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Sexual Health

  • Sexual Health

    Understanding Sexual Health

    Coming up with a definition of sexual health is a difficult task, as each culture, sub-culture, and individual has different standards of sexual health. ASHA believes that sexual health includes far more than avoiding disease or unplanned pregnancy. We also believe that having a sexually transmitted infection or unwanted pregnancy does not prevent someone from being or becoming sexually healthy.

    Here is ASHA’s definition of sexual health:

    Sexual health is the ability to embrace and enjoy our sexuality throughout our lives. It is an important part of our physical and emotional health. Being sexually healthy means:

    • Understanding that sexuality is a natural part of life and involves more than sexual behavior.
    • Recognizing and respecting the sexual rights we all share.
    • Having access to sexual health information, education, and care.
    • Making an effort to prevent unintended pregnancies and STDs and seek care and treatment when needed.
    • Being able to experience sexual pleasure, satisfaction, and intimacy when desired.
    • Being able to communicate about sexual health with others including sexual partners and healthcare providers.

     

    Defining Sexual Health

    ASHA Board member and professor of pediatrics at Indiana University School of Medicine J. Dennis Fortenberry, MD, considers the term sexual health, how it is used, and how it can be defined.

    The phrase “sexual health” encompasses a range of public health and clinical issues related to prevention of sexually transmitted infections. I use the phrase a lot in my own work and its widening currency is a welcome new paradigm in our field. In fact, the concept of sexual health seems to me of fundamental relevance to all aspects of prevention of sexually transmitted infections.

    To be honest, though, all of the talk about sexual health doesn’t seem to have influenced the day-to-day particulars of our work. Sex still is primarily seen as a set of risk factors that we counsel against. I am convinced that this perspective on sex and sexuality as “risk” legitimates the stigma associated with sexually transmitted infections and contributes to our society’s poisonous intolerance of sexual diversity. A sexual health perspective incorporates the concept of personal and epidemiologic risks of sex, but recognizes the pervasive importance of sex in our lives.

    However, I’ve begun to wonder if I know what sexual health means in the first place. It’s a big concept, and maybe it’s natural that definitions seem idealistic, overwrought, and self-righteous. Consider the well-known working definition of the World Health Organization:

    “Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.”

    There is a lot to agree with in this definition, especially in its recognition of the complex physical, emotional, mental and social attributes of sexual health, and the anchoring of sexual health in universal sexual rights. But, I find this definition to be quaintly admonishing and parental (“…the possibility of having pleasurable and safe sexual experiences…”). More importantly, however, the definition is sexually vague. No matter how many times I’ve read, used, and cited this definition, I can’t derive from it even a rudimentary vision of how sexual health operates in people’s daily lives. I feel the same about the more recently wrought definition of the U.S. Centers for Disease Control & Prevention, particularly because sexual rights and of sexual pleasure are absent from that sexual health definition.

    So, maybe I need to get clearer with myself about what sexual health is. And, sexual health should be more than just the negatives: not coerced; not discriminated; not violent. The prevalence of these negatives in many people’s lives tells us how far we are from achieving a just and equitable society. But I think that sexual health ultimately requires much more active involvement from all of us, and it seems quite insufficient to hope that sexual health will arise on its own if coercion, discrimination, and violence are finally conquered.

    From: ASHA

  • Sexual Health

    Are You Ready for Sex?

    Sexual expression is an amazing gift. Sex, in its many different forms, can provide a way to express love, and learn about yourself and the ways in which you communicate with other people. With that said, sex is also deeply personal, and can result in feeling vulnerable to another person. Your reaction to sexual expression is uniquely yours, and only you can determine, in any relationship, when you’re ready to have sex.

    Even more importantly, no one ever has the right to pressure you into having sex. If you’re not ready–even if you and that person have had sex before–you always have the right to say no. It can be hard to say “no,” even if you want to; you might feel badly about hurting someone else’s feelings, or feel that there are expectations about what is supposed to happen. But you are the only person who should have control over your body.

    MAKE THE RIGHT CHOICE FOR YOU

    Are you ready for sex?

    The best way to prepare for the decision to have sex is to become comfortable with communicating about your needs. Choosing to take part in one kind of sexual activity doesn’t automatically mean that you’re up for anything. The best way to make sure that your limits are understood and respected is to have a partner who not only respects you and your body, but who will talk with you before you have sex about your concerns and boundaries.

    Communicating these things before you’re actually in a sexual situation can be very helpful in making sure that you are both on the same page. If you don’t feel right about something, say so! Anyone who challenges your choices about whether or not to have sex is not giving you the respect that you deserve. Pay attention to your feelings, and don’t let anyone make you feel guilty for making decisions that are right for you.
    Your Feelings Are Your Own

    Because sex can bring about new feelings, it is helpful to think about your reactions, emotions and possible risks associated with sex. Make sure you take time to think about how to prepare yourself for an experience that could be wonderful, but can also be hard emotionally. These questions can be helpful:

    • How will you feel about yourself after you have sex?
    • Why is it a good idea to have sex now, with this person?
    • How will you feel about your partner after you have sex?
    • Can you talk to that person about how you’re protecting yourself against pregnancy and STD/STIs?

    If you’re new to sexual activity, have you spoken with someone you trust about how to find and use that protection (i.e. birth control methods, condoms, etc.) correctly?

     

    Abstinence

    Choosing abstinence, or making the decision not to have sex at all, is your option at any time. Even if you’ve had sex before, it’s still totally your right to decide that it’s not something that you want to do. You might choose not to have sex at all for a long time; you might decide not to do so after you’ve been sexually active for several years. Remember: it’s your body! Pay attention to your feelings, and give yourself time and space to make the best choice for you.

    Asexuality

    Asexuality is another thing that might come into play in your life. Being asexual means that you don’t feel sexual attraction to anyone. Remember that it is absolutely normal to experience phases in your life that don’t include sex. However, if you want to learn more about your own feelings of asexuality or feel uncomfortable about them – especially if they come about abruptly – don’t hesitate to talk to a doctor or therapist.

    From: ASHA

  • Sexual Health

    Recognize Problems in Your Body

    Recognize Problems

    It’s important to know how your body works, and be able to recognize when something isn’t quite right. If something changes or doesn’t seem quite right, get checked by a qualified healthcare provider.

    If you have any symptoms that you’re just not sure about, get evaluated. But you don’t have to have a symptom to get checked, though. All sexually active women under age 26 are recommended to be tested yearly for chlamydia. Older women with risk factors (new or several partners) should also be tested. If you have questions about testing for sexually transmitted infections (STIs), don’t be shy about talking to your healthcare provider (learn more how to do that here).

    Also, ask about pelvic exams (see more below) and Pap tests. While not designed to detect STIs, these simple exams are an important part of a woman’s sexual and reproductive health. The American Cancer Society recommends women begin Pap testing within three years of first intercourse, or by age 21.
    Learn to Recognize Problems

    Menstrual

    Irregular Cycles
    In a perfect world, women would have their period on a regular cycle of 28 days. In reality, the range is more like 21-45 days. A young girl who is just beginning to have her periods and an older woman who’s at the end of her reproductive life may both have erratic periods.

    Get checked if:

    • You’re sexually active and skip a period. You may be pregnant.
    • Your period still hasn’t settled into a relatively predictable pattern after three years, or if you have four or five regular periods and then skip a period or becomes irregular.
    • Your cycle is less than 21 days or more than 45 days or if you don’t get a period for three months after first beginning your period.
    • Heavy, prolonged periods or no periods at all

    Either extreme can be a sign of trouble. The cause may be as simple as a hormone imbalance or as serious as a structural problem.

    Get checked if:

    • You’re soaking through at least one sanitary napkin (pad) an hour for several hours in a row
    • You have periods that last longer than 7 days
    • You haven’t started your period and you’re three years past the first signs of puberty or 16 years old
    • You’ve had normal periods then suddenly stop having periods for more than six months or for three of your usual cycles

    Painful periods
    Having cramps for a day or two of your period is normal, but if they’re severe enough to keep you from participating in your normal activities, it’s time to get checked.

    Abnormal bleeding
    This could be a sign of many things, such as endometriosis (tissue growing outside the uterus) for example, or other conditions. Get checked.

    Toxic shock syndrome
    This illness is caused by toxins, which create a bacterial infection. While linked with tampon use, it can also associated with the use of contraceptive sponge and diaphragm. If you have a high fever, diarrhea, vomiting or are in shock, get checked right away. Of course, the symptoms may not be related to toxic shock syndrome, but better to be safe than sorry.

    Sexually Transmitted Infections

    If you are sexually active, you have to protect yourself from diseases and infections. Obviously, the best protection is abstinence, but if you are having sexual intercourse, use a condom every time.

    Using a condom doesn’t mean you can forget about sexual health. You still need to be vigilant. Remember, many STIs do not produce symptoms.

    However, if you notice any of the following:

    • pain in the pelvic area
    • pain in the lower abdomen
    • pain when having sex
    • discharge from the vagina
    • a bad smell
    • bleeding between periods
    • burning when you pee

    Or if you notice a problem with the following:

    • painful bowel movements
    • nausea, vomiting or loss of appetite
    • fever or fatigue
    • blisters, sores, warts (or any odd skin change, including rashes and yellowed skin)
    • itching or swelling
    • inflammation (redness)

    …get checked.

    Having a symptom doesn’t mean you have a disease. The symptoms (or lack of) are so many and varied, it’s hard to tell if, for example, bleeding between periods is simply the result of a normal, age-related hormone imbalance or a sexually transmitted infection. Get checked anyway.

    Each year, one of every four sexually active teens will get an STD/STI. By age 25, half of all young people will have acquired one or more infections. If you have any symptoms that you’re just not sure about, get evaluated.

    What to Expect at Your First Pelvic Exam

    Whoever you choose—male or female doctor, nurse practitioner or physician’s assistant—let the provider know this is your first exam. He or she will be more apt to explain the procedure as you go along. Your provider will examine your external sexual organs for any changes or abnormalities. They will also use an instrument called a speculum to open your vagina and take a look at your cervix. A Pap test is often done as part of a pelvic exam. While the vagina is open, the healthcare provider will use a small stick or brush to take a collection of cells from your cervix. These cells are then sent to a lab and examined under a microscope for anything that looks abnormal. The Pap test is an important means of preventing cervical cancer.
    The whole exam is quick, painless and necessary.

    Once a baseline has been established, any changes in your body will be noticeable and easier to diagnose. If an abnormality exists, it can be treated.

    Bottom line? Pay attention to your body and how it works. Make sure a qualified healthcare provider is tracking your reproductive health. If something changes or doesn’t seem quite right, get checked.

    From: ASHA

  • Birth Control, Sexual Health, Tough Questions

    Types of Birth Control and Their Pros and Cons

    Which Birth Control Method is Best for You?

    Birth control can sometimes be a taboo subject and can be especially uncomfortable for teens to talk about. It is important to remember that birth control is used for numerous reasons such as helping with regulating periods, treating symptoms of endometriosis, and preventing unwanted pregnancies, which is the primary purpose. It is essential to know your options when getting birth control. Most people think the pill is their only option, but there are several different forms of birth control. Some factors one might consider when deciding which type of birth control to use include its effectiveness for preventing pregnancy, the frequency with which you renew it, and how well or poorly your body reacts to it. Here are the four main types of birth control on the market which one should consider when thinking about getting on birth control.

    1. The Pill

    The pill is the first on the list because it is the most obvious. The pill is good because you can take it just a day at a time, and if you want to quit then you just stop taking it. The downside to taking the pill is that you DO have to worry about it every single day, and if you forget to take it then it can throw you off. While birth control is used for more than just protecting against pregnancy, if you do use it while being sexually active and you miss just one day, it can result in pregnancy. Even if you don’t forget, the pill only works 91% of the time when protecting against unwanted pregnancy, which most people don’t realize. Many people end up taking the pill because they don’t know there are other options available to them.

    2. Depo-Provera aka “The Shot”

    Depo-Provera is birth control in the form of a shot given by your gynecologist every three months. The main pro is not having to worry about it as often as the pill, but you still have to remember to get your shots on time for it to be effective for whatever reason you may be getting it. When using it to protect against pregnancy, it protects about 97% of the time and can protect up to 99% of the time if you get your shots regularly and on time. The shot is a good middle ground because it is more effective than the pill but is somewhat less effective than the implants. It also requires less frequent attention than the pill, but more attention than the implants which can last for years.

    3. The IUD

    The IUD and arm implant are similar. The IUD is placed in the uterus and works by releasing hormones directly into the uterus which keep the sperm from reaching the egg. Most people who have an IUD can also expect to experience no menstruation at all, so it is also great for those who have heavy periods. This option prevents pregnancy more than 99% of the time and can last anywhere from 3-5 years depending on what kind you get. Some people, like myself, tend to avoid this option because they don’t like the idea of having something placed into their uterus. The uterus is a sensitive area, and having something foreign placed there can cause complications every so often. Even though this is not common, there is still the possibility, and it does happen on occasion.

    4. Implanon/Nexplanon aka “The Arm Implant”

    The implant is the birth control which I personally use because, to me, it seemed like the easiest option. However, the majority of women do not know about this option. I did not know about it until I started researching the types of birth control which exist on the market. I did not want to worry about taking a pill every single day and, even though I was using it to regulate my period, 91% effectiveness in pregnancy prevention did not sit well with me, had I needed to use it for that reason. The implant is basically a small white stick about 1.5 inches long and 2mm in diameter. It is inserted into your upper left arm by your gynecologist, and that’s it; you are good for three years. You don’t have to think about it for a while, and it protects against unwanted pregnancy more than 99% of the time. The con to this option is that people are prone to bleed over a period of time after they receive the implant. For me, I had a period for two weeks, but after it finally ended, I didn’t have a period in the two years between then and now. Others aren’t always so lucky. Some women have bled for up to six months and just decided it wasn’t worth it. Basically, some people don’t react well to it. Talk to your gynecologist about the best options for you and the concerns you may have if you are thinking about getting the implant. Every woman is different, and our bodies react differently to different medicines.

  • Articles, Sexual Health

    Usher and Consent

    News broke recently that R&B and pop singer Usher Raymond, better known simply as Usher, is being sued by at least three people for exposing them to the herpes virus without informing them beforehand. There is no cure for herpes once someone is infected. This is clearly a serious accusation, no matter who is being accused. But there is more to why it is serious than might meet the eye.

    The biggest reason this is an issue is because of consent. This word frequently pops up when people are discussing sex, but many people do not know exactly what it means. Consent at its most basic means permission. When someone consents to something, that means they are giving permission for it to happen.

    So, when it comes to sex, many resources say, “You need to get consent before you have sex.” This is true; otherwise, it is not sex that is occurring, it is rape. But consent encompasses much more than a lack of a “no.”

    To get consent, a “yes” is required. The lack of a “no” is not consent; the presence of a “yes” is. If a partner is silent, that is not a yes. If a partner is unsure but does not quite say no, that is not a yes.

    In addition, if a partner does not know what they are consenting to, that means that they have not given consent. This brings us back to Usher. The people accusing him may have said yes to having sex, but they thought that they were saying yes to sex with someone who did not have any sexually transmitted diseases. The fact is that Usher may have gotten consent, but he did not have what is referred to as informed consent. Informed consent is extremely important. Without it, there is no respect, and there is a risk of legal action.

    Consent is mandatory. According to the attorney representing the accusers in the Usher case, one of her clients has been diagnosed with herpes. The reason this is a big deal is because the person who contracted herpes from Usher did not decide for themselves to take the risk that they might get herpes. They decided that they would have sex with him, yes, but they did not decide that the risk of herpes was worth it. Had they had been informed before having sexual contact that Usher had herpes, they may not have decided to have sex with him.

    Informed consent is essential because everyone has a right to know what they are getting into before making any decisions. No matter how much you want it, having sex is never more important than a partner’s right to decide whether they want to have sex with you and, if applicable, expose themselves to any diseases that you know you have.

    Usher was definitely in the wrong here. Hopefully he will learn from this and not repeat his mistakes. Everyone has a right to decide whether they are going to give consent, even when it’s a celebrity that they are talking to.

    (Written by Megan Flint.)