were about 70 different intra-uterine devices on the market in the USA. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/532677/original/file-20230619-29-abqt5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Sketch of a Dalkon shield IUD" src="https://images.theconversation.com/files/532677/original/file-20230619-29-abqt5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/532677/original/file-20230619-29-abqt5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=554&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532677/original/file-20230619-29-abqt5w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=554&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532677/original/file-20230619-29-abqt5w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=554&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532677/original/file-20230619-29-abqt5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=697&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532677/original/file-20230619-29-abqt5w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=697&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532677/original/file-20230619-29-abqt5w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=697&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">dalkon shield.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Dalkon_Shield#/media/File:Sketch_of_a_Dalkon_Shield_IUD-_2013-04-9_05-16.jpg">Andy Ratchick</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>But one of these copper coils, the infamous <a href="https://www.britannica.com/science/Dalkon-Shield">Dalkon shield, allowed</a> bacteria to ascend into the womb, because of the design of the threads used to retrieve it. This was responsible for high numbers of infections and made acceptance of intrauterine methods plummet in the 1970s. </p>
<p>Modern intrauterine devices (IUDs) sit fully in the womb, contain either copper or slow-release progesterone-type hormones, and are much safer and more effective than older devices. Infections due to <a href="https://www.healthline.com/health/birth-control/iud-infection#risk-factors">IUDs are rare now</a> but occasionally happen in the first few weeks after insertion. Both hormonal and copper coils now have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3638209/">failure rates of less than 1%</a>. </p>
<p>We now have several methods of contraception which, if used correctly, rarely fail, but women still struggle to find a method that suits them. New research is focused on reducing the side effects of contraception but in the meantime governments should invest in sexual health services to give people better, faster access to contraceptives and advice to choose the method that suits them best.</p><img src="https://counter.theconversation.com/content/207572/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Walker has received funding from Bayer PLC and has been a consultant to NaturalCycles. </span></em></p>Contraception today may not be perfect but it’s better than methods of the past.Susan Walker, Reader in Contraception, Reproductive and Sexual Health, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2085532023-07-24T19:54:44Z2023-07-24T19:54:44ZWhat to expect when you’re expecting: How will your sex life change during pregnancy and postpartum?<figure><img src="https://images.theconversation.com/files/538886/original/file-20230724-23-sj2thq.jpg?ixlib=rb-1.1.0&rect=142%2C0%2C7499%2C5190&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The perinatal period can be hectic. It's understandable that sex may be on the back burner for a little while.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/what-to-expect-when-youre-expecting-how-will-your-sex-life-change-during-pregnancy-and-postpartum" width="100%" height="400"></iframe>
<p>Welcoming a new baby is often a joyous experience for couples. While many couples take time to prepare for the arrival of their bundle of joy, fewer take time to prepare for challenges that can emerge in their sexual and romantic relationships during this period. </p>
<p>At The University of British Columbia’s <a href="https://swelllab.psych.ubc.ca/">Sexuality and Well-Being Lab (SWell)</a>, we conduct research to understand the factors that lead some couples to thrive during pregnancy and the postpartum while others struggle. We then use this research to develop resources to help couples navigate these changes together.</p>
<h2>What to expect</h2>
<p>Sexual challenges during pregnancy and the postpartum are common. Up to <a href="https://doi.org/10.1007/s11930-021-00313-8">88 per cent of people who give birth and 45 per cent of their partners experience problems with their sex life during this time</a>. </p>
<p>With shifting roles and responsibilities, the perinatal period (pregnancy and up to one year postpartum) can be hectic. It’s understandable that sex may be on the back burner for a little while. </p>
<p>Studies conducted by our team and <a href="https://natalieorosen.com/">our collaborators at Dalhousie University</a> have shown that many expectant and new parents <a href="https://doi.org/10.1037/fam0000689">desire sex less often and/or at different times than their partner</a>. </p>
<p>Many couples report having <a href="https://doi.org/10.1080/00224499.2020.1836114">distressing concerns about their sex life</a>, such as body image or whether having sex during pregnancy will hurt the baby — <a href="https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/sex-during-pregnancy/art-20045318#:%7E:text=Sexual%20activity%20won't%20affect,of%20comfort%20and%20sexual%20desire.">FYI, it won’t</a>. Approximately one in five people who gave birth <a href="https://doi.org/10.1097%2FAOG.0000000000004662">report moderate pain during sex that either starts in pregnancy or after the baby is born</a>. </p>
<p><a href="https://doi.org/10.1037/fam0000689">Sexual problems usually get worse throughout pregnancy until three months postpartum</a>, when they generally start improving.</p>
<figure class="align-center ">
<img alt="A pregnant woman lying on her back and a smiling man lying beside her with his hand on her belly" src="https://images.theconversation.com/files/538887/original/file-20230724-27-lwti2r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/538887/original/file-20230724-27-lwti2r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/538887/original/file-20230724-27-lwti2r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/538887/original/file-20230724-27-lwti2r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/538887/original/file-20230724-27-lwti2r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/538887/original/file-20230724-27-lwti2r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/538887/original/file-20230724-27-lwti2r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Expectant and new parent couples often don’t know what to expect when it comes to their sex lives.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>If this seems daunting, you’ll be encouraged to hear that despite sexual challenges being common, <a href="https://doi.org/10.1007/s11930-021-00313-8">64 per cent of couples say that they are still sexually satisfied during this time</a>. </p>
<p>This is great news because <a href="https://doi.org/10.1111/j.1751-9004.2011.00408.x">having a strong sexual connection with your partner is important for your mental and physical health</a>, and <a href="https://doi.org/10.1037/0893-3200.20.2.339">contributes to the longevity of your relationship</a>. </p>
<h2>The information gap</h2>
<p>Expectant and new parent couples often don’t know what to expect when it comes to their sex lives. In <a href="https://doi.org/10.1080/00224499.2023.2193570">a recent study</a> sampling 204 couples across Canada and the United States, we found that up to 78 per cent of expectant and new parents received little to no information about changes to their sexuality. This is despite most individuals wanting to receive sex-related information! </p>
<p>Given that sexual problems are common and not inconsequential to the health of the romantic relationship, this lack of information for couples about what to expect regarding their perinatal sexuality is a problem.</p>
<p>On top of this information gap, the content of information that couples receive doesn’t match what they want to receive. </p>
<p>In our study, we found that expectant and new parents most often received information about things like safety of sexual activity in pregnancy, contraception, when to resume sex in the postpartum and information only relevant to the partner who gave birth. </p>
<p>What’s missing is reassurance that changes to sexuality are common and advice on how to manage changes. Information about the sexuality of the partner who didn’t give birth is also lacking, even though <a href="https://doi.org/10.1007/s11930-021-00313-8">both members of the couple are affected</a>. Expectant and new parents <a href="https://doi.org/10.1080/00224499.2023.2193570">want a variety of information to help them be better prepared.</a></p>
<p>Research has also revealed that psychological factors such as <a href="https://doi.org/10.1093/abm/kaaa117">postpartum depression</a>, social factors such as <a href="https://doi.org/10.1177/0192513X15604343">divisions of labour</a> and relationship factors such as <a href="https://doi.org/10.1177/02654075221107393">coping together as a couple</a> are important for couples’ sexual relationships in pregnancy and the postpartum. </p>
<p>Perhaps surprisingly, biological factors — such as whether the delivery was vaginal or caesarean, and the degree of tearing — <a href="https://doi.org/10.1097%2FAOG.0000000000004662">are not strong predictors of sexual problems during this time</a>. </p>
<h2>Translating knowledge into practice</h2>
<p><a href="https://doi.org/10.1111/jmwh.13206">Health-care professionals feel they have a lack of knowledge and training to talk about sexual health with expectant and new parents</a>, and worry that doing so would make them and/or their patients feel uncomfortable. However, our research showed that <a href="https://doi.org/10.1080/00224499.2023.2193570">most couples would welcome these conversations</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/n0iLT_1jJCw?wmode=transparent&start=2" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Researchers at Dalhousie University have made a series of videos that summarize recent research on sex after having a baby.</span></figcaption>
</figure>
<p>Health-care professionals need training on how to initiate conversations about perinatal sexual health with expectant and new parents, but they also need to know the latest research in this area.</p>
<p>Researchers at Dalhousie University recently produced <a href="https://postbabyhankypanky.com/">a series of short informational videos</a> that summarize recent research on sex after having a baby. The goal of #PostBabyHankyPanky is to normalize changes to postpartum sexuality, encourage conversations about sex between partners and help health-care professionals feel more prepared to have these discussions with their patients. </p>
<p>If you’re a new or expectant parent and you’ve been noticing changes in your relationship, here’s some good news: Our research shows that when couples receive more information about what to expect regarding changes to their sex lives in pregnancy or the postpartum (like what you’ve read here) they report greater desire, engage in sex more often, feel more sexually satisfied and feel less worried about their sex lives.</p><img src="https://counter.theconversation.com/content/208553/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Erin T. Fitzpatrick receives funding from the Social Sciences and Humanities Research Council of Canada and the Guiding Interdisciplinary Research on Cisgender and Transgender Women and Girl’s Health and Well-being (GROWW) program. </span></em></p><p class="fine-print"><em><span>Dr. Samantha Jane Dawson works for the University of British Columbia. She receives funding from the Natural Sciences and Engineering Research Council, the Social Sciences and Humanities Research Council, the Women's Health Research Institute, and the Michael Smith for Health Research BC foundation. </span></em></p>Sexual challenges during pregnancy and postpartum are common, but couples often don’t know what to expect when it comes to their sex lives during this time. The good news is that information helps.Erin T. Fitzpatrick, Master's Student in Clinical Psychology, University of British ColumbiaSamantha Jane Dawson, Assistant Professor, Clinical Psychology, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2056272023-06-01T20:35:24Z2023-06-01T20:35:24Z‘Blue balls’: There’s no evidence they’re harmful, and they shouldn’t be used to pressure partners into sex<figure><img src="https://images.theconversation.com/files/529017/original/file-20230530-15-p0dr9l.jpg?ixlib=rb-1.1.0&rect=422%2C217%2C3603%2C2438&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Even though most people — including health-care professionals — are familiar with the term 'blue balls,' there is surprisingly little research on this phenomenon.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/-blue-balls---there-s-no-evidence-they-re-harmful--and-they-shouldn-t-be-used-to-pressure-partners-into-sex" width="100%" height="400"></iframe>
<p>What are blue balls? <a href="https://doi.org/10.1542/peds.106.4.843">Most people</a> — health-care providers included — are familiar with this term referring to scrotal discomfort experienced in response to prolonged sexual arousal without orgasm. </p>
<p>Although no one knows how the pain of blue balls develops, most implicate the slowed drainage of blood from the testicles in the <a href="https://www.healthline.com/health/mens-health/blue-balls">absence of orgasm during sexual arousal</a>.</p>
<p>One of the key physiological aspects of sexual arousal is <a href="https://doi.org/10.1016/B978-0-444-63247-0.00002-X">increased blood flow to areas of the body</a>, including the genitals. Genital-based signs of sexual arousal include engorgement of the genital structures leading to erection of the penis and external clitoris, and this engorgement usually resolves quickly after orgasm, which acts like a fast release valve.</p>
<p>In the absence of orgasm, the increased blood flow can take longer to get back to a non-aroused state (think of a slow-release valve), which is hypothesized to result in <a href="https://www.medicalnewstoday.com/articles/324870#summary">discomfort or pain in some people</a>. In addition, the genitals may take on a blue hue due to the lingering presence of <a href="https://doi.org/10.1080/10304312.2013.737193">deoxygenated blood under the skin</a>, hence the adjective “blue” in “blue balls.”</p>
<p>Even though most people have heard about “blue balls” and a quick internet search reveals links to a variety of health-related and popular websites containing basic information, there is surprisingly little research on this phenomenon in medical journals. Is this because the experience of blue balls is “no big deal?”</p>
<h2>Anyone can get ‘blue balls’</h2>
<figure class="align-center ">
<img alt="four blue kettle bell weights with black handles" src="https://images.theconversation.com/files/529021/original/file-20230530-23-m6pkqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529021/original/file-20230530-23-m6pkqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=273&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529021/original/file-20230530-23-m6pkqf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=273&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529021/original/file-20230530-23-m6pkqf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=273&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529021/original/file-20230530-23-m6pkqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=343&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529021/original/file-20230530-23-m6pkqf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=343&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529021/original/file-20230530-23-m6pkqf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=343&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">‘Blue balls’ isn’t specific to genitals featuring a scrotum; it can occur in all bodies.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>My research team and I paired up with the <a href="https://open.spotify.com/episode/5FTH9JkC3JlA4Gr489Gouv?si=Z6aDdrfIT_2AeAIPjYGL2Q">Science Vs podcast</a> team Wendy Zukerman and Blythe Terrell to analyze the results of a survey they conducted in 2021 examining who experiences discomfort during sexual arousal without orgasm. </p>
<p>The survey also asked about consequences of this experience in terms of frequency and level of discomfort, as well as whether respondents had been asked to continue sexual activity by a sexual partner who may have experienced this.</p>
<p>The results, featuring responses from more than 2,000 participants (about 57 per cent with a penis and 43 per cent with a vagina) and published in <a href="https://doi.org/10.1093%2Fsexmed%2Fqfad016"><em>Sexual Medicine</em></a>, revealed that in some ways, this experience is “no big deal” and in other ways, it is a very big deal.</p>
<p>Let’s first clarify a major issue assumed by the term “blue balls” related to who can experience this phenomenon, based on the results of this study. </p>
<p>The term assumes that discomfort resulting from sexual arousal without orgasm only exists in “balls,” referring to the scrotum. The process of sexual arousal described earlier, however, isn’t specific to genitals featuring a scrotum. It occurs in all bodies, as long as there are no obstacles (for example, health conditions impacting blood flow) to physiological sexual response.</p>
<p>In line with this, our results show that just over 42 per cent of participants with a vulva reported experiencing discomfort resulting from sexual arousal without orgasm. Fifty-six per cent of respondents with a penis reported this experience. </p>
<p>Also, the discomfort and pain experiences were overall mild and infrequent. This is consistent with the lack of medical research and clinical attention to this topic.</p>
<h2>Concerns about coercion</h2>
<p>Respondents’ reports of consequences of being with a partner who experienced or feared experiencing pain without orgasm, however, were extremely concerning. Significantly more participants with a vagina (40.1 per cent) than with a penis (3.7 per cent) reported pressure to engage sexually in this situation.</p>
<figure class="align-center ">
<img alt="A man and a woman sitting a bed with their backs to each other and their heads bowed" src="https://images.theconversation.com/files/529018/original/file-20230530-21-n7taap.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529018/original/file-20230530-21-n7taap.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529018/original/file-20230530-21-n7taap.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529018/original/file-20230530-21-n7taap.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529018/original/file-20230530-21-n7taap.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529018/original/file-20230530-21-n7taap.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529018/original/file-20230530-21-n7taap.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Pressure to engage in sexual activity is sexual coercion, which is associated with negative outcomes in terms of health and well-being.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Pressure to engage in sexual activity is sexual coercion, which is associated with negative outcomes in terms of health and well-being, such as <a href="https://doi.org/10.1007/s10508-006-9129-0">increased risk of depression and anxiety, low self-esteem and negative sexual self-perceptions</a>. Sexual activity in response to coercion certainly does not conform to enthusiastic and freely given <a href="https://doi.org/10.1080/00224499.2020.1765953">sexual consent</a>.</p>
<p>A recent discussion about sexual coercion in response to “blue balls” <a href="https://www.buzzfeed.com/kristatorres/blue-balls-tiktok">gained much attention</a> in response to a TikTok, which has since been deleted. This TikTok claimed that “blue balls” are not painful and that men use it as a ruse to convince partners to engage sexually with them. This resulted in an uproar, with angry comments posted by those who recounted experiences of continuing sexual activity out of guilt to prevent their partner’s pain.</p>
<p>In our study, many participants reported in their own words that the experience of pain without orgasm should never be used as a coercive tactic. Yet, results also showed that almost half the participants — mostly women and some men — reported pressure to engage sexually.</p>
<h2>Gendered expectations</h2>
<p>It will take effort to change ideas related to sexual expectations in our society, many of which are gendered. </p>
<p>The <a href="https://doi.org/10.1007/s10508-023-02558-x">traditional sexual script</a> — guidelines for “appropriate” sexual behaviour in heterosexual couples (for example, the “steps” to sexual intercourse, such as kissing and genital touching) — emphasizes heterosexual men’s pleasure. The <a href="https://doi.org/10.1007/s10508-017-0939-z">orgasm gap</a>, defined as the higher orgasm frequency in heterosexual men as compared to heterosexual women during partnered sexual activity, is only one example of the real-life manifestation of this privileging of men’s sexual pleasure.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-are-men-having-more-orgasms-than-women-in-heterosexual-relationships-180080">Why are men having more orgasms than women in heterosexual relationships?</a>
</strong>
</em>
</p>
<hr>
<p>Sexual coercion in response to pain due to sexual activity without orgasm, is another example. Also note that <a href="https://doi.org/10.1177/0886260513506056">this has been shown to occur in men who have sex with men</a>.</p>
<p>Sexual coercion includes actions like begging, pleading, and making someone feel guilty about the pain or that it is their fault that the pain is there (for example, calling someone a “tease”). <a href="https://doi.org/10.1093%2Fsexmed%2Fqfad016">Our research</a> has found that plenty of things can help with the pain that does not involve coercion, including masturbation, waiting it out, cold or heat application and engaging in nonsexual activities such as exercising, sleeping or studying.</p>
<p>It’s time to take the management of this pain into your own hands, so to speak, as it will pass, and it is not a valid excuse to implicate unwilling others in its resolution.</p><img src="https://counter.theconversation.com/content/205627/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Caroline Pukall receives funding from the Canadian Institutes of Health Research.</span></em></p>The pain of ‘blue balls’ should never be used as a coercive tactic. But almost half of study participants — mostly women and some men — reported pressure to engage sexually.Caroline Pukall, Professor, Department of Psychology, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2067462023-06-01T20:00:23Z2023-06-01T20:00:23ZPeople with disability face barriers to sexual and reproductive health care. New recommendations are only the start<figure><img src="https://images.theconversation.com/files/529502/original/file-20230601-23342-2aafv8.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/down-syndrome-woman-baby-39593026">Shutterstock</a></span></figcaption></figure><p>The recently released <a href="https://parlinfo.aph.gov.au/parlInfo/download/committees/reportsen/RB000075/toc_pdf/EndingthepostcodelotteryAddressingbarrierstosexual,maternityandreproductivehealthcareinAustralia.pdf">findings</a> of the senate inquiry into reproductive health care sets the stage for potential transformative change.</p>
<p>Its recommendations are aimed at dismantling the barriers that have long hindered the sexual, maternal, and reproductive health care of women, non-binary, trans, and gender-diverse people, <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/ReproductiveHealthcare/Report/Chapter_4_-_Delivering_appropriate_and_adapted_care">including</a> people with disability.</p>
<p>Its recommendations are strong, welcome and important. For too long, people with disability have been stripped of their autonomy, self-determination and dignity when it comes to accessing sexual and reproductive health care.</p>
<p>But the latest recommendations are not enough to dismantle entrenched biases and stereotypes. Here’s what needs to happen next.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australian-womens-access-to-abortion-is-a-postcode-lottery-heres-what-needs-to-change-206504">Australian women's access to abortion is a postcode lottery. Here's what needs to change</a>
</strong>
</em>
</p>
<hr>
<h2>Why this is so badly needed</h2>
<p>The report outlined two key recommendations focused on people with disability, including: </p>
<ol>
<li><p>improved training for health practitioners on the ways to engage and communicate with people with disability </p></li>
<li><p>developing accessible, inclusive and empowering sexual and reproductive health education programs and resources for people with disability, and their family and carers.</p></li>
</ol>
<p>These recommendations came after the senate inquiry received a number of <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/ReproductiveHealthcare/Submissions">submissions</a> that highlighted the struggle women with disability face in engaging with sexual and reproductive health care. </p>
<p>The most obvious and well-known barriers are inaccessible health care settings and services, lack of relevant and complete information about options available to them, and inadequately educated and trained health workers. The recommendations only partially deal with these barriers.</p>
<p>However, the covert, <a href="https://theconversation.com/ableism-and-disablism-how-to-spot-them-and-how-we-can-all-do-better-204541">ableist barriers</a> women with disability face are much more pervasive and harmful.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1657844861498974208"}"></div></p>
<p>Women with disability are often <a href="https://www.frontiersin.org/articles/10.3389/fcomm.2021.667627/full?&utm_source=Email_to_authors_&utm_medium=Email&utm_content=T1_11.5e1_author&utm_campaign=Email_publication&field=&journalName=Frontiers_in_Communication&id=667627">stereotyped</a> as being incapable of controlling their sexual impulses, or being non-sexual and child-like with no desire or capacity for intimate relationships. Other stereotypes include lacking capacity to care for their children, manage menstruation or control their sexuality and fertility. </p>
<p>These disabilist views have endured, largely unchallenged and with pervasive influence. As a result, sexual and reproductive education for people with disability and health professionals tends to adopt a narrow perspective. It <a href="https://www.edgeeffect.org/wp-content/uploads/2020/08/Out-of-the-Margins_Full-Report_June-2020_FINAL.pdf">disregards</a> the diverse identities and concerns of the disabled community, driven instead by cis-heteronormative, ableist, and Eurocentric values. </p>
<p>Current practice often centres on disease and pregnancy prevention, with an emphasis on paternalistic safeguarding of “vulnerable” women.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1602416475431927810"}"></div></p>
<p>The impact of these stereotypes means people with disability of diverse genders continue to experience menstrual suppression using pharmaceuticals, forced contraception, sterilisation, and forced abortion, particularly those in <a href="https://disability.royalcommission.gov.au/system/files/2021-10/DRC.9999.0080.0001.pdf">guardianship arrangements</a>.</p>
<p>Women with disability are also disproportionately affected by sexual violence and abuse. <a href="https://disability.royalcommission.gov.au/system/files/2021-10/DRC.9999.0080.0001.pdf">A total of 90%</a> of women with intellectual disability have endured sexual abuse at some time in their lives. Women with disability are <a href="https://disability.royalcommission.gov.au/news-and-media/media-releases/alarming-rates-family-domestic-and-sexual-violence-women-and-girls-disability-be-examined-hearing#:%7E:text=From%20the%20age%20of%2015,16%25%20of%20women%20without%20disability.">nearly twice as likely</a> as non-disabled women to experience sexual violence.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-count-what-matters-and-violence-against-people-with-disability-matters-51320">We count what matters, and violence against people with disability matters</a>
</strong>
</em>
</p>
<hr>
<p>When it comes to expectant and new mothers with disability, appropriate and accessible health care is also hard to find. Many receive no tailored pre- and post-natal care and people with disability and are <a href="https://parlinfo.aph.gov.au/parlInfo/download/committees/reportsen/RB000075/toc_pdf/EndingthepostcodelotteryAddressingbarrierstosexual,maternityandreproductivehealthcareinAustralia.pdf">often prevented</a> from receiving a full complement of care that non-disabled women receive.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1660465511354736640"}"></div></p>
<p>The question remains whether the senate inquiry’s recommendations will be enough to tackle the deeply ingrained stigma and discrimination women with disability face when it comes to accessing sexual health care, unbiased fertility and reproductive information, affordable contraception, and support for sexual choices.</p>
<p>It’s unlikely the barriers created by inherent ableism will be easily dismantled through education alone. So, what else is needed?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/autistic-people-often-feel-theyre-doing-love-wrong-but-theres-another-side-of-the-story-199200">Autistic people often feel they’re ‘doing love wrong’ – but there’s another side of the story</a>
</strong>
</em>
</p>
<hr>
<h2>1. Human rights legislation</h2>
<p>Sexual and reproductive rights are inherent entitlements of every being, regardless of gender or disability. However, the right to parenthood is particularly precarious for people with disability in Australia. </p>
<p><a href="https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities/article-23-respect-for-home-and-the-family.html">Article 23</a> of the UN Convention on the Rights of Persons with Disabilities unequivocally upholds the right to a family, including the right to marry and have children.</p>
<p>Those who do have children, face additional pressures. <a href="https://www.aihw.gov.au/reports/children-youth/australias-children/contents/social-support/parental-health-and-disability">About 15%</a> of Australian children have at least one parent who has a disability but <a href="https://www.sydney.edu.au/news-opinion/news/2022/08/19/parents-with-intellectual-disability-need-more-support.html">three out of every five</a> of these children face the possibility of <a href="https://www.researchgate.net/publication/278110861_Parents_labelled_with_Intellectual_Disability_Position_of_the_IASSID_SIRG_on_Parents_and_Parenting_with_Intellectual_Disabilities">being removed</a> from their parents.</p>
<p>People with disability want their right as a decision-maker over their own health, life and bodily integrity to be <a href="https://www.sciencedirect.com/science/article/abs/pii/S0266613822002686">validated</a>.
So we need to move beyond educating people with disability, their families and health professionals. We need a courageous examination of systemic deeply rooted stereotypes and biases in how sexual and reproductive health care is understood and delivered. And health systems need to be accountable. </p>
<p>We can do this partly with <a href="https://humanrights.gov.au/sites/default/files/content/letstalkaboutrights/downloads/HRA_questions.pdf">human rights legislation</a> that specifically affirms and acknowledges the rights of people with disability and their health care. Establishing a legal mechanism for rights would, at a minimum, provide disabled Australians with some protection. </p>
<p>Little change will occur in Australia until we align with the global shift to support people with disability to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9141465/">make their own decisions</a> about their health care. Australia is starting to do this, but we still lag behind many other countries.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-a-charter-of-rights-could-protect-australians-fundamental-freedoms-81947">How a charter of rights could protect Australians' fundamental freedoms</a>
</strong>
</em>
</p>
<hr>
<h2>2. Accessible information</h2>
<p>Accessibility – physical, sensory, cognitive – remains a major challenge to sexual and reproductive health care. Without it, we limit access to essential services. Education alone will not shift these barriers. </p>
<p>The success of the senate inquiry’s recommendations will also hinge on the provision of accessible and inclusive health information in various formats, such as Braille, large print Easy English, audio, with sign language interpretation. </p>
<p>Accessible communication and personally relevant, transparent, and complete information are critical for people with disability to feel their rights are protected, their treatment is <a href="https://www.sciencedirect.com/science/article/abs/pii/S0266613822002686">dignified</a> and they are supported to make informed choices and decisions.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sex-technology-and-disability-its-complicated-99849">Sex, technology and disability – it's complicated</a>
</strong>
</em>
</p>
<hr>
<h2>3. Collaboration and commitment</h2>
<p>Close collaboration between the government and the disability sector is needed if we are to successfully implement the senate inquiry’s recommendations. This means active involvement of disabled people’s organisations, advocates, and people with disability. Sufficient funding for genuine co-design and authentic engagement will also be essential. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/529496/original/file-20230601-23156-ye5n18.png?ixlib=rb-1.1.0&rect=7%2C0%2C1673%2C1121&q=45&auto=format&w=1000&fit=clip"><img alt="Latinx disabled woman and an Asian disabled genderfluid person chat and sit on couch, both holding coffee mugs. Electric lightweight mobility scooter rests on the side" src="https://images.theconversation.com/files/529496/original/file-20230601-23156-ye5n18.png?ixlib=rb-1.1.0&rect=7%2C0%2C1673%2C1121&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529496/original/file-20230601-23156-ye5n18.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529496/original/file-20230601-23156-ye5n18.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529496/original/file-20230601-23156-ye5n18.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529496/original/file-20230601-23156-ye5n18.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529496/original/file-20230601-23156-ye5n18.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529496/original/file-20230601-23156-ye5n18.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People with disability need to share their experiences and knowledge if we are to design better health care.</span>
<span class="attribution"><a class="source" href="https://affecttheverb.com/gallery/disabledandhere/coffeechat/">Disabled And Here</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>4. Change attitudes</h2>
<p>To effectively implement these recommendations and make any meaningful and lasting change, we must also invest heavily in influencing public perceptions.</p>
<p>That includes challenging the ableist view that sexuality is “taboo” for people with disability, and eliminating stigma, misconceptions and misunderstandings about parenting by people with disability.</p>
<hr>
<p><em>This article was co-authored by <a href="https://au.linkedin.com/in/karin-swift-0bb46744">Karin Swift</a>. Karin is an Adjunct Citizen Scientist at Griffith University, President of <a href="https://wwda.org.au">Women with Disabilities Australia</a> and a private consultant on disability, human rights, gender advocacy and social policy. She was Senior Engagement and Policy Consultant at Queenslanders with Disability Network.</em></p><img src="https://counter.theconversation.com/content/206746/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>For too long, people with disability have been stripped of their autonomy, self-determination and dignity when it comes to accessing sexual and reproductive health care.Elizabeth Kendall, Professor, Director, Griffith Inclusive Futures, Griffith University, Griffith UniversityKelsey Chapman, Research Fellow Dignity Project, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2065042023-05-30T20:08:09Z2023-05-30T20:08:09ZAustralian women’s access to abortion is a postcode lottery. Here’s what needs to change<figure><img src="https://images.theconversation.com/files/528969/original/file-20230530-26-lpaj2.jpg?ixlib=rb-1.1.0&rect=71%2C691%2C5901%2C3296&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/IMpmnH2IC98">Lili Kovac/Unsplash</a></span></figcaption></figure><p>When the American legal precedent protecting women’s right to an abortion in the United States, Roe versus Wade, was <a href="https://theconversation.com/us-supreme-court-overturns-roe-v-wade-but-for-abortion-opponents-this-is-just-the-beginning-185768">overturned last year</a>, women around the world felt anxious.</p>
<p>In Australia, despite abortion being legal, there was increasing concern about women’s ability to access abortion. This led to a <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/ReproductiveHealthcare">Senate inquiry into universal access to reproductive health care</a>.</p>
<p>This inquiry has now concluded. A <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/ReproductiveHealthcare/Report">key recommendation</a> is that:</p>
<blockquote>
<p>all public hospitals within Australia […] provide surgical pregnancy terminations, or timely and affordable pathways to other local providers.</p>
</blockquote>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1661964298489561088"}"></div></p>
<p>This recommendation has been welcomed by abortion advocates around the country. But why is a recommendation like this necessary? Why don’t hospitals already provide abortions?</p>
<h2>A safe, common procedure</h2>
<p>Abortion is a safe, routine procedure that nearly <a href="https://www.mja.com.au/journal/2018/209/9/unintended-and-unwanted-pregnancy-australia-cross-sectional-national-random">one in five Australian women</a> who have ever been pregnant will undergo by the age of 45.</p>
<p>Abortions can be provided either medically or surgically. A medical abortion is a <a href="https://youtu.be/qpukRNLUG9U">medically induced miscarriage</a>. In Australia, the medication needed to have an abortion is registered for use until a woman is nine weeks’ pregnant.</p>
<p>Many women prefer a medical abortion as the medication can be taken and the abortion occurs in the woman’s own home.</p>
<p>But a medical abortion is not for everyone. Some women may not be able to manage it at home, don’t have a safe and private space, or have health issues that preclude a medical abortion.</p>
<p>Some women miss the nine-week cut-off for a medical abortion because they don’t realise they are pregnant, or they make the decision to abort after nine weeks (this sometimes happens because of a relationship breakdown when the woman <a href="https://www.guttmacher.org/report/delays-in-accessing-care-among-us-abortion-patients">finds out she is pregnant</a>), or because of other issues such as domestic violence, rape, drug use or mental health issues. </p>
<figure class="align-center ">
<img alt="Mum with her two kids" src="https://images.theconversation.com/files/528971/original/file-20230530-3350-mnvuq2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/528971/original/file-20230530-3350-mnvuq2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/528971/original/file-20230530-3350-mnvuq2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/528971/original/file-20230530-3350-mnvuq2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/528971/original/file-20230530-3350-mnvuq2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/528971/original/file-20230530-3350-mnvuq2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/528971/original/file-20230530-3350-mnvuq2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many women who have an abortion already have children.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mom-helping-kids-homework-girl-playing-1703032996">Shutterstock</a></span>
</figcaption>
</figure>
<p><a href="https://www.betterhealth.vic.gov.au/health/healthyliving/abortion-procedures-surgical">Surgical abortions</a> usually involve a woman having a suction curette to remove pregnancy related tissue from the uterus under sedation in a hospital or day surgery centre.</p>
<p>Some women prefer this approach as it’s quicker. A surgical abortion also gives women the opportunity to have an intrauterine device (IUD) inserted for future contraception.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heres-why-there-should-be-no-gestational-limits-for-abortion-121500">Here's why there should be no gestational limits for abortion</a>
</strong>
</em>
</p>
<hr>
<p>It’s important for women to have a <a href="https://www.rcog.org.uk/globalassets/documents/guidelines/abortion-guideline_web_1.pdf">choice</a> about the type of abortion they have and for surgical abortion to be also be <a href="https://www.acog.org/advocacy/abortion-is-essential">available</a> for women who find out later in the pregnancy there is a serious problem with the fetus.</p>
<h2>So why is access so patchy?</h2>
<p>Many hospitals, particularly those outside major metropolitan areas, don’t currently provide any abortions, let alone surgical ones.</p>
<p><a href="https://www.publish.csiro.au/py/PY22194">Our research</a> has found many hospitals discourage referrals from general practitioners.</p>
<p>There have also been <a href="https://www.smh.com.au/national/nsw/women-turned-away-from-public-hospitals-three-years-after-abortion-decriminalised-in-nsw-20230303-p5cp5e.html">reports of hospitals turning away women</a> who need care in the uncommon event of complications following a medical abortion.</p>
<figure class="align-center ">
<img alt="Woman sits in waiting room" src="https://images.theconversation.com/files/529033/original/file-20230530-25-io2k3r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529033/original/file-20230530-25-io2k3r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=452&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529033/original/file-20230530-25-io2k3r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=452&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529033/original/file-20230530-25-io2k3r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=452&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529033/original/file-20230530-25-io2k3r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=568&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529033/original/file-20230530-25-io2k3r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=568&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529033/original/file-20230530-25-io2k3r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=568&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Women need to be able to access hospital care.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/blurred-patients-doctors-waiting-room-369431135">Shutterstock</a></span>
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<p>The reasons for this are complex. Abortion remains <a href="https://lens.monash.edu/@medicine-health/2022/05/26/1384710/in-roe-v-wades-shadow-theres-an-urgent-need-to-tackle-abortion-stigma-in-australia">very stigmatised in our community</a>. Few gynaecologists <a href="https://www.lawreform.vic.gov.au/content/law-abortion-final-report-html-version">want to perform</a> the procedure.</p>
<p>Training on how to provide abortion has not been a routine part of gynaecology or GP training and there is <a href="https://www.lawreform.vic.gov.au/content/law-abortion-final-report-html-version">a shortage of trained providers</a>, particularly for complex cases.</p>
<p>Hospitals <a href="https://parlinfo.aph.gov.au/parlInfo/download/committees/reportsen/RB000075/toc_pdf/EndingthepostcodelotteryAddressingbarrierstosexual,maternityandreproductivehealthcareinAustralia.pdf">haven’t felt obligated</a> to provide abortions. To date, no-one has held them accountable for providing this essential service. There has also not been any regional-level planning to ensure services are locally available.</p>
<p>Some health professionals are also conscientious objectors who believe they should not be forced to provide abortions.</p>
<h2>What does it mean for women needing an abortion?</h2>
<p>As the Senate inquiry report states, it’s a postcode lottery. Many women don’t know how to get an abortion, what’s available or where to go. Some will look online or go to their GP.</p>
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<strong>
Read more:
<a href="https://theconversation.com/abortion-is-no-longer-a-crime-in-australia-so-why-is-it-still-so-hard-to-access-182413">Abortion is no longer a crime in Australia. So why is it still so hard to access?</a>
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<p>If they decide on a surgical abortion, their local public hospital may not offer this and so their only option is a private clinic. Many of these clinics <a href="https://www.theguardian.com/australia-news/2021/jun/18/key-abortion-provider-marie-stopes-closes-regional-clinics-in-queensland-nsw">have closed in recent years</a> and more are open very limited hours or staffed by fly-in-fly-out teams, which means they can be very difficult to access.</p>
<p>Women may need to travel long distances to get a surgical abortion. This means taking time off work, organising childcare (as many women who have an abortion <a href="https://doi.org/10.5694/j.1326-5377.2009.tb02278.x">already have children</a> and arranging accommodation. This all comes with significant out-of-pocket costs.</p>
<h2>How can we fix the system?</h2>
<p>The Senate inquiry recognises many public hospitals, particularly women’s hospitals, that receive public funding are faith-based and will not allow abortions to be delivered at their premises, even if the doctors and nurses want to offer them.</p>
<p>The inquiry’s key recommendation seeks to ensure all public hospitals provide surgical abortions – and if not, at least ensure women in their catchment can access timely and affordable care via other local providers.</p>
<p>The inquiry also recommends that contraception and abortion access (particularly for rural and regional women) is made available via publicly funded community and hospital-based services, with regional-level planning, training and accountability.</p>
<p>To make this a reality, there has to be consequences if it doesn’t happen. Funding should be tied to provision. For full transparency, hospitals should also be made to issue public reports that spell out how many and what type of abortions they provide each year.</p>
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<strong>
Read more:
<a href="https://theconversation.com/one-in-six-australian-women-in-their-30s-have-had-an-abortion-and-were-starting-to-understand-why-111246">One in six Australian women in their 30s have had an abortion – and we're starting to understand why</a>
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<p>Funding also needs to be offered to train health professionals to deliver the services to ensure that now and into the future, we have a health workforce capable of delivering the services needed.</p>
<p>GPs need to know that if they provide a medical abortion, their local public hospital will provide support and see patients if and when needed.</p>
<p>GPs also need to have <a href="https://www.publish.csiro.au/py/PY22194">clear referral pathways</a> so women can get into surgical abortion services in a streamlined and timely way.</p>
<p>Finally, women need assistance to navigate to abortion services when they need to. The inquiry recommends governments develop coordinated campaigns and education materials to improve women’s knowledge of their rights and options for accessing effective contraception and abortion care. It also recommends establishing a national information services like the Victorian <a href="https://www.1800myoptions.org.au/">1800myoptions hotline</a>. </p>
<p>While the recommendations are a step in the right direction, action is needed to translate these recommendations into actual services on the ground. The government’s response is eagerly awaited.</p><img src="https://counter.theconversation.com/content/206504/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Danielle Mazza receives funding from the NHRMC and the MRFF and non government organisations such as the RACGP and RANZCOG. She has previously received research funding from Bayer and Organon. Professor Mazza is the Chair of the SPHERE Coalition which consists of key stakeholders, health professionals and consumers who together are advocating for improved women's sexual and reproductive health care quality and access.</span></em></p>A parliamentary inquiry recommends all Australian public hospitals provide abortions or timely and affordable pathways to other local providers. Why don’t hospitals already do this?Danielle Mazza, Director, SPHERE NHMRC Centre of Research Excellence in Women's Sexual and Reproductive Health in Primary Care and Professor and Head of the Department of General Practice, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2034432023-05-15T15:43:21Z2023-05-15T15:43:21ZGetting too excited can stop men from orgasming – but there’s a solution<figure><img src="https://images.theconversation.com/files/525107/original/file-20230509-28-amnssx.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C9504%2C6317&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-handsome-man-beard-wearing-casual-1680559948">Krakenimages.com/Shutterstock</a></span></figcaption></figure><p>The way sex is portrayed in pop culture films and music could easily give you the idea that it, at least physically, should happen easily – particularly for men. </p>
<p>Sex may seem like a straightforward activity but it actually involves a high degree of coordination between the brain and body parts. Recent data suggests that erectile dysfunction affects <a href="https://www.kcl.ac.uk/news/the-global-prevalence-of-erectile-dysfunction">around one in five UK men</a>, with the figure rising to <a href="https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/erectile-dysfunction-impotence">50% for the 40-70 age group</a>. </p>
<p>With this data in mind, we set out to explore how we could mathematically model the essence of sexual response in men and improve the experience. We found that <a href="https://doi.org/10.1063/5.0143190">too much psychological arousal</a> before or during sexual stimulation can make it difficult to climax.</p>
<p>Until recently, little was known scientifically about physiology and psychology of what happens when people are having sex, partly because of the taboo around it. A breakthrough came in the 1960s with the work of <a href="https://www.strandbooks.com/product/9780465079995?title=masters_of_sex_the_life_and_times_of_william_masters_and_virginia_johnson_the_couple_who_taught_america_how_to_love">US researchers William Masters and Virgina Johnson</a>. They invited over 380 women and over 300 men to a lab and observed them having sex, taking notes of the physiological changes that happened.</p>
<p>Having collected data from over 10,000 sex acts, Masters and Johnson published their results in 1966 in their <a href="https://www.britannica.com/topic/Human-Sexual-Response">Human Sexual Response paper</a>. It proposed a paradigm of the <a href="https://www.webmd.com/sex-relationships/guide/sexual-health-your-guide-to-sexual-response-cycle#:%7E:text=The%20sexual%20response%20cycle%20has,the%20timing%20usually%20is%20different.">human sexual response cycle</a> as a sequence of excitement, plateau, orgasm, resolution. For each of these stages Masters and Johnson described in minute detail physiological changes in genital areas, as well as more general reactions, such as hyperventilation, increased pulse and blood pressure, and involuntary sweating immediately after orgasm. </p>
<p>While sexual responses in women are less understood, the Masters-Johnson sexual response cycle for men has stood the test of time and is still the best representation of the stages men go through when having sex. Data collected by <a href="https://www.tandfonline.com/doi/pdf/10.1080/009262300278641">later studies</a> showed that female sexual responses are more diverse and don’t follow the linear progression of excitement-plateau-orgasm-resolution of the Masters-Johnson model.</p>
<h2>Practical insights</h2>
<p>One of the criticisms of the Masters-Johnson framework was that it did not account for psychological component of sexual response. In our <a href="https://aip.scitation.org/doi/10.1063/5.0143190">mathematical model</a>, we wanted to capture interactions between physiological and psychological aspects of sexual response in men. Our model focused on how the levels of physiological and psychological arousal (turn-on) change during sexual stimulation. </p>
<p>We combined data about physiological responses from the Masters-Johnson study with insights from five functional magnetic resonance imaging (fMRI) studies of people having sex from 2003 to 2011. fMRI <a href="https://www.radiologyinfo.org/en/info/fmribrain">measures the small changes in blood flow</a> that occur with brain activity. </p>
<p>Our model made two assumptions. First, that psychological turn on increases when someone is physically excited, from watching porn or from observing a partner and interacting with them. We also assumed that after sex, psychological excitement eventually subsides.</p>
<h2>Getting over excited</h2>
<p>The results of our model show that if a man becomes psychologically overly excited, either due to their initial level of psychological turn-on before, or during sex, this can be detrimental to their chances of achieving orgasm. One explanation for this is that when someone is overly excited they are too focused on their sexual performance or achieving an orgasm. </p>
<p>This can cause anxiety, which is itself a state of psychological overstimulation. As a result, people can come to a frustrating state of being agonisingly close to the point of climax yet not being able to reach it. The solution to this is to mentally switch-off and relax to allow your psychological arousal to decrease.</p>
<p>Another finding of our model is that the level of physical arousal decreases with psychological stimulation. Although this may seem counter-intuitive, it fits with the data from <a href="https://www.sciencedirect.com/science/article/abs/pii/S1053811909013238">fMRI studies</a> from around 15 years ago, in which 21 men were put inside an fMRI scanner and asked to bring themselves to orgasm either through self-stimulation or with the help of their partners. </p>
<p>The results showed that right before orgasm, many areas of the brain become deactivated. These include the amygdala (responsible for processing emotions and threatening stimuli) frontal cortical regions (controls judgement and decision making) and orbitofrontal cortex (integrates sensory input and takes part in decision making for emotional and reward-related behaviour). </p>
<p>So orgasm is associated with <a href="https://www.newscientist.com/article/mg21028124-600-sex-on-the-brain-orgasms-unlock-altered-consciousness/">letting go</a> – it’s a mental release as much as a physical one. </p>
<p>The same result follows from the <a href="https://journals.sagepub.com/doi/10.1177/0959354394044004">Yerkes-Dodson law</a>, which over 100 years ago established that for some tasks optimal physical performance is achieved with intermediate levels of psychological arousal. For example, difficult or intellectually demanding tasks may require a lower level of arousal (to facilitate concentration), whereas tasks demanding stamina or persistence need higher levels of arousal (to increase motivation). </p>
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<p><a href="https://link.springer.com/book/10.1007/978-0-387-79388-7">Mathematical models</a> have already helped us understand the dynamics of other physiological processes, such as blood circulation, heart disease, cancer, neural firing in the brain. Applying them to such complex phenomenon such as sexual response can provide insights that can help improve sexual performance and develop new approaches to treatment of sexual dysfunction.</p>
<h2>What next?</h2>
<p>Women have a <a href="https://www.bbc.com/future/article/20160630-the-enduring-enigma-of-female-desire">greater variety of sexual responses</a> that can include single or multiple orgasms.</p>
<p><a href="https://link.springer.com/article/10.1007/s10508-017-0939-z">Recent data</a> suggests that while heterosexual men achieve orgasm about 95% of the time, the equivalent figure for heterosexual women is a measly 65%. </p>
<p>Our next step would be to explore how to develop a mathematical model to represent the dynamics of female sexual response using the latest <a href="https://www.tandfonline.com/doi/pdf/10.1080/009262300278641">Basson’s circular model</a>, which will hopefully help close the <a href="https://www.theguardian.com/lifeandstyle/2023/mar/21/the-orgasm-gap-and-how-to-close-it-dont-equate-sex-and-penetration">orgasm gap</a>.</p><img src="https://counter.theconversation.com/content/203443/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We found you can have too much of a good thing - psychological stimulation.Konstantin Blyuss, Reader in Mathematics, University of SussexYuliya Kyrychko, Reader in Mathematics, University of SussexLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2031312023-04-10T20:00:33Z2023-04-10T20:00:33ZBritish Columbia’s coverage of contraceptives should inspire the rest of North America<figure><img src="https://images.theconversation.com/files/520087/original/file-20230410-7003-jfzc31.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6000%2C3655&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">British Columbia's move to provide free contraception is an act of defending and upholding reproductive rights and freedoms.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p><a href="https://bc.ctvnews.ca/access-to-free-birth-control-begins-in-british-columbia-1.6339248">As of April 1, 2023 all residents of British Columbia gained access to free prescription contraception</a>. This includes the birth control pill, injections and implants, IUDs and emergency contraception known as Plan B or the “morning after” pill.</p>
<p>The bold move makes good on a campaign promise of the NDP government. </p>
<p>It’s the focus of sustained activism of groups like <a href="https://www.accessbc.org/">AccessBC</a> and Action Canada for Sexual Health and Rights, and was ignited by the ongoing abortion politics south of the border, where a judge in Texas just <a href="https://www.nytimes.com/2023/04/07/health/abortion-pills-ruling-texas.html">issued a preliminary ruling invalidating the Food and Drug Administration’s 23-year-old approval of the abortion pill mifepristone</a>. That ruling was almost immediately followed <a href="https://apnews.com/article/washington-abortion-pills-lawsuit-fda-1857d1a4fd356c61ad76e00621e93b44">by a contradictory decision</a> by a judge in Washington state.</p>
<p>The <a href="https://www2.gov.bc.ca/gov/content/health/health-drug-coverage/pharmacare-for-bc-residents/what-we-cover/prescription-contraceptives">B.C. policy</a> could serve as a model for other provinces — Ontario’s Progressive Conservative government, for example, has already said it’s “<a href="https://www.thestar.com/politics/provincial/2023/03/08/ontario-looking-closely-at-bc-plan-to-offer-free-contraception-health-minister-says.html">looking closely at what British Columbia has proposed</a>.” </p>
<p>Nonetheless, universal coverage of contraception beyond British Columbia is unlikely at the moment. It does not seem to be a serious proposal of any current provincial government. </p>
<p>While some provincial opposition parties have promised universal contraception, policy progress depends on whether they actually get elected. It will also depend on a number of factors that will shape their political agenda once in office.</p>
<h2>List not fully complete</h2>
<p>The new coverage in B.C. is extended to anyone with a provincial health card and requires a physician’s prescription until later this spring, when <a href="https://www2.gov.bc.ca/gov/content/health/accessing-health-care/pharmacy-services">pharmacists will be able to prescribe contraceptives</a>. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/519991/original/file-20230409-6385-i30zeg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A package of birth control pills." src="https://images.theconversation.com/files/519991/original/file-20230409-6385-i30zeg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/519991/original/file-20230409-6385-i30zeg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=458&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519991/original/file-20230409-6385-i30zeg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=458&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519991/original/file-20230409-6385-i30zeg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=458&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519991/original/file-20230409-6385-i30zeg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=576&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519991/original/file-20230409-6385-i30zeg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=576&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519991/original/file-20230409-6385-i30zeg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=576&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A one-month dosage of hormonal birth control pills.</span>
<span class="attribution"><span class="source">(AP Photo/Rich Pedroncelli, File)</span></span>
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<p>The list of contraceptives included in this plan <a href="https://www.timescolonist.com/local-news/bc-provides-list-of-birth-control-methods-to-be-covered-6668608">is comprehensive but not exhaustive</a>. Other forms of birth control and menstrual regulation, according to the B.C. government, might be considered in the future. </p>
<p>There seems to be no significant discussion of extending the coverage to B.C. residents who don’t have a provincial health card, such as undocumented residents and migrant workers for whom <a href="https://www.alternateroutes.ca/index.php/ar/article/view/22448">reproductive rights</a> are already sometimes inaccessible. </p>
<p>And accessibility will be dependent upon pharmacists’ willingness to dispense medication, something that might be particularly contentious, not to mention time-sensitive with emergency contraception. </p>
<p>Pharmacists are allowed to refuse to stock or dispense medication as a matter of conscience, something that has been a <a href="https://doi.org/10.1370/afm.2562">barrier for medication abortion access</a> in Canada, especially in rural areas. Yet despite these criticisms, the B.C. plan serves as an example of equitable primary sexual and reproductive health care delivered at the provincial level.</p>
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Read more:
<a href="https://theconversation.com/roe-v-wade-canada-can-respond-to-u-s-bans-by-improving-access-to-abortion-care-here-185827">Roe v. Wade: Canada can respond to U.S. bans by improving access to abortion care here</a>
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<h2>Opposition promises in other provinces</h2>
<p>Opposition parties in Alberta, Manitoba and Saskatchewan have all promised to implement the <a href="https://bc.ctvnews.ca/access-to-free-birth-control-begins-in-british-columbia-1.6339248">same policy</a> if elected. But at this point, such a commitment really just amounts to a progressive idea in the context of conservative provincial politics, with <a href="https://thecanadaguide.com/data/provincial-premiers/">centre-right parties in power in eight of 10 provinces. </a></p>
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<img alt="A man is seen in profile under a large golden ceiling light." src="https://images.theconversation.com/files/519993/original/file-20230409-24-z3gijl.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/519993/original/file-20230409-24-z3gijl.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519993/original/file-20230409-24-z3gijl.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519993/original/file-20230409-24-z3gijl.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519993/original/file-20230409-24-z3gijl.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=511&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519993/original/file-20230409-24-z3gijl.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=511&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519993/original/file-20230409-24-z3gijl.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=511&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">B.C. Health Minister Adrian Dix is seen during a news conference with his provincial counterparts in Vancouver in November 2022.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span>
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<p>This means that the B.C. policy might reflect the uniqueness of the province’s political dynamics and also demonstrates what is possible, given the right political conditions, in the realm of <a href="https://doi.org/10.1086/722896">reproductive rights</a>. </p>
<p>It’s also reflective of the broader North American <a href="https://doi.org/10.1177/14647001221114611">politics of abortion</a>, as the timing of the policy — a campaign promise of the NDP government, elected in 2020 — seems to respond to the reversal of reproductive rights in the United States with the <a href="https://www.nytimes.com/2022/06/24/us/roe-wade-overturned-supreme-court.html">overturn of <em>Roe v. Wade</em> </a> in June 2022.</p>
<p>The end of constitutional protection of the right to abortion in the U.S. created momentum for strengthening abortion policy and reproductive rights in Canada. </p>
<p>In response <a href="https://www.nytimes.com/interactive/2022/06/24/us/politics/supreme-court-dobbs-jackson-analysis-roe-wade.html">to the U.S. Supreme Court ruling</a>, the <a href="https://www.cbc.ca/news/politics/abortion-funding-expanded-roe-v-wade-1.6449487">federal Liberal government has increased and sustained commitments to ensuring access to abortion</a> and other areas of sexual and reproductive health and rights.</p>
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<strong>
Read more:
<a href="https://theconversation.com/mexicos-help-to-american-women-who-need-abortions-should-inspire-canada-202117">Mexico's help to American women who need abortions should inspire Canada</a>
</strong>
</em>
</p>
<hr>
<h2>Reproductive justice</h2>
<p>Much of this work is carried out by organizations like <a href="https://www.actioncanadashr.org/">Action Canada for Sexual Health and Rights</a> and the <a href="https://nafcanada.org/">National Abortion Federation Canada</a>, with advocacy and information campaigns by the <a href="https://www.arcc-cdac.ca/">Abortion Rights Coalition</a>. </p>
<p>All insist that contraception and abortion are both matters of individual autonomy and <a href="https://www.sistersong.net/reproductive-justice">reproductive justice</a>. At the provincial level, <a href="https://montreal.ctvnews.ca/mobile/quebec-college-of-physicians-announces-new-guidelines-to-make-access-to-abortion-medication-easier-1.5988310">Québec reduced restrictions</a> on the dispensing of mifegymiso, the drug used in medication abortion. Other provinces, including <a href="https://www.thecoast.ca/news-opinion/how-to-get-an-abortion-in-nova-scotia-28911462">Nova Scotia</a>, created abortion self-referral networks.</p>
<p>But the B.C. government’s universal contraception announcement is the most recent positive policy response to the reversal of reproductive rights in the U.S.</p>
<p>Of course not all of the impact of the <em>Dobbs</em> decision on Canada has been positive. In the immediate aftermath of the overturn of <em>Roe</em>, the Manitoba legislature <a href="https://winnipeg.ctvnews.ca/ndp-bill-for-abortion-clinic-buffer-zones-defeated-in-house-1.5623693">defeated a bill</a> that would have provided buffer zone protection for abortion clinics. </p>
<p>The same organizations that benefit from increased federal funding — and use it to support women and other pregnant people — indicate that Canadian women who used to travel to the U.S. for certain kinds of abortions are finding it more difficult to do so due to increased restrictions and bans on the American side of the border.</p>
<p>The recent <a href="https://www.washingtonpost.com/politics/2023/04/07/abortion-pill-ruling-texas-washington/">duelling U.S. court decisions</a> concerning restrictions on mifepristone will only increase this difficulty and limit reproductive rights. </p>
<p>Policies like B.C.’s universal coverage of contraception will help to expand reproductive rights. That’s why it’s such an important decision.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/519992/original/file-20230409-16-dgu48i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A sea of people carrying pro-choice signs." src="https://images.theconversation.com/files/519992/original/file-20230409-16-dgu48i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519992/original/file-20230409-16-dgu48i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519992/original/file-20230409-16-dgu48i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519992/original/file-20230409-16-dgu48i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519992/original/file-20230409-16-dgu48i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519992/original/file-20230409-16-dgu48i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519992/original/file-20230409-16-dgu48i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People march through downtown Atlanta in June 2022 to protest the U.S. Supreme Court’s decision to overturn Roe v. Wade.</span>
<span class="attribution"><span class="source">(AP Photo/Ben Gray, File)</span></span>
</figcaption>
</figure>
<h2>Defending reproductive rights</h2>
<p>On a practical level, funding for contraception has the effect of making birth control available for everyone, with no privilege for those who have private insurance or can afford to pay and no disadvantage for those who have trouble affording it.</p>
<p>But beyond this, public support and payment for contraception serves to normalize birth control, Plan B and sexual health and reproductive rights as a public good and as a matter of public responsibility. </p>
<p>In an age of increased privatization in health care in general, and the increased stigmatization and criminalization surrounding abortion, the B.C. move is a positive step that fully embraces sexual and reproductive health and rights for everyone in post-<em>Roe</em> North America.</p><img src="https://counter.theconversation.com/content/203131/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Candace Johnson receives funding from The Social Sciences and Humanities Research Council of Canada (SSHRC).</span></em></p>British Columbia’s move to provide free contraceptives is a positive step that fully embraces sexual and reproductive health and rights for everyone in post-Roe North America.Candace Johnson, Professor of Political Science, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1954522023-03-13T19:03:47Z2023-03-13T19:03:47ZPeople who experience childhood sexual abuse tell us it affects their entire life – and research backs them up<figure><img src="https://images.theconversation.com/files/514827/original/file-20230312-5282-ak0c82.jpg?ixlib=rb-1.1.0&rect=108%2C190%2C5930%2C3820&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Getty Images</span></span></figcaption></figure><p>When survivors of childhood sexual abuse tell their own stories in court or through government inquiries, they often describe the pervasive personal impact across many aspects of their life. In the words of one survivor, “in every way, it had a negative impact”. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1195502411261136896"}"></div></p>
<p>A long history of <a href="https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2011.300636">research</a> <a href="https://doi.org/10.1016/S1359-1789(96)00027-4">aligns</a> with these personal reflections. It shows survivors are <a href="https://pubmed.ncbi.nlm.nih.gov/31519507/">more likely to have long-term difficulties</a> with their mental and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910944/">physical health in adulthood</a>.</p>
<p>There has been a lot of research on the long-term impacts of childhood sexual abuse, but most of it focuses only on one aspect (usually mental health) and one point in a person’s life. But we know from survivors and their families that the consequences can emerge in many different aspects and at different stages of life. </p>
<p>Based on information drawn from the long-running <a href="https://dunedinstudy.otago.ac.nz/">Dunedin Study</a>, which has followed the lives of around 1,000 people since they were born in the early 1970s, our <a href="https://www.cambridge.org/core/journals/development-and-psychopathology/article/childhood-sexual-abuse-and-pervasive-problems-across-multiple-life-domains-findings-from-a-fivedecade-study/CFF5EDFA57A274075C1680787FCE5B97">research</a> confirms the long-term consequences of childhood sexual abuse and the lifelong challenges survivors might face.</p>
<h2>Understanding the impacts</h2>
<p>To better understand the long-term impacts of childhood sexual abuse, we wanted to investigate survivors’ experiences across a long period of time, from young adulthood to middle age. </p>
<p>We also wanted to find out whether people who had experienced childhood sexual abuse were more likely to have persistent difficulties across adulthood in multiple life domains, including physical health, mental health, sexual health, interpersonal relationships, economic wellbeing and antisocial behaviour.</p>
<p>To answer these questions, we used information collected up to the Dunedin Study’s latest assessment in 2017-18. At this point, study members were 45 years old. Over their lifetimes, they and their parents have contributed a wealth of information, including about their health, wealth and wellbeing, as well as data from government records and results from physical, cognitive and oral health tests.</p>
<p>To find out about experiences of childhood sexual abuse, we asked study members when they were young adults a series of questions about unwanted sexual contact before age 16. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/use-proper-names-for-body-parts-dont-force-hugs-how-to-protect-your-kids-from-in-person-sexual-abuse-139970">Use proper names for body parts, don't force hugs: how to protect your kids from in-person sexual abuse</a>
</strong>
</em>
</p>
<hr>
<p>Around 30% of females and 9% of males reported experiencing unwanted sexual contact of any type before age 16, while 10% of females and 2% of males reported severe forms of childhood sexual abuse. These figures may seem high, but they are not unique to our study. They align with those seen in other <a href="https://pubmed.ncbi.nlm.nih.gov/23623446/">New Zealand population-based research</a> with <a href="https://www.sciencedirect.com/science/article/pii/S0277953620307930">people of the same generation</a>.</p>
<p>By repeatedly measuring outcomes in multiple life domains and across adulthood (at ages 26, 32, 38 and 45), we were able to see whether people who reported experiencing childhood sexual abuse were at increased risk for long-term difficulties. </p>
<h2>Life-long and pervasive consequences</h2>
<p>After adjusting for other major life stressors such as child poverty, other types of abuse and neglect, serious household dysfunction and sexual assault in adulthood, we found survivors were 1.5-2 times more likely than their peers to experience persistent difficulties. This included smoking and alcohol consumption, high systemic inflammation, poor oral health, poor mental health, sexually transmitted diseases, high-conflict relationships, financial difficulties and high levels of antisocial behaviour. </p>
<p>Survivors were also 2.5-4 times more likely to have attempted suicide, with the highest risk among those who experienced more severe abuse.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/to-prevent-child-sexual-abuse-we-need-to-change-our-thinking-and-stop-exploitation-before-it-happens-198394">To prevent child sexual abuse, we need to change our thinking — and stop exploitation before it happens</a>
</strong>
</em>
</p>
<hr>
<p>There are many reasons why people who experience childhood sexual abuse are more likely to go on to have long-term difficulties across many different aspects of their lives. </p>
<p>These reasons range from the long-term impact of chronic stress on the body and brain to interpersonal difficulties arising in part from a learned lack of trust in others. People who experience childhood sexual abuse are also more likely to have had other major early-life challenges, including growing up in very dysfunctional households and in poverty.</p>
<h2>Prevention and healing</h2>
<p>There is no single factor that explains survivors’ increased risk for long-term difficulties. In our study, using the comprehensive information collected over study members’ lifetimes, we were able to look at the long-term consequences of childhood sexual abuse separately from the consequences associated with other major life stressors.</p>
<p>Preventing childhood sexual abuse in the first place is of course the best way forward. </p>
<p>The next best thing is to recognise the cumulative, long-term impact such abuse can have and to invest in early interventions to help survivors as much and as quickly as possible. When thinking about treatment and support for survivors as they get older, our research shows it is important to consider wellbeing broadly, not just mental health.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1421380108317691915"}"></div></p>
<p>It is important to remember a person’s path is not set in stone. On average, the chances of having persistent difficulties across multiple life domains increases with abuse severity, but not all survivors experienced those long-term difficulties. People who get the right treatment and support are the most likely to go on to live their best lives.</p><img src="https://counter.theconversation.com/content/195452/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>About a third of women and 9% of men who participate in the long-running Dunedin Study reported experiencing unwanted sexual contact before age 16. For many, this has a life-long impact.Hayley Guiney, Research Fellow at the Dunedin Multidisciplinary Health and Development Research Unit, University of OtagoRichie Poulton, Director Dunedin Multidisciplinary Health & Development Research Unit (DMHDRU), University of OtagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1883282022-12-14T13:13:45Z2022-12-14T13:13:45ZMpox, AIDS and COVID-19 show the challenges of targeting public health messaging to specific groups without causing stigma<figure><img src="https://images.theconversation.com/files/500108/original/file-20221209-33805-9vw3eu.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C1020%2C708&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fear-based public health messaging can both motivate and alienate at-risk groups.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/AIDSCrisis1987/8d02dadb8af04606bed1a5f9f6100ba1">AP Photo/Gillian Allen</a></span></figcaption></figure><p>During infectious disease outbreaks, clinicians and public health officials are tasked with providing accurate guidance for the public on how to stay safe and protect themselves and their loved ones. However, <a href="https://doi.org/10.3390%2Fijerph19148550">sensationalized media coverage</a> can distort how the public perceives new emerging infections, including where they come from and how they spread. This can foster <a href="https://doi.org/10.1016/j.lanepe.2022.100536">fear and stigma</a>, especially toward communities that are already mistrustful of the health care system.</p>
<p>The racial and sexual <a href="https://doi.org/10.3389/fpsyg.2021.648086">stigma surrounding monkeypox</a> is what spurred the World Health Organization to <a href="https://www.who.int/news/item/28-11-2022-who-recommends-new-name-for-monkeypox-disease">rename the disease to mpox</a> in November 2022. While this is a step in the right direction, I believe more work needs to be done to reduce the stigma surrounding infectious diseases like mpox.</p>
<p>I am an <a href="https://profiles.dom.pitt.edu/faculty_info.aspx/Ho5747">infectious disease researcher</a> who studies HIV, COVID-19 and mpox. During the COVID-19 pandemic, I was the lead investigator at the University of Pittsburgh for a <a href="https://www.coronaviruspreventionnetwork.org/compass-clinical-study">national survey</a> looking at how COVID-19 has affected different communities. Effective public health communication isn’t easy when conflicting messages may come from many sources, including family and friends, other community members or the internet. But there are ways that public health officials can make their own messaging more inclusive while mitigating stigma.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500110/original/file-20221209-41828-ft8xxk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Posters promoting condom use reading " src="https://images.theconversation.com/files/500110/original/file-20221209-41828-ft8xxk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500110/original/file-20221209-41828-ft8xxk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500110/original/file-20221209-41828-ft8xxk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500110/original/file-20221209-41828-ft8xxk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500110/original/file-20221209-41828-ft8xxk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500110/original/file-20221209-41828-ft8xxk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500110/original/file-20221209-41828-ft8xxk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Tailoring public health messages to target groups could improve their reach.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/posters-that-promote-healthy-sexual-behavior-hang-inside-news-photo/160899714">Chip Somodevilla/Getty Images</a></span>
</figcaption>
</figure>
<h2>Creating an inclusive message</h2>
<p>Inclusive public health messaging can motivate the public to make better decisions regarding their personal health and the health of others. This effort often involves engaging the communities most affected by an outbreak. Unfortunately, because these communities are heavily affected by the infection and tend to <a href="https://www.ama-assn.org/delivering-care/health-equity/impact-covid-19-minoritized-and-marginalized-communities">experience some form of inequity</a>, they are often blamed by society for spreading the disease.</p>
<p>COVID-19 drove an increase in hate crimes related to the pandemic against <a href="https://doi.org/10.1007/s12103-020-09545-1">Chinese and other Asian communities</a> in the United States. A <a href="https://healthpolicy.ucla.edu/newsroom/press-releases/pages/details.aspx">2022 UCLA survey</a> found that 8% of Asian American and Pacific Islander adults in California experienced a COVID-19 related hate incident.</p>
<p>Effective public health messaging can focus on the fact that while infections may first affect certain groups of people, they often <a href="https://doi.org/10.1098/rstb.2014.0111">spread to other groups</a> and eventually encompass entire communities. Infections are caused by bacteria, viruses and fungi. They don’t discriminate by race, gender or sexual orientation. Messages that focus on the pathogens, rather than the communities, may reduce stigma.</p>
<p><a href="https://www.cdc.gov/poxvirus/monkeypox/resources/reducing-stigma.html">Visually inclusive messages</a> are also likely to engage a greater portion of the community. Examples include making sure that the people represented in posters and flyers, images on TV and websites, and other informational material are from diverse backgrounds. This sends a more unified message that what affects an individual also affects the larger community.</p>
<h2>Avoiding blame and fear</h2>
<p>Many media outlets, especially on social media, use <a href="https://theconversation.com/does-scaring-people-work-when-it-comes-to-health-messaging-a-communication-researcher-explains-how-its-gone-wrong-during-the-covid-19-pandemic-174287">fear-based messaging</a> to report on infectious diseases. While this may reinforce certain protective behaviors, such as using condoms during sex, it may also increase stress and anxiety. Fear-based messages also <a href="http://dx.doi.org/10.1136/bmjgh-2019-001911">worsen stigma</a>, leading to increased discrimination against communities that are already vulnerable and mistrustful of health care. Ultimately, this leads people to avoid seeking health care and can worsen health outcomes.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/TRGZcNMR24o?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Normalizing sexual health could help reduce stigma around sexually transmitted infections.</span></figcaption>
</figure>
<p>Public health officials have often used fear-based messaging in response to sexually transmitted infections, or STIs, like <a href="https://doi.org/10.1016%2FS2352-3018(21)00078-3">HIV</a>, <a href="http://dx.doi.org/10.1080/01292986.2017.1384030">chlamydia</a> and <a href="https://doi.org/10.1080/01292980600857831">gonorrhea</a>. Sex itself is <a href="https://magazine.jhsph.edu/2022/stigmas-toll-sexual-and-reproductive-health">highly stigmatized</a> by society. I have found that some of my patients would prefer to avoid getting tested and treated for an STI rather than deal with the <a href="https://www.verywellhealth.com/the-stigma-stds-have-in-society-3133101">shame of having an STI</a>.</p>
<p>Making sexual health and STI testing <a href="https://doi.org/10.1016/j.eclinm.2021.100764">routine and integral</a> parts of overall wellness and health is an important step to reduce the stigma around them. Similarly, messaging that normalizes the challenges faced by people at risk for certain infections could help avoid causing shame.</p>
<h2>Tailoring the message</h2>
<p>Infections affect different people differently. <a href="https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html">COVID-19</a> might be a mildly stuffy nose for one person, and it could be months in an intensive care unit hooked up to a ventilator for another. Messages that <a href="https://www.hsph.harvard.edu/ecpe/the-importance-of-getting-the-message-right-in-your-risk-communication-strategy/">focus on the successes</a> of medical and public health interventions that resonate with communities are most likely to be successful.</p>
<p>Different groups have different exposure risks as well. Mpox heavily affected gay and bisexual men in 2022. One reason why was related to how the virus is transmitted. <a href="https://www.cdc.gov/poxvirus/monkeypox/if-sick/transmission.html#">Prior research</a> suggested that mpox was largely transmitted by close skin-to-skin contact, but <a href="https://www.nbcnews.com/nbc-out/out-health-and-wellness/sex-men-not-skin-contact-fueling-monkeypox-new-research-suggests-rcna43484">emerging studies</a> raised the question of whether the 2022 outbreaks were being driven more by sexual transmission.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500109/original/file-20221209-40125-yviwsg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person passing poster with health information on mpox" src="https://images.theconversation.com/files/500109/original/file-20221209-40125-yviwsg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500109/original/file-20221209-40125-yviwsg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=394&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500109/original/file-20221209-40125-yviwsg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=394&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500109/original/file-20221209-40125-yviwsg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=394&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500109/original/file-20221209-40125-yviwsg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=495&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500109/original/file-20221209-40125-yviwsg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=495&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500109/original/file-20221209-40125-yviwsg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=495&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The 2022 mpox outbreaks predominantly affected gay and bisexual men.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/poster-on-commercial-street-in-provincetown-ma-on-the-issue-news-photo/1242177865">Jonathan Wiggs/The Boston Globe via Getty Images</a></span>
</figcaption>
</figure>
<p>There was <a href="https://www.npr.org/2022/07/26/1113713684/monkeypox-stigma-gay-community">controversy</a> as to whether public health messaging should highlight sexual encounters as a potential transmission route. This can risk further stigmatizing gay and bisexual men versus potentially overlooking these key at-risk populations. <a href="https://www.scientificamerican.com/article/monkeypox-is-a-sexually-transmitted-infection-and-knowing-that-can-help-protect-people">Some advocates argued</a> that promoting the message that mpox was primarily transmitted by close contact would prevent resources and interventions from reaching the groups of people most affected by the disease.</p>
<p>One size does not always fit all when it comes to public health messaging. Multiple messages may be necessary for different groups of people based on their risk of infection or severe disease. An August 2022 Centers for Disease Control and Infection survey found that <a href="http://dx.doi.org/10.15585/mmwr.mm7135e1">50% of gay and bisexual men</a> reduced their sexual encounters in response to the mpox outbreak. Since late summer, <a href="https://www.npr.org/sections/health-shots/2022/08/26/1119659681/early-signs-suggest-monkeypox-may-be-slowing-in-the-u-s">mpox rates have been dropping</a> rapidly, and many experts think that both behavior change and vaccination may have contributed to the falling rates. Studies like these further support the importance of directly engaging with communities to encourage healthy behavior change.</p>
<h2>Trusted messengers</h2>
<p>Mistrust is also a barrier to effective messaging. Some communities may be mistrustful of medical and health care systems because of prior histories of exploitation, such as the <a href="https://www.mcgill.ca/oss/article/history/40-years-human-experimentation-america-tuskegee-study">Tuskegee study</a>, where researchers prevented Black participants from receiving syphilis treatment for decades in the mid-20th century, and ongoing fear of mistreatment.</p>
<p>Identifying trusted community champions and health care providers – especially ones who belong to that community – to deliver a public health message may increase its acceptance. One <a href="https://doi.org/10.1257/aer.20181446">2019 study</a>, for example, found that Black men were more likely to accept vaccines, medical advice and engage in health care services if they had a Black health care provider.</p>
<p>Effectively delivering public health messaging is a complicated and challenging process. But talking to and listening to the communities most affected by an outbreak can make a difference.</p><img src="https://counter.theconversation.com/content/188328/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ken Ho does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Prejudice and stigma can discourage the communities most affected by infectious diseases from seeking care. Inclusive public health messaging can prevent misinformation and guide the most vulnerable.Ken Ho, Assistant Professor of Infectious Diseases, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1953052022-11-28T11:55:03Z2022-11-28T11:55:03ZHIV prevention: new injection could boost the fight, but some hurdles remain<figure><img src="https://images.theconversation.com/files/497219/original/file-20221124-7159-uy40xe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>While the world has focused on the COVID pandemic for nearly three years, less and less attention is being paid to HIV. However, HIV is still a global problem. In 2021, according to the United Nations, <a href="https://www.unaids.org/en/resources/documents/2022/UNAIDS_FactSheet">38.4 million</a> people were living with HIV, over 650,000 died from AIDS-related illnesses, and 1.5 million became newly infected. </p>
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<p>Nearly 70% of infections occur in key groups: sex workers and their clients, men who have sex with men, people who inject drugs, and transgender people and their sexual partners. Adolescent girls and young women in sub-Saharan Africa are another important group, with nearly 5,000 getting HIV every week. </p>
<p>For many years, options for HIV prevention were quite limited. Early campaigns consisted of the ABCs – abstinence, being faithful, and condoms. In the early 2000s, male circumcision was added, but multiple attempts at developing a vaccine have been disappointing. </p>
<p>In 2012, however, much excitement surrounded the introduction of HIV pre-exposure prophylaxis, or PrEP. The initial form of PrEP was a combination oral pill consisting of two medications used to treat HIV – emtricitabine and tenofovir. When taken regularly, <a href="https://pubmed.ncbi.nlm.nih.gov/35545381/">PrEP is highly effective</a> in preventing HIV infection and very safe. PrEP was seen as a game-changer by enabling people to take charge of their sexual health, particularly for those who could not necessarily control when or how they had sex.</p>
<p>Oral <a href="https://pubmed.ncbi.nlm.nih.gov/35545381/">PrEP has worked well</a> for many, particularly for men who have sex with men in high income settings and for serodifferent couples (couples in which one person has HIV and the other does not). </p>
<p>For others – like young people – it’s hard to take a pill consistently during periods of risk for getting HIV. The interest is there, but lots of <a href="https://pubmed.ncbi.nlm.nih.gov/35147580/">things get in the way</a>. Some relate to the person, like forgetfulness, transport to a clinic, and alternative priorities. Other factors relate to stigma and lack of support. </p>
<p>PrEP administered via a <a href="https://www.nejm.org/doi/full/10.1056/nejmoa1506110">vaginal ring</a> is another safe option that’s been developed. It’s not yet clear how many people will want to use it as it becomes more widely available.</p>
<p>Access to PrEP has <a href="https://www.prepwatch.org/resources/global-prep-tracker/">been slow</a> and mostly limited to high income countries. Some countries, like Kenya, Uganda, South Africa, Zambia, and Nigeria, have been more proactive than others, but it is still hard for many to get PrEP.</p>
<p>Now that injectable PrEP is an option, it’s poised to make a huge difference in HIV prevention – as long as some key issues can be overcome.</p>
<h2>Benefits of injectable PrEP</h2>
<p>The latest version of PrEP is an injection of another HIV drug – cabotegravir (called CAB-LA for cabotegravir-long acting). It is given in the buttocks and lasts for two months. It is even more effective than <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00538-4/fulltext">oral PrEP and it’s safe</a>. </p>
<p>Another injectable drug – lenacapavir – would only need to be given once every six months, and would be easier to inject because it only needs to go into the skin; but it is still in clinical trials.</p>
<p>In many ways, injectable PrEP seems like a perfect solution. It’s discreet, there’s no burden of frequent pill taking, and it can be combined with other services and injections, like contraception for women. People in the CAB-LA trials in many parts of the world, including sub-Saharan Africa, South America, and the US, really liked it. Although some public health officials and healthcare workers have worried about the pain and any swelling due to the injection itself, most people do very well. </p>
<h2>Drawbacks of injectable PrEP</h2>
<p>Several issues, however, may get in the way of injectable PrEP revolutionising HIV prevention. </p>
<p>First, most people <a href="https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(22)00167-9/fulltext">can’t get it</a>. The United States was the first country to approve CAB-LA in December 2021. The next was Zimbabwe in October 2022. The necessary paperwork is being processed in other countries in sub-Saharan Africa, but regulatory processes are slow and access is likely be to a challenge for some time.</p>
<p>Second, it’s expensive. CAB-LA is priced at over <a href="https://www.nytimes.com/2022/09/27/health/injectable-prep-hiv-africa.html">$22,000 per person per year</a> in the US. It could be covered to some extent by health insurance companies, but not everyone has health insurance. The drug manufacturer will lower the price for the markets in low- and middle-income countries, but the exact cost is not yet known. Some estimates are around $250 per person per year. That’s still about five times as much as oral PrEP costs. The increased effectiveness may be worth it for people at high risk of getting HIV, but getting it to those people will be challenging for ministries of health.</p>
<p>Third, logistical issues complicate delivery of injectable PrEP, including the need for refrigerators to store the drug and nurses to give the injections. Clinics may not be set up to provide many injections in a given day, and limited availability may mean people can’t get the shots when they need them.</p>
<p>Finally, continuing to get injections over time is still likely to be a problem. The experience with injectable contraception has taught us that up to half of people who select that form of family planning <a href="https://pubmed.ncbi.nlm.nih.gov/32389457/">stop it within a year</a>. Injectable PrEP does not solve the other barriers people face, like transport to clinic and prioritisation of HIV prevention.</p>
<p>The lack of access raises important ethical concerns. Most of the thousands of people in the CAB-LA trials live in countries without access to it, including Botswana, Eswatini, Kenya, Malawi, South Africa, Uganda, and Zimbabwe among others. Processes to enable access are unacceptably slow, although the drug is available in the US (and just recently Zimbabwe). </p>
<h2>Where to go from here?</h2>
<p>Despite these challenges, injectable PrEP is a huge advantage for the HIV prevention toolbox. Choice is critical for most interventions to work, and HIV prevention is no different. <a href="https://pubmed.ncbi.nlm.nih.gov/35030296/">PrEP use increases</a> when people are given effective options and can choose what works best for them. </p>
<p>PrEP needs to be easier for people to take, for instance by making it more convenient and less medical. Programmes are starting to do this through community delivery. That approach may be more challenging with injections, but it may get easier with time and with injections in the skin, like lenacapavir.</p>
<p>Advocacy will be critical for expediting the regulatory process and negotiating with pharmaceutical companies to license other companies to produce more affordable generics.</p><img src="https://counter.theconversation.com/content/195305/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jessica Haberer has been a consultant for Merck and the US Centers for Disease Control and Prevention. She has been an investigator in studies with drug donation from Gilead and Viiv. She has received grant funding from the US National Institutes of Health, USAID, and the Bill and Melinda Gates Foundation. </span></em></p>Some countries, like Kenya, Uganda, South Africa, Zambia, and Nigeria, have been more proactive than others, but it is still hard for many to get PrEP.Jessica Haberer, Director of Research, Massachusetts General Hospital Center for Global Health and Professor of Medicine, Harvard Medical School, Harvard UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1928592022-10-24T19:02:41Z2022-10-24T19:02:41ZThe foot scene in House of the Dragon was upsetting, but it’s nothing compared to the real history of the fetish<figure><img src="https://images.theconversation.com/files/491260/original/file-20221024-21-qlcwmm.jpg?ixlib=rb-1.1.0&rect=40%2C0%2C1237%2C718&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Unsplash/HBO</span></span></figcaption></figure><p>From the day it first graced our screens, the Game of Thrones franchise became infamous for depicting rather shocking and taboo sexual proclivities. From incest and necrophilia, to sadism and borderline-cannibalism, viewers have truly been exposed to (an often disturbing) range of erotic desires. Yet, even after a decade on our screens, the lasciviousness of the Seven Kingdoms still holds the power to shock us. </p>
<p>The most recent episode of House of the Dragon, the prequel set 200 years before the main events of Game of Thrones, depicted a fetish which caused <a href="https://www.elle.com/culture/movies-tv/a41651192/house-of-the-dragon-foot-scene-larys-alicent/">some fans</a> to declare the show-runners had finally gone “too far.” </p>
<p>In exchange for information which may secure her son’s reign, Queen Alicent must appease the sexual appetite of Lord Larys Strong – by removing her socks and shoes, displaying her bare, naked feet for him to strenuously admire. </p>
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<h2>Feet throughout history</h2>
<p>Foot fetishes are no new feat. In fact, we find evidence of this desire throughout the ancient world. </p>
<p>At least three of the love letters of the great philosopher Philostratus evidence a particular interest in feet. In <a href="https://www.loebclassics.com/view/philostratus_elder-letters/1949/pb_LCL383.451.xml">To A Barefoot Boy</a>, Philostratus worships the shape of his lover’s feet and implores them to always walk barefoot so he may kiss the footprints left behind: </p>
<blockquote>
<p>O perfect lines of feet most dearly loved! O flowers new and strange! O plants sprung from earth! O kiss left lying on the ground! </p>
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<p>Things take a turn for the slightly kinkier once we get to his 37th letter. Philostratus describes the feet of a woman even better than those of Aphrodite (who, according to Hesiod’s origin story, had feet so perfect the grass grew beneath them) and wishes he could be dominated by these feet:</p>
<blockquote>
<p>O thrice charmed would I be and blessed, if you [feet] would tread on me. </p>
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<h2>Starting on the right foot</h2>
<p>Worship of feet wasn’t solely linked to the bedroom. It sometimes played quite a prominent role in public life. </p>
<p>The emergence of foot-washing as a custom is a prime example of this, intimately tied to displays of reverence and love. During his reign as Pope in the 9th century, Eugene II began the custom of kissing the feet of the Pope, which still continues today. </p>
<p>In the century following this, the torturous practice of foot-binding was brought to life in 10th century China during the reign of Emperor Li Yu. He was said to have been entranced by a court dancer, Yao Niang, who bound her feet into the shape of a moon, and danced on her toes inside a six-foot golden lotus. </p>
<p>This obsession was linked to sexual desire from the very beginning. It was quickly taken up as a fashion by ladies of the court, and became a symbol of high status feminine refinement. The last shoe factory only ceased to make “lotus” shoes in 1999.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/491234/original/file-20221024-13-r9fw6s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/491234/original/file-20221024-13-r9fw6s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/491234/original/file-20221024-13-r9fw6s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=871&fit=crop&dpr=1 600w, https://images.theconversation.com/files/491234/original/file-20221024-13-r9fw6s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=871&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/491234/original/file-20221024-13-r9fw6s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=871&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/491234/original/file-20221024-13-r9fw6s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1095&fit=crop&dpr=1 754w, https://images.theconversation.com/files/491234/original/file-20221024-13-r9fw6s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1095&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/491234/original/file-20221024-13-r9fw6s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1095&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">18th century illustration showing Yao Niang binding her own feet.</span>
<span class="attribution"><span class="source">Wikimedia Commons</span></span>
</figcaption>
</figure>
<p>By the 13th century, troubadour poets began singing praise of the beautiful feminine foot, desiring arches that were high, and toes that were slender and long. One group of researchers have suggested feet surged in erotic interest during this time as a result of the 13th century gonorrhoea epidemic. Their <a href="https://journals.sagepub.com/doi/10.2466/pr0.1998.83.2.491">1998 study</a> found erotic literature about feet rises exponentially during major sexually transmitted epidemics in history. </p>
<p>For instance, during the syphilis epidemic of the 16th century, a movement in popular fashion began to draw eroticised attention to women’s feet. The term “toe-cleavage” became used to describe shoes which displayed the base of the first two toes. Similarly, by the 19th century epidemic, brothels began to specialise in foot-eroticisation.</p>
<p>When genital-contact proves to dangerous, feet are (historically) the next most-likely body part to be eroticised. </p>
<h2>Tickling your fancy</h2>
<p>F. Scott Fitzgerald (or, Feet-zgerld, if you will) is believed to have been one patron of this new specialisation. Fitzgerald repeatedly visited one sex-worker because of her feet, and was even described by her as a “foot fetishist”. </p>
<p>While he loved feet (at least the feet of this particular woman), he detested his own and refused to let anyone see them naked. He admitted he was plagued by a “Freudian shame about his feet”. </p>
<p>Sigmund Freud, of course, had a very insightful take on foot fetishes. As with all things Freud, it all had to do with the penis – lusting after feet was so common because the feet and toes resemble the shape of the penis. (I honestly believe it would be harder to find a part of the body that Freud does not think looks like the penis.)</p>
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<a href="https://images.theconversation.com/files/491235/original/file-20221024-18-w6xqi7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/491235/original/file-20221024-18-w6xqi7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/491235/original/file-20221024-18-w6xqi7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=742&fit=crop&dpr=1 600w, https://images.theconversation.com/files/491235/original/file-20221024-18-w6xqi7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=742&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/491235/original/file-20221024-18-w6xqi7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=742&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/491235/original/file-20221024-18-w6xqi7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=933&fit=crop&dpr=1 754w, https://images.theconversation.com/files/491235/original/file-20221024-18-w6xqi7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=933&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/491235/original/file-20221024-18-w6xqi7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=933&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">F. Scott Fitzgerald, potentially looking at a pair of beautiful feet.</span>
<span class="attribution"><span class="source">Wikimedia Commons</span></span>
</figcaption>
</figure>
<p>It wasn’t until the 1980s, however, that the connection between foot fetishes and the contemporary epidemic was explicitly recognised. As foot-pornography emerged in magazines, some editorials advertised “foot-sex” could be regarded as a pleasurable, safe alternative to penetrative sex, which ran the risk of sexually transmitted diseases. </p>
<p>After completing their review of historical literature, the researchers of the 1998 study went on to review issues from eight of the largest pornographic magazines in the United States, released between 1965 to 1994. </p>
<p>Their <a href="https://journals.sagepub.com/doi/10.2466/pr0.1998.83.2.491">investigation</a> proved the number of foot-orientated pictures in pornographic magazines rose exponentially over the course of the AIDS epidemic. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/madness-miscarriages-and-incest-as-in-house-of-the-dragon-real-life-royal-families-have-seen-it-all-throughout-history-189225">Madness, miscarriages and incest: as in House of the Dragon, real-life royal families have seen it all throughout history</a>
</strong>
</em>
</p>
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<h2>If you’re thinking of getting into this fetish, don’t get cold feet</h2>
<p>If this is true, it may explain why queer men are most likely to have fantasised about feet. According to <a href="https://www.menshealth.com/sex-women/a19523651/foot-fetish/">data collected</a> by social psychologist Justin Lehmiller, one in seven people today have had a sexual fantasy in which feet or toes played a prominent role. </p>
<p>The fantasy was most common amongst gay and bisexual men (21%), followed by heterosexual men (18%), lesbian and bisexual women (15%), and finally heterosexual women (5%). </p>
<p>With such a prevalent amount of the population having fantasised about feet, it is perhaps surprising the representation of this fetish-interest in The House of the Dragon was met with such shock. </p>
<p>Despite its pervasiveness, both today and throughout history, this erotic desire has rarely found itself feet-ured by many historical accounts. The decision for show is perhaps radical for this reason – a decision which may well have left one in every seventh viewer very happy.</p><img src="https://counter.theconversation.com/content/192859/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Esmé Louise James does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>From Popes and philosophers to writers and emperors, the foot fetish has a long and storied history in our world.Esmé Louise James, Doctor of Philosophy, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1886282022-08-16T20:39:37Z2022-08-16T20:39:37ZTreating monkeypox like an STI may help control the outbreak, but stigma is a danger<figure><img src="https://images.theconversation.com/files/479474/original/file-20220816-9810-ms19br.jpg?ixlib=rb-1.1.0&rect=0%2C77%2C1789%2C1319&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Monkeypox is transmitted mainly through direct contact with skin lesions, but the current outbreak is following patterns similar to STIs.</span> <span class="attribution"><span class="source">(NIAID, cropped from original)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>The recent monkeypox global outbreak, now declared by the World Health Organization as a <a href="https://www.who.int/europe/news/item/23-07-2022-who-director-general-declares-the-ongoing-monkeypox-outbreak-a-public-health-event-of-international-concern">Public Health Emergency of International Concern</a> (PHEIC), is sadly yet another reason for society to stigmatize and discriminate against the LGTBQ2SA+ community. This is in part because it has been suggested that monkeypox is a sexually transmitted infection (STI).</p>
<p><a href="https://www.who.int/news-room/fact-sheets/detail/monkeypox">Monkeypox started as a zoonosis</a> (an infection transmitted by contact with animals). However, this close relative of the variola virus (which causes smallpox) can also be transmitted from human to human, mainly through direct contact with the skin lesions. </p>
<p>Although transmission through semen and vaginal secretions has yet to be proven, it can be transmitted during sexual intercourse because of the obvious close contact it entails. </p>
<p>Cases have been identified for decades mainly in West African countries, but it was only recently when cases appeared in Europe and America that it caught the international attention it deserved. Cases continue to rise in many countries, to the point of prompting the WHO to declare it a PHEIC. </p>
<p><a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2207323">One excellent study</a> put together a series of 500 patients distributed across 16 countries. The researchers analyzed patients’ demographics as well as their clinical characteristics. They found that 98 per cent of the cases were men who prefer to have sex with men (MSM). Of note, 41 per cent of the cases were people living with HIV (PLWH). </p>
<h2>Characteristics of lesions</h2>
<p>Another finding was the characteristics of the lesions. Monkeypox used to present with skin lesions mainly on the face, trunk, arms and legs, but most of the reported cases during this global outbreak have had a different presentation. Many cases have lesions in the perineal region (73 per cent) or genitals or even around the mouth. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/479465/original/file-20220816-10908-w9vs5d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man in a black T-shirt is pointing at a large screen showing a series of images of skin lesions." src="https://images.theconversation.com/files/479465/original/file-20220816-10908-w9vs5d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/479465/original/file-20220816-10908-w9vs5d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/479465/original/file-20220816-10908-w9vs5d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/479465/original/file-20220816-10908-w9vs5d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/479465/original/file-20220816-10908-w9vs5d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/479465/original/file-20220816-10908-w9vs5d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/479465/original/file-20220816-10908-w9vs5d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An epidemiologist conducts monkeypox disease training to health investigators at the Salt Lake County Health Department on July 29, 2022, in Salt Lake City.</span>
<span class="attribution"><span class="source">(AP Photo/Rick Bowmer)</span></span>
</figcaption>
</figure>
<p>This could be consistent with sexual transmission as the lesions are presenting at the site of infection, a clinical course also described in <a href="https://doi.org/10.1016/S0140-6736(22)01436-2">this paper from Spain</a>. Additionally, 30 per cent of the patients also have another more common STI such as gonorrhea or syphilis, a pattern frequently found in many STIs. Managing a patient with an STI always implies ruling out other STIs. </p>
<p>Grouping diseases by their mode of transmission is helpful for doctors because it allows us to make mental lists of probable causes when confronted with a case. We call this differential diagnosis. </p>
<p>When a patient presents with a genital lesion, a health-care provider will establish a list of possible diagnoses based on the characteristics of the lesion, the accompanying symptoms and the local epidemiology. This makes it possible to treat empirically (before we can confirm the diagnosis) for the most probable cause. </p>
<h2>What is an STI?</h2>
<p>Any disease passed from one person to another through bodily fluids during a sexual encounter is <a href="https://www.who.int/health-topics/sexually-transmitted-infections#tab=tab_1">considered an STI</a>. However there are diseases that occur more frequently than others and as such are grouped in this category, such as chlamydia and gonorrhea. </p>
<p>Other diseases may be transmitted through genital secretions but are not considered an STI by the medical community. For example, Ebola has been shown to be <a href="https://doi.org/10.1371/journal.pmed.1003273">transmitted through genital secretions</a>, however it is not considered within the group of the more frequent STIs because it is not its main mode of transmission. </p>
<figure class="align-center ">
<img alt="A man in a plaid shirt getting an injection from a woman in a blue dress and face mask, both sitting in folding chairs, seen from behind" src="https://images.theconversation.com/files/479471/original/file-20220816-22-9qskhm.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/479471/original/file-20220816-22-9qskhm.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=432&fit=crop&dpr=1 600w, https://images.theconversation.com/files/479471/original/file-20220816-22-9qskhm.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=432&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/479471/original/file-20220816-22-9qskhm.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=432&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/479471/original/file-20220816-22-9qskhm.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=543&fit=crop&dpr=1 754w, https://images.theconversation.com/files/479471/original/file-20220816-22-9qskhm.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=543&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/479471/original/file-20220816-22-9qskhm.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=543&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A man receives a monkeypox vaccine at an outdoor walk-in clinic in Montréal in July 2022.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span>
</figcaption>
</figure>
<p>The mode of presentation of monkeypox during this global outbreak has <a href="https://doi.org/10.1016/S0140-6736(22)01497-0">prompted the medical community</a> to consider monkeypox diagnosis, along with other STIs, in any person who has had a recent unprotected sexual contact, and presents with a painful skin lesion in the genitals, perianal region or mouth.</p>
<p>Considering monkeypox as an STI seems logical in order to face the current outbreak, but the <a href="https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2018-44/issue-2-february-1-2018/article-5-stigma-sexually-transmitted-infections.html">stigma and discrimination</a> this could cause is a major problem. An infection acquired through sex is still something that causes guilt and fear of rejection by society. STIs are still viewed by many as a <a href="https://slate.com/technology/2019/12/genital-herpes-stigma-history-explained.html">punishment for certain behaviours</a>. </p>
<p>Additionally, classifying monkeypox as an STI may create a false sense of security for people who may think they’re not at risk. Both stigma and a low perception of risk can hinder efforts for early identification of cases, rapid isolation and limitation of the outbreak. Worst of all, stigma related to this outbreak would perpetuate harms to the LGTBQ2SA+ community.</p>
<p>Monkeypox is behaving like an STI during this global outbreak, so including this diagnosis as part of sexual health management may be beneficial to stop transmission. However, bigger efforts addressing stigma and discrimination are necessary.</p><img src="https://counter.theconversation.com/content/188628/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Santiago Perez Patrigeon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Monkeypox is not considered an STI but is spreading among sexual partners. Adding sexual health strategies to the public health response is helpful, but there is a danger of stigmatizing MPXV.Santiago Perez Patrigeon, Assistant professor, Division of Infectious Diseases, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1856492022-07-03T13:24:38Z2022-07-03T13:24:38Z1 in 4 people experience pain during sex, but research excludes the needs of the LGBTQ+ community<figure><img src="https://images.theconversation.com/files/471954/original/file-20220630-12-4rrjfp.jpeg?ixlib=rb-1.1.0&rect=12%2C186%2C4122%2C3101&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research on pain during sex often excludes LGBTQ+ people, which limits ideas about the bodies and identities of people who have this type of pain to the experiences of cisgender individuals. </span> <span class="attribution"><span class="source">(Pexels/Lisett Kruusim)</span></span></figcaption></figure><p>Chronic genitopelvic pain, defined as pain in the genital and/or pelvic region lasting three months or more, <a href="https://doi.org/10.1016/j.jsxm.2015.12.034">affects up to 27 per cent of people</a> and has a <a href="https://doi.org/10.1016/j.jsxm.2015.12.021">significant impact on their psychological health, relationship adjustment and overall well-being</a>. </p>
<p>In most research on chronic genitopelvic pain, the people in the studies represent sexual and gender majorities: people who identify as heterosexual and cisgender, the latter meaning that their gender identity is aligned with their sex assigned at birth. Most of these studies focus on a common symptom of chronic genitopelvic pain: <a href="https://doi.org/10.1080/0092623X.2014.931315">pain experienced during “sex,” defined as penile-vaginal intercourse</a>.</p>
<p>This point of view neglects the experiences of sexual and gender minorities (those who identify as lesbian, gay, bisexual, queer, trans, two-spirit, etc.). It limits the potential experience of pain during penetrative sexual activity to those engaging in a narrowly defined heterocentric idea of sex: penile-vaginal intercourse. That limits ideas about the bodies and identities of people who can experience this type of pain to the experiences of cisgender individuals.</p>
<h2>Broadening the definition of sex</h2>
<p>Definitions of sex can be broadened to include any activity that engages someone in a sexual way; even “just” fantasizing can be “sex” for some. Those definitions can incorporate responses during sexual activity, like arousal or orgasm. </p>
<figure class="align-right ">
<img alt="A person who presents as male lying with one hand behind his head, looking off to the side, and another person asleep with his head on his chest." src="https://images.theconversation.com/files/471922/original/file-20220630-20-ll7l24.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/471922/original/file-20220630-20-ll7l24.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=750&fit=crop&dpr=1 600w, https://images.theconversation.com/files/471922/original/file-20220630-20-ll7l24.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=750&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/471922/original/file-20220630-20-ll7l24.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=750&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/471922/original/file-20220630-20-ll7l24.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=943&fit=crop&dpr=1 754w, https://images.theconversation.com/files/471922/original/file-20220630-20-ll7l24.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=943&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/471922/original/file-20220630-20-ll7l24.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=943&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Expanding the definition of sex removes the framework of heterocentricity.</span>
<span class="attribution"><span class="source">(Unsplash/Ha Nguy)</span></span>
</figcaption>
</figure>
<p>Expanding the definition of sex removes the framework of heterocentricity. Sex then takes on a different meaning — one that can apply to a variety of activities, responses, identities, bodies and contexts (solitary or partnered, for example). </p>
<p>Then, pain during sex (in the expanded definition) can theoretically affect anyone who engages sexually.</p>
<p>According to a <a href="https://www.newswire.ca/news-releases/according-to-lgbt-realities-the-first-pancanadian-survey-on-lgbt-communities-conducted-by-crop-for-the-benefit-of-the-fondation-jasmin-roy-13-of-the-canadian-population-belongs-to-the-lgbt-community-639432223.html">survey, 13 per cent</a> of the Canadian population — which amounts to approximately five million people — identifies as part of a sexual or gender minority. It’s reasonable to assume that some of them also experience chronic genitopelvic pain.</p>
<p>My research indicates that <a href="https://doi.org/10.1080/0092623X.2014.931315">up to 45 per cent of sexual minority women report experiencing pain during sex</a>. In this study, my team and I examined the characteristics and experiences of chronic genitopelvic pain in a sample of more than 800 lesbian, bisexual and heterosexual women. We found that experiences and characteristics of pain were similar among sexual minority and majority groups. </p>
<p>In another study, my team and I reported on the under-investigated phenomenon of <a href="https://doi.org/10.1016/j.jsxm.2017.04.356">pain during receptive anal penetration</a>. Pain during receptive anal penetration has been reported primarily in men who have sex with men, but <a href="https://doi.org/10.1080/0092623X.2011.607039">it can affect anyone who engages in this activity</a>. Although mild in most, <a href="https://doi.org/10.1080/00926239808403963">the pain can be long-standing and severe</a>.</p>
<figure class="align-center ">
<img alt="A genderqueer person sitting in a hospital gown sitting in an exam room" src="https://images.theconversation.com/files/471918/original/file-20220630-23-vsuxkb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/471918/original/file-20220630-23-vsuxkb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/471918/original/file-20220630-23-vsuxkb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/471918/original/file-20220630-23-vsuxkb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/471918/original/file-20220630-23-vsuxkb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/471918/original/file-20220630-23-vsuxkb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/471918/original/file-20220630-23-vsuxkb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Assuming that pain during sex affects only those who engage in penile-vaginal sex can make it more difficult to have honest conversations with health-care providers.</span>
<span class="attribution"><span class="source">(The Gender Spectrum Collection)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Reports of <a href="http://dx.doi.org/10.1007/s00266-017-1003-z">prolonged genitopelvic pain following gender-affirming bottom (genital) surgery</a> in trans individuals have also been documented, as well as <a href="https://prevention.ucsf.edu/sites/prevention.ucsf.edu/files/inline-files/2013-0514_Web_Trans-Men-and-Sexual-Health_ENG.pdf">painful orgasms in trans men on testosterone</a>, which is part of their lifetime regimen of hormones. However, very little research attention has been devoted to chronic genitopelvic pain in trans individuals. </p>
<p>Assumptions can have negative consequences for people in real life. If it is assumed that chronic genitopelvic pain conditions associated with pain during sex affect those only who engage in penile-vaginal sex, it can <a href="https://doi.org/10.1080/13691058.2019.1643499">make it more difficult</a> to have honest conversations with health-care providers.</p>
<p>This is a significant issue in health care beyond chronic genitopelvic pain. For example, women have been excluded from HIV research based on assumptions — for example, that it is not common in women — rather than fact: research has shown that <a href="http://doi.org/10.1097/QAI.0000000000000842">women represent about half the HIV cases</a>. Assumptions do not always correspond with scientific facts.</p>
<h2>Inclusive research</h2>
<p>My team and I are currently working on a <a href="https://webapps.cihr-irsc.gc.ca/funding/detail_e?pResearchId=9777282&p_version=CIHR&p_language=E&p_session_id=3805300">research program</a> investigating chronic genitopelvic pain characteristics and experiences in sexual and gender minorities. It uses broad definitions of sex, and a “choose your own adventure”-type survey that examines experiences over time. This enables individuals — based on their responses — to answer questions tailored to their experiences and preferences.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/471908/original/file-20220630-14-vgv94z.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A person in red shorts and a black tank top and a person in a yellow dress kissing, with a crowd in the background" src="https://images.theconversation.com/files/471908/original/file-20220630-14-vgv94z.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/471908/original/file-20220630-14-vgv94z.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/471908/original/file-20220630-14-vgv94z.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/471908/original/file-20220630-14-vgv94z.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/471908/original/file-20220630-14-vgv94z.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/471908/original/file-20220630-14-vgv94z.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/471908/original/file-20220630-14-vgv94z.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Two people kiss as they walk in the Pride parade in Toronto on June 26, 2022.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Eduardo Lima</span></span>
</figcaption>
</figure>
<p>Importantly, the creation of this study has been informed by researchers, clinicians, those with lived experience and people representing a variety of identities to best capture the diversities of chronic genitopelvic pain in LGBTQ+ people. </p>
<p>The results of this research program will centre the representation of sexual and gender minorities in the field of chronic genitopelvic pain. It will inform clinical practice and future research by educating health-care providers and creating specialized services for LGBTQ+ individuals. </p>
<p>In June, in Canada, rainbows become prominent to celebrate Pride month. Pride is a time to collectively promote visibility and equality of lesbian, gay, bisexual, trans, two spirit and queer people.</p>
<p>Since the <a href="https://time.com/5604865/stonewall-riot-uprising-rebellion/">Stonewall uprising</a>, people who identify as LGBTQ+ have been fighting for equal rights and representation in all areas of life. Although some progress has been made, their representation in health research overall, and on health research focusing on chronic genitopelvic pain, has been lagging. It is time for this to change.</p><img src="https://counter.theconversation.com/content/185649/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Caroline Pukall (she/her|elle) receives funding from the American Institute of Bisexuality, the National Vulvodynia Association, the International Society for the Study of Women's Sexual Health, the Canada Foundation for Innovation, and the Canadian Institutes for Health Research. She is the Chair of the Subcommittee for Female Genitopelvic Pain for the International Consultation for Sexual Medicine (International Society of Sexual Medicine) and an Expert Member on the Project Management Team for the Core Outcome Set for Provoked Vestibulodynia (Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU)).</span></em></p>Pain during sex is common, but research on the topic focuses on a narrow heterosexual, cisgender definition of sex, excluding lesbian, gay, bisexual, trans and queer people’s experiences.Caroline Pukall, Professor, Department of Psychology, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1831922022-05-29T14:43:26Z2022-05-29T14:43:26ZOverturning Roe v. Wade would have wide-reaching implications beyond U.S. borders<figure><img src="https://images.theconversation.com/files/465104/original/file-20220524-20-phg9ay.JPG?ixlib=rb-1.1.0&rect=17%2C0%2C5734%2C3828&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A protester shouts at people taking part in the March for Life on Parliament Hill in Ottawa in May, 2022.</span> <span class="attribution"><span class="source"> THE CANADIAN PRESS/ Patrick Doyle</span></span></figcaption></figure><p>After after a U.S. Supreme Court opinion indicating <em>Roe v. Wade</em> could be overturned <a href="https://www.politico.com/news/2022/05/02/supreme-court-abortion-draft-opinion-00029473">was leaked earlier this month</a>, there has been a lot of discussion about how it will impact Americans. But this will also have wide-reaching implications <a href="https://progressive.org/latest/central-america-anti-abortion-laws-abbott-220511/">outside of the United States</a>. </p>
<p>U.S. policy decisions are influential beyond their borders. While the fall of <em>Roe v. Wade</em> would not immediately create legal changes in other countries, there will certainly be spillover effects. </p>
<p>In Canada, this might mean continued limited and uneven access, a real problem in <a href="https://www.actioncanadashr.org/about-us/media/2019-09-23-abortion-access-across-canada-remains-unequal-new-report-shows">some parts of the country</a>. It would also likely embolden <a href="https://utorontopress.com/9781442668768/the-changing-voice-of-the-anti-abortion-movement/">anti-choice politicians and activists</a>, even though the <a href="https://www.theglobeandmail.com/canada/article-most-canadians-say-they-support-a-womans-right-to-choose-to-have-an/">vast majority of Canadians</a> supports a woman’s right to choose.</p>
<p><a href="https://www.britannica.com/event/Roe-v-Wade"><em>Roe v. Wade</em> is the 1973 Supreme Court</a> decision that established a right to abortion. Despite the fact that <a href="https://www.pewresearch.org/fact-tank/2021/05/06/about-six-in-ten-americans-say-abortion-should-be-legal-in-all-or-most-cases/">the majority of Americans support pro-choice positions</a>, the overturn of the decision has seemed inevitable for years, maybe decades.</p>
<p>According to a <a href="https://leger360.com/surveys/legers-north-american-tracker-may-11-2022/">recent public opinion poll by Leger</a>, 74 per cent of Americans support abortion, yet 29 per cent of those claim that this support applies only in certain conditions. </p>
<p>That same opinion poll revealed that 28 per cent of Americans believe <em>Roe v. Wade</em> should be overturned (56 per cent believe it should not). </p>
<h2>Abortion is always necessary</h2>
<p>Foreshadowed by increasing abortion restrictions, such as <a href="https://www.plannedparenthood.org/learn/teens/stds-birth-control-pregnancy/parental-consent-and-notification-laws">parental notifications</a>, <a href="https://journalofethics.ama-assn.org/article/mandated-ultrasound-prior-abortion/2014-04">mandatory ultrasounds</a>, <a href="https://doi.org/10.11604%2Fpamj.2020.35.80.22043">counselling and waiting periods</a>, <a href="https://www.plannedparenthoodaction.org/issues/abortion/types-attacks/trap-laws">targeted regulation of abortion provider laws</a> and the recent appointment of justices during Donald Trump’s presidency. The <a href="https://www.politico.com/news/2022/05/02/read-justice-alito-initial-abortion-opinion-overturn-roe-v-wade-pdf-00029504">draft opinion</a> confirmed what many people expected: <em>Roe v. Wade</em> would be overturned.</p>
<p>The opinion contains several contentious points of law — is there a criminal justification for abortion in the <a href="https://www.law.berkeley.edu/wp-content/uploads/2017/11/CommonLawCivilLawTraditions.pdf">Common Law tradition</a>? Are constitutional protections for abortion consistent with “<a href="https://policyoptions.irpp.org/2015/12/01/harper/">ordered liberty</a>?” It also contains troubling social commentary on the (mischaracterized) <a href="https://www.penguinrandomhouse.com/books/155575/killing-the-black-body-by-dorothy-roberts/">racialized dimensions of abortion</a> and modern developments that have seemingly created a set of conditions for women so advanced that abortion should be unnecessary.</p>
<p>But this sort of reasoning is not a reflection of reality. Abortion is always necessary. </p>
<figure class="align-center ">
<img alt="A woman with a megaphone wears a shirt that says 'i am a vagina voter'" src="https://images.theconversation.com/files/465366/original/file-20220525-22-xfeb4r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/465366/original/file-20220525-22-xfeb4r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/465366/original/file-20220525-22-xfeb4r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/465366/original/file-20220525-22-xfeb4r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/465366/original/file-20220525-22-xfeb4r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/465366/original/file-20220525-22-xfeb4r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/465366/original/file-20220525-22-xfeb4r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A woman chants during a rally for for abortion rights in front of the Supreme Court of the United States in Washington on May 14, 2022.</span>
<span class="attribution"><span class="source">(AP Photo/Amanda Andrade-Rhoades)</span></span>
</figcaption>
</figure>
<p>According to the <a href="https://www.guttmacher.org/fact-sheet/induced-abortion-worldwide">Guttmacher Institute</a>, a sexual and reproductive health and rights research and policy organization in the U.S., “unintended pregnancy rates are highest in countries that restrict abortion access and lowest in countries where abortion is broadly legal. As a result, abortion rates are similar in countries where abortion is restricted and those where the procedure is broadly legal (i.e., where it is available on request or on socio-economic grounds).”</p>
<p>So even with the removal of the constitutional protection offered by <em>Roe v. Wade</em>, and the ability of <a href="https://www.cbsnews.com/news/roe-v-wade-supreme-court-abortion-states-rights/">individual states to make their own laws and impose restrictions</a>, demand for abortion will not decrease. </p>
<h2>Potential implications in the U.S.</h2>
<p>When <em>Roe v. Wade</em> falls, which is expected to be <a href="https://www.cnbc.com/2022/05/06/how-supreme-court-went-from-roe-v-wade-to-drafting-opinion-to-overturn-it.html">this summer</a>, there are <a href="https://www.nytimes.com/2022/05/04/us/abortion-trigger-laws.html">13 states with legislation waiting to go into effect</a> that will ban abortion with very limited exceptions. And several other states are expected to ban or severely restrict abortion as soon as constitutional protections are removed. </p>
<p>While many women <a href="https://abcnews.go.com/US/traveled-state-lines-abortions-now-fear-post-roe/story?id=84490133">will be forced to travel across state lines to access abortion</a> — barring those who can’t leave family, jobs or can’t afford to — some will travel across international borders to <a href="https://thehill.com/policy/healthcare/3487998-canada-mexico-brace-for-influx-of-americans-seeking-abortions/">Canada or Mexico in order to have the procedure done</a>. </p>
<p>According to the <a href="https://www.cdc.gov/reproductivehealth/data_stats/abortion.htm">Centers for Disease Control and Prevention</a>, nearly half (42.3 per cent) of all abortions conducted in the U.S. in 2019 were medical. </p>
<p>A <a href="https://www.newyorker.com/news/news-desk/mexicos-historic-step-toward-legalizing-abortion">2021 Mexican Supreme Court ruling</a> decriminalized abortion throughout the country. And while it is not yet legal in all Mexican states, a <a href="https://www.npr.org/2022/05/09/1097210654/mexican-border-town-sees-an-increase-in-sales-of-abortion-drugs-to-women-from-th">broad range of pills are widely available</a> and affordable.</p>
<p>Americans are accustomed to travelling to Mexico to <a href="https://www.newsweek.com/thousands-americans-cross-border-mexico-affordable-medical-treatment-each-1426943">access affordable medical treatment</a> that is out of reach in their own country. Overturning <em>Roe v. Wade</em> will have some Americans looking to Canada as an option. </p>
<h2>What’s happening in Canada?</h2>
<p>In Canada, abortion is <a href="https://ppt.on.ca/factsheets/abortion/">safe and legal</a>, but not always widely available. And there is concern that the spillover effects of overturning <em>Roe v. Wade</em> might make the fragile existing system even worse. </p>
<p>During the last federal election campaign the <a href="https://liberal.ca/our-platform/protecting-your-sexual-and-reproductive-health-and-rights/">Liberal government promised</a> to improve access to <a href="https://doi.org/10.1080/14616742.2021.1997150">sexual and reproductive health and rights</a>, including abortion, but so far there has been little to show for it. </p>
<p><a href="https://www.cbc.ca/news/politics/abortion-funding-expanded-roe-v-wade-1.6449487">Last week</a>, in response to the leaked opinion, the federal government announced $3.5 million in new funding for two initiatives to improve access to abortion. The <a href="https://www.theglobeandmail.com/politics/article-canada-abortion-rights-trudeau/">federal government also withheld</a> money from New Brunswick’s health transfer for its continued refusal to fund surgical abortions outside of a hospital. </p>
<p>This sort of token investment and minor enforcement of the Canada Health Act is largely symbolic, but $3.5 million is simply not enough to have any real impact and punishing New Brunswick does little to affect policy decisions at the provincial level. </p>
<figure class="align-center ">
<img alt="People take part in the March for Life on Parliament Hill" src="https://images.theconversation.com/files/465105/original/file-20220524-19-3uwtx5.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/465105/original/file-20220524-19-3uwtx5.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=392&fit=crop&dpr=1 600w, https://images.theconversation.com/files/465105/original/file-20220524-19-3uwtx5.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=392&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/465105/original/file-20220524-19-3uwtx5.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=392&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/465105/original/file-20220524-19-3uwtx5.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=492&fit=crop&dpr=1 754w, https://images.theconversation.com/files/465105/original/file-20220524-19-3uwtx5.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=492&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/465105/original/file-20220524-19-3uwtx5.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=492&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In Canada, many pro-life groups are funded by their American counterparts.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/ Patrick Doyle</span></span>
</figcaption>
</figure>
<p>While <a href="https://utorontopress.com/9780802084668/health-care-entitlement-and-citizenship/">health is a right</a>, the provision of health care falls into the jurisdiction of the provinces. This results in uneven abortion access across the country. </p>
<p>According to <a href="https://www.actioncanadashr.org/resources/factsheets-guidelines/2019-09-19-access-glance-abortion-services-canada">Action Canada for Sexual Health and Rights</a>, there are 49 abortion providers in Québec, 38 in Ontario and 24 in British Columbia. But there is only one provider in the Northwest Territories, as well as one in Prince Edward Island and one in the Yukon. There are also no rural providers across seven provinces and territories. </p>
<p>The overturn of <em>Roe v. Wade</em> would likely not mean that a <a href="https://doi.org/10.1017/S0008423922000452">similar judicial decision</a> is forthcoming in Canada, or that federal legislation, in the short term, would erode access. </p>
<p>The Liberals have supported reproductive choice and denied state funding for anti-choice groups, the Bloc Québécois is decidedly pro-choice and the Conservatives seem to want to avoid or underplay abortion. Both the NDP and Green Party are officially pro-choice, although it took the Greens time to come to this as an official position. </p>
<p>The impending fall of <em>Roe v. Wade</em> will <a href="https://ottawacitizen.com/news/local-news/canadas-march-for-life-organizers-buoyed-by-leaked-roe-v-wade-draft-in-u-s">embolden people who are anti-choice</a> and it is conceivable that the end of constitutional protections for abortion in the U.S. will fuel pro-life groups to fund projects elsewhere.</p>
<p>The denigration of reproductive rights in the U.S. might permit provinces that are not doing enough to ensure access to maintain the status quo. <em>Roe v. Wade</em> demonstrates that reproductive rights are fragile, often insufficient and in need of protection everywhere.</p><img src="https://counter.theconversation.com/content/183192/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Candace Johnson receives funding from the Social Sciences and Humanities Research Council (SSHRC). </span></em></p>Roe v. Wade demonstrates that reproductive rights are fragile, often insufficient and in need of protection everywhere.Candace Johnson, Professor of Political Science, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1831292022-05-24T20:04:40Z2022-05-24T20:04:40Z‘I want an orgasm but not just any orgasm’: How To Please A Woman shifts the way we depict the sexuality of older women<figure><img src="https://images.theconversation.com/files/464897/original/file-20220524-14810-6r0yfh.jpg?ixlib=rb-1.1.0&rect=0%2C14%2C4785%2C3168&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Madman</span></span></figcaption></figure><p>Australian writer and director Renée Webster’s new film <a href="https://www.imdb.com/title/tt10530838/?ref_=nv_sr_srsg_0">How to Please a Woman</a> turns much of what we think we know about sexual desire – especially for older women – on its head.</p>
<p>How to Please a Woman features 50-something Gina (Sally Phillips), who hasn’t had sex with her husband (Cameron Daddo) in over a year because he is no longer interested in sexual relations – with her or anyone.</p>
<p>Gina’s main source of intimacy comes from the regular beach swims she has with a group of three women (Tasma Walton, Caroline Brazier, and Hayley McElhinney) and their changing-room conversations that cover everything from peeing on jellyfish stings to the multipurpose use of coconut oil, including as a natural lubricant.</p>
<p>When Gina’s friends rent a stripper (Alexander England) to dance for her on her birthday (a much more intimate present than the two $50 bills she receives from her husband), and he offers to do anything for her (“Anything?” “Totally …”) she asks him to clean her house.</p>
<p>Realising the pleasure she experienced having her house cleaned by a shirtless, handsome man, Gina starts her own male cleaning business and her swimming crew become her first clients. </p>
<p>But they want more than their houses cleaned. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/5ZLv4v4odkE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<h2>The sexual desire of women over 50</h2>
<p>One of the strengths of this film is the sensitive way it represents the different desires of individual women. After all, the title of the film is How to Please <em>a</em>
Woman not <em>How to Please Women</em>.</p>
<p>For Gina to ensure her clients receive the pleasure they want, she meets individually with them and writes down their preferences. One woman wants to take it slow and start with gin and tonic. Another woman does not want her breasts touched. A third woman wants a very specific orgasm: she does not want just any orgasm that sneaks up on you, but one you ease up to and pull away from, ease up to and pull away from until total annihilation. Another client says that after several bookings with men she is starting to feel all kinds of things, so she wants to book a session with a woman.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/464899/original/file-20220524-14-h6s8xw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/464899/original/file-20220524-14-h6s8xw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/464899/original/file-20220524-14-h6s8xw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/464899/original/file-20220524-14-h6s8xw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/464899/original/file-20220524-14-h6s8xw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/464899/original/file-20220524-14-h6s8xw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/464899/original/file-20220524-14-h6s8xw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/464899/original/file-20220524-14-h6s8xw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Hayley McElhinney, Tasma Walton, Sally Phillips and Caroline Brazier in How To Please A Woman.</span>
<span class="attribution"><span class="source">Madman</span></span>
</figcaption>
</figure>
<p>It is rare to see in popular culture a range of mostly older women being frank about what gives them sexual pleasure and to see how their desire become more adventurous and diverse. Sadly, the sexual desire of women over 50 is often unrepresented, misrepresented, and/or shown as comedic. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/grace-and-frankie-is-the-longest-running-series-on-netflix-and-a-show-for-women-who-dont-see-themselves-on-television-182298">Grace and Frankie is the longest running series on Netflix – and a show for women who don’t see themselves on television</a>
</strong>
</em>
</p>
<hr>
<h2>The socially transmitted disease of ageism</h2>
<p>According to <a href="https://www.google.com.au/books/edition/Sex_Matters_for_Women/BtX56c0CuMkC?hl=en&gbpv=1&printsec=frontcover">Foley, Kope & Sugrue</a>, </p>
<blockquote>
<p>The greatest barrier to a woman’s sexuality in midlife is the socially transmitted disease of ageism. </p>
</blockquote>
<p>Older women are represented as asexual and past it. They are <a href="https://en.wikipedia.org/wiki/Cougar_(slang)">“cougars”</a> or ageing <a href="https://ijlls.org/index.php/ijlls/article/view/784">femme fatales</a>, like Blanche Du Bois in Tennessee William’s A Streetcar Named Desire, who set a tone for generations as a figure of fun whose desires are twisted, ridiculed, and ultimately punished.</p>
<p>Older age is by far the largest developmental human period plagued by misconceptions and stereotypes, kept alive by incessant jokes.</p>
<p>And no gender absorbs these jokes more than the female. Sexiness is equated with youth, and <a href="https://theconversation.com/invisible-lives-where-are-all-the-older-women-in-film-and-tv-168012">older women and their sexuality are made invisible</a>. When older women are represented in popular media, their sexuality is <a href="https://womensagenda.com.au/latest/hollywoods-intentional-and-harmful-neglect-of-women-over-50/">often not shown</a> or is aligned with deviance, such as in the relationship between Darlene and Wyatt in Netflix’s highly-acclaimed Ozark.</p>
<p>Depictions in media trivialising desirous or sexually active older women, or women who seek sex outside of loving and steady relationships as abnormal, <a href="https://pubmed.ncbi.nlm.nih.gov/24384365/">contribute to negative stereotypes</a> and to judgemental attitudes about older sexuality.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/464901/original/file-20220524-16-bqkf5b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/464901/original/file-20220524-16-bqkf5b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/464901/original/file-20220524-16-bqkf5b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/464901/original/file-20220524-16-bqkf5b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/464901/original/file-20220524-16-bqkf5b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/464901/original/file-20220524-16-bqkf5b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/464901/original/file-20220524-16-bqkf5b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/464901/original/file-20220524-16-bqkf5b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Alexander England and Sally Phillips.</span>
</figcaption>
</figure>
<h2>And just like that…</h2>
<p>Fortunately, we are starting to see the lives of women over 50 appear more positively in stories on television, recent examples including <a href="https://theconversation.com/frank-unapologetic-and-female-oriented-the-cultural-legacy-of-sex-and-the-city-and-the-lure-of-the-reboot-175061">And Just Like That</a> the reboot of Sex and the City, and the hugely popular Netflix comedy series <a href="https://theconversation.com/grace-and-frankie-is-the-longest-running-series-on-netflix-and-a-show-for-women-who-dont-see-themselves-on-television-182298">Grace and Frankie</a> – and in films like <a href="https://www.imdb.com/title/tt1230414/">It’s Complicated</a> and Girl’s Trip.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/frank-unapologetic-and-female-oriented-the-cultural-legacy-of-sex-and-the-city-and-the-lure-of-the-reboot-175061">Frank, unapologetic, and female-oriented: the cultural legacy of Sex and the City, and the lure of the reboot</a>
</strong>
</em>
</p>
<hr>
<p>The tone of these stories plays more for laughs, though, while How to Please a Woman balances between comedy and drama. <a href="https://www.theaureview.com/watch/interview-director-renee-webster-on-how-to-please-a-woman-and-finding-the-comedy-in-truth-and-pain/">As director Renée Webster says</a>, </p>
<blockquote>
<p>The best comedy comes from truth and a little bit of pain.</p>
</blockquote>
<p>How to Please a Woman shows older women’s sexual desire as respectful and tender for both women and men, even though it is set within a comedy. </p>
<p>But the women aren’t being laughed at, they’re the ones laughing. This depiction seems new and significant. <a href="https://link.springer.com/article/10.1007/BF02701260">Stories impact and inspire relationships</a> and images about ageing and sexuality influence individual behaviour. </p>
<p><a href="https://if.com.au/with-how-to-please-a-woman-renee-webster-puts-the-audience-first/?fbclid=IwAR1sPidra6uO64jjiSbyfbQ069LrZQ8ZBLYUXpX0tdL-7CjE63J1yAtuRks">Webster herself says</a> she is “starting to get unsolicited texts of my friends’ husbands vacuuming the carpet and hearing from people that they took something home from the movie, and it opened up some new conversations for them.”</p>
<p>Female sexuality is seen as part of a rich fabric of women’s lives, not its single orgasmic culmination. As Steve (Erik Thomson) says in the film while eating a croissant, “one is never enough.”</p><img src="https://counter.theconversation.com/content/183129/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Debra Dudek receives funding from the Australian Government through the Australian Research Council's Discovery Projects funding scheme (project DP190102435). The views expressed herein are those of this author and are not necessarily those of the Australian Government or the Australian Research Council.</span></em></p><p class="fine-print"><em><span>Elizabeth Reid Boyd and Madalena Grobbelaar do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Sadly, the sexual desire of women over 50 is often unrepresented, misrepresented, and shown as comedic in culture – the new Australian film depicts a different reality.Debra Dudek, Associate professor, School of Arts and Humanities, Edith Cowan UniversityElizabeth Reid Boyd, Senior Lecturer School of Arts and Humanities, Edith Cowan UniversityMadalena Grobbelaar, Lecturer, Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1822982022-05-09T19:59:49Z2022-05-09T19:59:49ZGrace and Frankie is the longest running series on Netflix – and a show for women who don’t see themselves on television<figure><img src="https://images.theconversation.com/files/461711/original/file-20220506-25-intjj3.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5168%2C3419&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Lara Solanki/Netflix</span></span></figcaption></figure><p>When the final 12 episodes of Grace and Frankie were released, the show became the <a href="https://deadline.com/2019/09/grace-and-frankie-to-end-with-seventh-season-becomes-netflixs-longest-running-original-1202710410/">longest running</a> television series on Netflix.</p>
<p>Over 94 episodes, this unlikely hit went where no other series had taken viewers: into the lives of older women forced to restart their lives, both socially and sexually, after their marriages of 40 years had ended. </p>
<p>Their husbands’ revelation that they had been lovers for 20 years – and now planned to marry each other – threw the central characters fractiously together in an admittedly idyllic San Diego beach house. </p>
<p>The show broke new ground when it launched in 2015, not only for its frank and fearless portrayal of ageing, but because its central characters were ageing women. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/CDv6PRi1SgQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>Older women are one of the <a href="https://www.tandfonline.com/doi/abs/10.1080/14680777.2018.1409969">least visible</a> demographics on television, and to see them front and centre is still unusual. </p>
<p>The Golden Girls (1985-92) is the only real precedent for Grace and Frankie, although the ages of its characters are surprising in retrospect.</p>
<p>In the first season of The Golden Girls, Rose is 55, Dorothy is 53, Blanche is 47 and Sophia is 79. In the reboot of Sex and the City, And Just Like That…, Miranda and Charlotte are 54, while Carrie is 55 – and they are certainly not portrayed as old. </p>
<p>But at the start of this series, Grace (Jane Fonda), Frankie (Lily Tomlin) and their former partners Robert (Martin Sheen) and Sol (Sam Waterson), are in their 70s. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/and-just-like-that-how-sex-and-the-city-sequel-is-broadening-the-representation-of-50-women-on-tv-173778">And Just Like That: how Sex and the City sequel is broadening the representation of 50+ women on TV</a>
</strong>
</em>
</p>
<hr>
<h2>The trouble with ageing</h2>
<p>The show covers many of the issues of ageing from the perspective of the aged. These include a broad range of health problems – arthritis, immobility, a knee reconstruction and mini-strokes – as well as negotiating the competing claims of children, grandchildren, lovers and friends. </p>
<p>In season four, following multiple health issues and falling victim to a major scam, Grace and Frankie are tricked by their children into moving into aged care.</p>
<p>When they find that they are not allowed to run a business there – among other lost freedoms – they launch an escape bid, stealing a golf cart and heading back to the beach house which has been sold from under them. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/NLy-BUelov4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>The issue of children making choices for their ageing parents against their will <a href="https://www.researchgate.net/publication/248346563_Prioritizing_parental_autonomy_Adult_children's_accounts_of_feeling_responsible_and_supporting_aging_parents">is fraught</a>. Older parents often require assistance from their children but at the same time don’t want to lose their autonomy. Children can jump in to resolve issues without taking their parents’ agency into account. </p>
<p>Here, this tension is mostly a source of humour at the expense of the aged care home. But Grace and Frankie also gives a glimpse into how vulnerable people can become when they have health issues. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/for-australians-to-have-the-choice-of-growing-old-at-home-here-is-what-needs-to-change-91488">For Australians to have the choice of growing old at home, here is what needs to change</a>
</strong>
</em>
</p>
<hr>
<h2>Let’s talk about sex</h2>
<p>One of the most striking elements of the show is its forthright approach to sex. Part of this is the frank acknowledgement that with age comes certain sexual challenges. </p>
<p>Typically, popular culture has run from the idea that older women could be sexual, especially as they do not conform to dominant ideas of beauty.</p>
<p>The issue of what is often obliquely referred to as “feminine dryness” is tackled directly when Frankie concocts a lube from yams. </p>
<figure>
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</figure>
<p>Together, both Grace and Frankie also develop a vibrator that not only takes account of arthritic hands but also of limited mobility. </p>
<p>Though it provides the opportunity for numerous missteps, their company “Vybrant” is ultimately a success, with women of all ages giving the product rapturous endorsement. </p>
<p>Giving women the power to take control of their own sexual needs is something the show is emphatic about. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-it-comes-to-older-people-and-sex-doctors-put-their-heads-in-the-sand-43556">When it comes to older people and sex, doctors put their heads in the sand</a>
</strong>
</em>
</p>
<hr>
<h2>Finding joy</h2>
<p>Bringing the challenges of coming out in your 70s for Robert and Sol into mainstream programming is also ground-breaking. Older gay men are another group who <a href="https://www.academia.edu/1764312/_Race_Aging_and_Gay_In_Visibility_on_US_Television_">rarely</a> see themselves on television.</p>
<p>Aspects of gay life – equal marriage, polyamory, promiscuity and leather men, together with gay musical theatre and obsessive dog ownership – are all depicted as part of the new world Robert and Sol enter into. </p>
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<p>Coming out, and living the lives they have longed for, has its ongoing challenges for both characters. It is this willingness to look at every issue with both honesty and humour that has marked the approach by directors and writers Marta Kauffman and Howard J. Morris and made the show such a success. </p>
<p>The key focus of Grace and Frankie, despite its many diversions into the lives of ex-husbands, new lovers, friends and children, is always the friendship of Grace and Frankie. </p>
<p>Their friendship is hard won, severely tested, and often seems completely over – but it is the central love of both women’s lives, enabling them to go into old age with confidence, support and times of joy.</p>
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</figure><img src="https://counter.theconversation.com/content/182298/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mandy Treagus does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Older women and gay men both rarely see themselves reflected on the small screen.Mandy Treagus, Associate Professor, Department of English, Creative Writing and Film, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1805812022-04-12T20:00:11Z2022-04-12T20:00:11ZDid everyone in Bridgerton have syphilis? Just how sexy would it really have been in Regency era London?<figure><img src="https://images.theconversation.com/files/456799/original/file-20220407-23-mke2pz.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3583%2C2398&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Colin Hutton/ Netflix</span></span></figcaption></figure><p>The success of Netflix’s Bridgerton is owed to many different factors: an addictive storyline, inspired casting choices, a dazzling costume design… and, of course, the fact the show is incredibly sexy.</p>
<p>Bridgerton has finally satisfied an ongoing craving for historical romance (and borderline erotica) which has existed since Mr Darcy’s <a href="https://news.artnet.com/art-world/mr-darcy-famous-wet-shirt-exhibition-jane-austen-house-2090193">wet-shirt moment </a>in the 1995 adaptation of Pride and Prejudice. </p>
<p>But how sexy would Bridgerton have been in real life?</p>
<p>The show is set in the early years of the 19th century, placing it in the middle of <a href="https://daily.jstor.org/why-are-so-many-romances-set-in-the-regency-period/#:%7E:text=The%20real%2Dlife%20Regency%20period,year%20period%2C%20the%20aristocracy%20flourished.">the Regency period</a> and towards the end of the Georgian era. Around this time, it is estimated <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/ehr.13000">one in five Londoners</a> would have had syphilis (or “the Pox”) by the age of 35. </p>
<p>If this number isn’t already shocking enough, historians also estimate the number who contracted gonorrhoea or chlamydia was far higher. According to historian <a href="https://www.sciencedaily.com/releases/2020/07/200706113937.htm">Professor Simon Szreter</a>: </p>
<blockquote>
<p>The city had an astonishingly high incidence of STIs at that time. It no longer seems unreasonable to suggest that a majority of those living in London while young adults in this period contracted an STI at some point in their lives.</p>
</blockquote>
<p>There was no effective cure found for syphilis until the beginning of the 20th century, meaning if you happened to fall within the unlucky 20% of society, there was generally no hope of recovery.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/456801/original/file-20220407-16-vr5i82.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/456801/original/file-20220407-16-vr5i82.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/456801/original/file-20220407-16-vr5i82.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=366&fit=crop&dpr=1 600w, https://images.theconversation.com/files/456801/original/file-20220407-16-vr5i82.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=366&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/456801/original/file-20220407-16-vr5i82.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=366&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/456801/original/file-20220407-16-vr5i82.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=460&fit=crop&dpr=1 754w, https://images.theconversation.com/files/456801/original/file-20220407-16-vr5i82.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=460&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/456801/original/file-20220407-16-vr5i82.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=460&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">William Hogarth, A Harlot’s Progress, shows Moll Hackabout dying of syphilis, having come to London as a young woman from the countryside and ‘fallen into prostitution’.</span>
<span class="attribution"><span class="source">The Trustees of the British Museum</span></span>
</figcaption>
</figure>
<h2>Syphilis in Bridgerton</h2>
<p>The drama of the recently released <a href="https://www.imdb.com/title/tt8740790/">season 2 of Bridgerton</a> primarily revolves around the love interest of the eligible Viscount Anthony Bridgerton and the spinsterly Kate Sharma. However, their enemies-to-lovers romance is complicated by Anthony’s intentions to court the Queen’s favourite and Kate’s younger sister, Edwina Sharma. </p>
<p>Kate’s initial objection to the match concerns Anthony’s objectionable personality – and rumours of his licentious past. With the prevalence of syphilis at the time in mind, Miss Sharma is rather well justified in rejecting her sister’s match on the basis of the Viscount’s libertine history. As a titillating montage at the beginning of the first episode reminds us, Anthony regularly employed sex workers to help him blow off a little steam at the end of the day. </p>
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<a href="https://images.theconversation.com/files/457330/original/file-20220411-17-ki3q68.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/457330/original/file-20220411-17-ki3q68.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/457330/original/file-20220411-17-ki3q68.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/457330/original/file-20220411-17-ki3q68.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/457330/original/file-20220411-17-ki3q68.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/457330/original/file-20220411-17-ki3q68.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/457330/original/file-20220411-17-ki3q68.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/457330/original/file-20220411-17-ki3q68.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Jonathan Bailey as Anthony Bridgerton, who historically, probably had syphilis.</span>
<span class="attribution"><span class="source">Liam Daniel/Netflix</span></span>
</figcaption>
</figure>
<p>Brothels and other forms of sex work were prolific across England during this time, commonly referred to as <a href="https://oxford.universitypressscholarship.com/view/10.1093/acprof:oso/9780198201656.001.0001/acprof-9780198201656-part-3">“the great social evil”</a>. Brothels which catered to higher members of society were generally run by women to the west of London, whereas the bawdy-houses of the East End tended to be run by men. </p>
<p>By the mid-eighteenth century, it was estimated <a href="https://books.google.com.au/books/about/Sex_and_the_Gender_Revolution_Volume_1.html?id=v_y4BEZUmOIC&redir_esc=y">50% of London’s brothels</a> were operated by women. Brothel Madams were generally considered to be more tactful when it came to dealings with clients; frequenting these establishments was something that Lords (and, in some rare cases, Ladies) would regularly do, yet not something that should be spoken of in polite society. </p>
<p>As may well be expected, the spread of syphilis and the popularity of these establishments were not entirely unconnected. Admission records of London’s hospitals and workhouse infirmaries show the disease was particularly rife among young, impoverished, mostly unmarried women, who used commercial sex to financially support themselves. </p>
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<figcaption>
<span class="caption">The Martyrdom of Mercury (1709). Depicts patients being treated for syphilis in an 18th-century hospital.</span>
<span class="attribution"><span class="source">University of Cambridge</span></span>
</figcaption>
</figure>
<p>With no effective treatment available for the Pox, those afflicted were often <a href="https://pharmaceutical-journal.com/article/opinion/syphilis-and-the-use-of-mercury">prescribed mercury as a treatment</a> (which, with the privilege of our modern worldview, we know to be just as detrimental – if not worse – than untreated syphilis). This led to the popular saying from the period, “A night with Venus, and a lifetime with mercury.”</p>
<p>For this reason, it was common for members of high society, such as Anthony Bridgerton, to have a more exclusive arrangement with a chosen mistress (or mistresses). This arrangement allowed Lords to minimise their risk of infection without forfeiting this favoured pastime. </p>
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<h2>Prevention is better than a cure (and also doesn’t exist)</h2>
<p>It wasn’t just a cure for STIs that was lacking, but also preventative methods. While <a href="https://wellcomecollection.org/articles/W88vXBIAAOEyzwO_">condoms did exist</a>, they were not anywhere near as widely accessible, encouraged, or effective as we know them today. </p>
<p>One of the major proprietors of condoms within London (particularly for sex workers) was the infamous <a href="https://www.britishmuseum.org/collection/term/BIOG212588">Mrs Phillips</a>, who held a shop in Leicester Square. These were made of sheep and goat gut, pickled, and fashioned by hand on glass moulds by <a href="https://www.amazon.com.au/Alarming-History-Medicine-Richard-Gordon/dp/0312104111">Mrs Phillips herself</a>. </p>
<p>While certainly better than nothing, the material by which these condoms were made meant that they were generally prone to breaking (and certainly not a sexy addition to any licentious affairs). </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-whole-new-set-of-horny-lords-and-ladies-how-bridgerton-brought-romance-book-serialisation-to-television-180303">A whole new set of horny lords and ladies: how Bridgerton brought romance book serialisation to television</a>
</strong>
</em>
</p>
<hr>
<p>It would not be until the 1910s that the first effective treatment for syphilis was discovered through the development of the drug, <a href="https://en.wikipedia.org/wiki/Arsphenamine#:%7E:text=Arsphenamine%2C%20also%20known%20as%20Salvarsan,the%20first%20modern%20antimicrobial%20agent.">Salvarsan</a>. Until this stage, mercury remained the primary treatment for the disease. By the 1940s, a safe and accessible cure was established with the production of penicillin. </p>
<p>While Bridgerton is not limited by the often strangulating bounds of historical accuracy, it is rather fascinating to consider the dirtier environmental factors that did impact this world of balls and fine fabrics.</p><img src="https://counter.theconversation.com/content/180581/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Esmé Louise James does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While Netflix’s Bridgerton is both incredibly romantic and erotic, the reality is it’s estimated 1in 5 people in the Regency period in London had syphilis and other STIs.Esmé Louise James, Doctor of Philosophy, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1778232022-03-22T01:04:26Z2022-03-22T01:04:26ZConsent education needs Blak voices for the safety and well-being of young First Nations people<figure><img src="https://images.theconversation.com/files/452336/original/file-20220315-27-1vucuwz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com.au/detail/photo/tender-moment-between-a-couple-royalty-free-image/1332202784">GettyImages</a></span></figcaption></figure><p><em>Readers are advised that the following article contains mentions of sexual assault.</em></p>
<p>The <a href="https://www.teachusconsent.com/">Teach Us Consent</a> movement - founded by Chanel Contos in 2021 - has gained bipartisan political support to mandate consent education in Australian schools from 2023. The movement was rapidly successful after collecting over <a href="https://www.teachusconsent.com/testimonies/">6,600 stories</a> of people who had experienced sexual assault by someone when they were at school.</p>
<p>This was followed quickly by the <a href="https://ministers.dss.gov.au/media-releases/8026">federal government committing $189 million</a> over five years to strengthen prevention and early intervention efforts in family, domestic and sexual violence.</p>
<p>Consent isn’t <a href="https://theconversation.com/not-as-simple-as-no-means-no-what-young-people-need-to-know-about-consent-155736">just about sex</a>. Consent needs to be taught in the context of our rights to say no to anything we’re not comfortable with. That education needs to start early, hence why the proposed curriculum is from school years K-12.</p>
<p>Teach Us Consent has advocated for comprehensive consent education that moves beyond simply teaching the law or explaining that “no means no”. Consent in a sexual context includes - but is not limited to - respect, healthy relationships, gender stereotypes, ethics, communication and empathy. </p>
<p>As strong and emotive reactions to recent speeches by <a href="https://www.youtube.com/watch?v=5wIzpu3qpvs">Grace Tame and Brittany Higgins</a> show, issues of sexual violence and consent are gaining momentum at a national level. Yet, within these important discussions, the voices, experiences and needs of First Nations people are not widely represented or heard.</p>
<p>Drawing on the current momentum and interest in consent education, there is an opportunity to fund place-based, culturally appropriate and co-designed consent education with First Nations young people. </p>
<p>The response to sexual violence must move beyond simply adding “dot paintings” to mainstream curricula to address the conditions that make sexual violence an issue for many.</p>
<p>To have a real impact on young people and our communities, we need to be telling the whole story of women, gender and sexual violence in Aboriginal and Torres Strait Islander people’s lives against the backdrop of colonisation. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-fair-game-racial-shame-and-the-women-who-demanded-more-176256">Friday essay: 'fair game', racial shame and the women who demanded more</a>
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</em>
</p>
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<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1492287589411340292"}"></div></p>
<h2>Acknowledging the impacts of colonisation</h2>
<p>Before colonisation, our diverse cultures were grounded in collective rights and responsibilities for <a href="https://www.austlit.edu.au/austlit/page/10194036">people</a> and Country. </p>
<p>Women were <a href="https://www.researchgate.net/publication/333672810_Reproductive_Justice_and_Culturally_Safe_Approaches_to_Sexual_and_Reproductive_Health_for_Indigenous_Women_and_Girls">keepers of knowledge</a> and Lore, and were responsible for passing knowledges down through our kinship lines. This involved educating and nurturing young girls as they transitioned into adulthood. </p>
<p>There were laws that regulated behaviours – sexual and otherwise – and women were revered in their roles as Elders, mothers and healers. </p>
<p>However, when Australia was colonised, Aboriginal women’s roles as teachers and matriarchs were <a href="https://www.mdpi.com/452560">rendered invisible</a> by the colonisers’ gaze, guns and violence.</p>
<p>When children were taken and family members murdered, this led to families and communities being displaced, and their cultural roles disrupted. <a href="https://humanrights.gov.au/our-work/publications/questions-and-answers-about-aboriginal-torres-strait-islander-peoples#:%7E:text=Protection%20and%20assimilation">Australia’s assimilation policies</a> laid the foundation for the entrenched racism and displacement we <a href="https://www.sydney.edu.au/news-opinion/news/2020/06/09/what-does-racism-look-like-in-australia-.html">experience today</a>.</p>
<p>This has contributed to First Nations people’s ongoing experience with inequalities in social and health indicators - <a href="https://www.anrows.org.au/project/understanding-the-role-of-law-and-culture-in-aboriginal-and-or-torres-strait-islander-communities-in-responding-to-and-preventing-family-violence/">including sexual and other violence</a>.</p>
<p>The ongoing impact of colonisation, <a href="https://www.tandfonline.com/doi/full/10.1080/01419870802302272">racism and cultural loss</a> are key drivers of violence in First Nations communities. This needs to be understood and addressed if our experiences are to be genuinely included in the national narrative around sexual consent and violence.</p>
<p>Growing relationships with First Nations people, communities and organisations based on genuine respect and cultural strength is fundamental to developing culturally safe education around consent.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mandatory-consent-education-is-a-huge-win-for-australia-but-consent-is-just-one-small-part-of-navigating-relationships-177456">Mandatory consent education is a huge win for Australia – but consent is just one small part of navigating relationships</a>
</strong>
</em>
</p>
<hr>
<h2>Culturally secure co-design for consent curricula</h2>
<p><a href="https://www.ourwatch.org.au/">Our Watch</a> – a national leader in the primary prevention of violence against women and children in Australia - has worked closely with First Nations people to develop <a href="https://media-cdn.ourwatch.org.au/wp-content/uploads/sites/2/2020/09/20231759/Changing-the-picture-Part-2-AA.pdf">Changing the Picture</a>. This is a resource to support the prevention of violence against Aboriginal and Torres Strait Islander women and children.</p>
<p>A co-design process would complement and build on the good work of Our Watch and those programs highlighted through this resource. It would draw on the professional and lived experiences of staff and communities working in this space. </p>
<p>Ways to approach consent education will vary depending on cultural, historical and local differences. Our communities need a curriculum that is flexible and adaptable enough to honour these diverse local and cultural needs. </p>
<p>To achieve this, collaboration must occur at all levels and stages of the design, rollout and evaluation of the new consent curriculum. </p>
<p>There has been <a href="https://ministers.dss.gov.au/media-releases/8026">further commitment</a> to fund responses beyond the national curriculum development, but there must be targeted funding for First Nations to ensure the responses are culturally appropriate.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-are-a-nation-of-jailers-jurrungu-ngan-ga-is-a-whirlwind-of-bodily-resistance-173987">'We are a nation of jailers': Jurrungu Ngan-ga is a whirlwind of bodily resistance</a>
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</em>
</p>
<hr>
<h2>Making decisions “with” people instead of “for” people</h2>
<p><a href="https://www.beyondstickynotes.com/what-is-codesign">Co-design</a> with First Nations communities and organisations is about all stakeholders - government, experts on sexual violence, community, advocacy bodies, young people and researchers - working together.</p>
<p>A key principle of co-design is that lived experience participants - in this case Aboriginal and Torres Strait Islander people - are valued and respected and their <a href="https://www.anrows.org.au/warawarni-gu-guma-statement/">knowledge</a> is privileged. </p>
<p>A good example of culturally secure co-design is the <a href="https://debakarn.com/">Looking Forward</a> project at Curtin University, in which methods were developed in a <a href="https://www.abc.net.au/radio/kimberley/programs/breakfast/cultural-health/12797394">collaboration</a> between Elders and young people.</p>
<p>The project includes two key <a href="https://www.tandfonline.com/doi/full/10.1080/18387357.2016.1173516">truth-telling</a> activities that build relationships and trust, ensuring the space is culturally secure: <a href="https://youtu.be/Xap1LbP0AgY">Storying and On Country</a>. </p>
<p>Storying is the process of sitting as equals and sharing the story of who you are as a person outside your professional role or qualifications. Equally as important is the deep listening and connecting with others in the room through our shared experiences. </p>
<p>Storying is followed by an On Country event. Activities are led, held and weaved together by Elders who share stories and knowledge about Country. This helps to better understand the central role culture has in people’s <a href="https://timhwb.org.au/wp-content/uploads/2021/04/SEWB-fact-sheet.pdf">social and emotional well-being</a> and how to include this in work practices.</p>
<p>Due to the complex legacies of colonisation, the relationships that begin to form through Storying and On Country events are integral in building trust with First Nations people. This enables non-Indigenous people to develop an understanding of culture, kinship and spirit. These activities are part of addressing the racialised power differences and developing a genuine commitment from non-Indigenous people. </p>
<p>This approach forms the foundation for <a href="https://www.tandfonline.com/doi/full/10.1080/18387357.2016.1173516">robust discussions</a> that need to occur in the development of any consent education around sexual violence.</p>
<p>These programs may not use the words “consent education”, but they do address the legacy of colonisation that is a driver of sexual violence. Importantly, these examples create culturally safe spaces for all members of the community to engage in conversations about violence against women. </p>
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<img alt="An Aboriginal person and a young child each hold a coolamon above their heads in ceremony." src="https://images.theconversation.com/files/453465/original/file-20220321-22-121eode.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453465/original/file-20220321-22-121eode.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453465/original/file-20220321-22-121eode.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453465/original/file-20220321-22-121eode.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453465/original/file-20220321-22-121eode.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453465/original/file-20220321-22-121eode.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453465/original/file-20220321-22-121eode.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Growing relationships with First Nations people is fundamental to developing culturally safe education.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newcastle-australia-december-10-2009-aboriginal-1591481089">shutterstock</a></span>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/increased-incarceration-of-first-nations-women-is-interwoven-with-the-experience-of-violence-and-trauma-164773">Increased incarceration of First Nations women is interwoven with the experience of violence and trauma</a>
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<h2>Walking forward together</h2>
<p>The federal government’s move to mandate consent education is a step in the right direction. If funded and resourced appropriately, it provides a unique opportunity to address sexual violence at a national level. </p>
<p>Moving forward, the voices, experiences and expertise of Aboriginal and Torres Strait Islander peoples must be listened to. Historical and current colonial violence, as well as the strengths of culture, must be understood and incorporated. </p>
<p>Engaging with First Nations people working in and for the community is where we need to start.</p><img src="https://counter.theconversation.com/content/177823/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amanda Sibosado works for the Looking Forward Research Team, on Our Journey Our Story at Curtin University. Our Journey, Our Story is funded by the Medical Research Future Fund (MRFF) Million Minds Mission. </span></em></p><p class="fine-print"><em><span>Michelle Webb works for the Looking Forward Research Team, on Our Journey Our Story at Curtin University. Our Journey, Our Story is funded by the Medical Research Future Fund (MRFF) Million Minds Mission</span></em></p>To have a real impact on First Nations communities, we need to tell the whole story of sexual violence in people’s lives against the backdrop of colonisation.Amanda Sibosado, Research Associate - Aboriginal Mental Health, Curtin UniversityMichelle Webb, Research Fellow - Psychology, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1765722022-02-11T20:37:32Z2022-02-11T20:37:32ZSex ed needs to talk about pleasure and fun. Safe sex depends on it and condom use rises<figure><img src="https://images.theconversation.com/files/445546/original/file-20220209-15-13y5sv9.jpg?ixlib=rb-1.1.0&rect=0%2C311%2C4831%2C2694&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/zFSo6bnZJTw">Unsplash/NeONBRAND</a></span></figcaption></figure><p>A focus on pleasure in sexual health education can increase condom use and enhance positive attitudes toward safe sex, according to <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0261034">a new international study</a> led by the University of Oxford.</p>
<p>The study, published today, supports decades of <a href="https://worldsexualhealth.net/resources/declaration-on-sexual-pleasure/">policy and advocacy work</a> seeking to push sexuality education <a href="https://doi.org/10.1080/19317610802157051">beyond abstinence or risk-based approaches</a> to improve sexual health outcomes. </p>
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Read more:
<a href="https://theconversation.com/netflixs-sex-education-is-doing-sex-education-better-than-most-schools-170776">Netflix's Sex Education is doing sex education better than most schools</a>
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<h2>What did the researchers find?</h2>
<p>The study, a systematic review and meta-analysis, involved collating and analysing all existing research on the topic.</p>
<p>The review included 33 interventions that placed pleasure and fun at the centre of safe-sex messaging. Interventions ranged from sex education workshops to online resources, videos and pamphlets. </p>
<p>The interventions targeted people from multiple countries and backgrounds, including gay men, heterosexual young people and adults, women attending primary care clinics, and men recently diagnosed with a sexually transmissible infection (STI). </p>
<p>Despite this wide diversity in settings and population groups, the studies showed consistent findings. Interventions which affirmed people’s right to pursue pleasurable sex were associated with more consistent use of sexual health services and improved awareness of contraception and preventing STIs.</p>
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<img alt="A young heterosexual couple cuddle in to each other." src="https://images.theconversation.com/files/445565/original/file-20220210-17-p52a2w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445565/original/file-20220210-17-p52a2w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445565/original/file-20220210-17-p52a2w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445565/original/file-20220210-17-p52a2w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445565/original/file-20220210-17-p52a2w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445565/original/file-20220210-17-p52a2w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445565/original/file-20220210-17-p52a2w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Open discussions about sex benefit young people and their intimate partners.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/WVG69HbLY_s">Edward Cisneros/Unsplash</a></span>
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<p>The meta-analysis combined data from eight interventions aimed at increasing condom use among their target population. </p>
<p>Findings showed emphasising eroticism and fun in condom messaging was more effective at increasing people’s uptake of condoms than other approaches, such as those that focus on messages about negative health outcomes. </p>
<p>This study makes an important contribution to existing evidence that risk-focused approaches to sexual health education, or health promotion, are less effective than <a href="https://doi.org/10.1080/19317611.2019.1654587">comprehensive approaches</a>, which encourage open communication about multiple aspects of sex and relationships, including sexual pleasure. </p>
<h2>Pleasure is part of life</h2>
<p>Sexual health interventions – which may include <a href="https://ajph.aphapublications.org/doi/10.2105/AJPH.2019.305320?utm_source=TrendMD&utm_medium=cpc&utm_campaign=Am_J_Public_Health_TrendMD_0">school-based education</a> or <a href="https://academic.oup.com/her/article/29/4/547/2845925">broader health promotion campaigns</a> targeting people of all ages – are usually designed to achieve particular health goals. These might be increasing STI screening, promoting human papillomavirus (HPV) vaccination, or reducing incidence of STIs. </p>
<p>Concern for sexual pleasure <a href="https://doi.org/10.1080/19317611.2019.1654587">is often not considered relevant</a> and messages about health risk dominate. </p>
<p>However, sexual relationships and pleasure are important aspects of human life and sexual health promotion is more effective if it accounts for this. </p>
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Read more:
<a href="https://theconversation.com/i-always-get-horny-am-i-not-normal-teenage-girls-often-feel-shame-about-pleasure-sex-education-needs-to-address-this-159543">'I always get horny ... am I not normal?': teenage girls often feel shame about pleasure. Sex education needs to address this</a>
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<p>Compelling examples of this come from the <a href="https://www.smithsonianmag.com/history/the-confusing-and-at-times-counterproductive-1980s-response-to-the-aids-epidemic-180948611/">HIV prevention campaigns</a> created by activists and community organisations in the 1980s and 90s. Many of these campaigns were controversial due to their use of <a href="https://www.afao.org.au/article/saved-lives-gay-community-australian-response-aids/">highly sexualised imagery and celebration</a> of gay and bisexual men’s sexuality, which had been criticised as hedonistic and irresponsible in the face of the HIV/AIDS crisis. </p>
<p>However, sex-positive messages were key to the success of these campaigns, which worked to normalise safe-sex through presenting it as fun and erotic. </p>
<h2>Pleasure and consent</h2>
<p>Affirmation of sexual pleasure is an <a href="https://doi.org/10.1080/14681811.2012.697440">important part</a> of sexual consent education. </p>
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<img alt="Two teenaged girls lay among grass, cuddling." src="https://images.theconversation.com/files/445564/original/file-20220210-13-641i87.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445564/original/file-20220210-13-641i87.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445564/original/file-20220210-13-641i87.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445564/original/file-20220210-13-641i87.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445564/original/file-20220210-13-641i87.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445564/original/file-20220210-13-641i87.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445564/original/file-20220210-13-641i87.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Intimate relationships require talking about what you do and don’t want.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/03tSOB03Xko">Masha S/Unsplash</a></span>
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<p>More than 30 years ago, <a href="https://www.hepg.org/her-home/issues/harvard-educational-review-volume-58,-issue-1/herarticle/the-missing-discourse-of-desire_448#:%7E:text=Michelle%20Fine%20argues%20that%20the,responsibility%20and%20subjectivity%20in%20adolescents.">in an important early paper</a>, American scholar Michelle Fine famously articulated how a “missing discourse of desire” in school-based sexuality education undermines young women’s sexual health and safety. </p>
<p>Writing about the US education system, Fine argued school-based sexuality education invalidates female sexual desire. This leaves young women more vulnerable to sexual violence or unwanted pregnancy. </p>
<p>The capacity to assert what one does <em>not</em> want in their sexual relationships, requires awareness of what one <em>does</em> want. It also requires the confidence to voice these desires without fear of being shamed. </p>
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Read more:
<a href="https://theconversation.com/how-to-get-consent-for-sex-and-no-it-doesnt-have-to-spoil-the-mood-172139">How to get consent for sex (and no, it doesn’t have to spoil the mood)</a>
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<p>Sexuality education should therefore be about building people’s sexual agency and <a href="https://theconversation.com/i-always-get-horny-am-i-not-normal-teenage-girls-often-feel-shame-about-pleasure-sex-education-needs-to-address-this-159543">confidence to talk openly</a> about the pleasures and risks of sex. Achieving this requires recognition of, and respect for, young people’s sexuality and relationships. </p>
<h2>Does sexual pleasure belong in classrooms?</h2>
<p>The idea that school-based sexuality education should focus on pleasure <a href="https://www.smh.com.au/lifestyle/life-and-relationships/sex-education-in-a-time-of-moral-panic-and-how-it-s-failing-our-children-20191007-p52y87.html">can be controversial</a>. How do we teach sexual pleasure in a classroom? </p>
<p>However, pleasure-based sexuality education is not about the mechanics of sex. Rather it’s <a href="https://doi.org/10.1080/19317611.2021.1921894">an approach to sexuality education</a> that affirms people’s right to sexual pleasure and fulfilment. </p>
<p>This <a href="https://pubmed.ncbi.nlm.nih.gov/17101419/">may include</a> emphasising fun and enjoyment in condom use, rather than focusing on cautionary tales. </p>
<p>Or it may be about giving people permission to talk openly about sexual identity or the complexities of relationships. </p>
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<img alt="Young African-Australian boy looks at his phone, texting." src="https://images.theconversation.com/files/445568/original/file-20220210-23-1fpn7ar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445568/original/file-20220210-23-1fpn7ar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445568/original/file-20220210-23-1fpn7ar.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445568/original/file-20220210-23-1fpn7ar.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445568/original/file-20220210-23-1fpn7ar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445568/original/file-20220210-23-1fpn7ar.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445568/original/file-20220210-23-1fpn7ar.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Pleasure-based sexuality education might include discussions about the complexities of sexual relationships.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/teenage-boy-listening-music-using-phone-343884407">Shutterstock</a></span>
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<p>Educators caution this approach <a href="https://www.tandfonline.com/doi/full/10.1080/14681811.2012.677208">should not impose particular definitions</a> of pleasure – pleasure can be many different things to different people. </p>
<p>Rather, pleasure-based sex education is about opening educational space for young people to safely explore, and developing critical thinking around, sex and relationships. </p>
<h2>Sexual pleasure supports sexual rights and health</h2>
<p>The basis of <a href="https://www.ippf.org/sites/default/files/sexualrightsippfdeclaration_1.pdf">sexual rights</a> is the opportunity for all people to pursue satisfying sexual relationships, free from harm or discrimination. </p>
<p>Respect for <a href="https://www.tandfonline.com/doi/pdf/10.1080/26410397.2019.1593787">sexual rights underpins</a> inclusive sexuality education, universal access to sexual and reproductive health care, and protection from sexual violence and discrimination.</p>
<p>Intrinsic to sexual rights is the acknowledgement that sexual pleasure is a <a href="https://doi.org/10.1080/19317611.2021.2015507">valued part of human relationships</a> that supports health and well-being. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/good-sex-ed-doesnt-lead-to-teen-pregnancy-it-prevents-it-60036">Good sex ed doesn't lead to teen pregnancy, it prevents it</a>
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<img src="https://counter.theconversation.com/content/176572/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer Power receives funding from the Australian Research Council, the Australian Department of Health and Fairer Victoria. She has previously received funding from ViiV Healthcare. </span></em></p>Pleasure-based sex education allows young people to safely explore and develop critical thinking around sex and relationships.Jennifer Power, Associate Professor and Principal Research Fellow at the Australian Research Centre in Sex, Health and Society, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.