Nov 092013

CC BY-NC-ND 2.0 - flickr user homelesshubDisclaimer: I am not a mental health professional but I’ve worked for a stint at a Men’s Mental Health Treatment Center in Pasadena. This post is a collection of my own thoughts on various aspects of mental health. It should NEVER be taken as medical advise. If you are in immediate distress, please call a hotline.

Gender and sexual minorities as a group have more difficulties with mental health than people who are not gender and sexual minorities. Mental health problems can create or worsen physical health problems, and vice versa. So I wanted to take a moment today to briefly discuss some issues surrounding mental health, specific mental health problems, mental health treatment, and things that you can do if you’re struggling.

What is mental health? It’s far harder to define mental health than it is mental illness. Mental health refers to how “healthy” or “unhealthy” our thoughts, emotions and behaviors are. Depending on who you talk to, a mentally healthy person may be a person who simply lacks a mental disorder…. or that may be insufficient. Am I healthy simply because I am not depressed, or does there need to be another component? Perhaps the ability to enjoy life, or feel fulfilled, or feel “happy” (whatever happiness is)? As you can see, mental health or mental wellness or psychological well-being is not an easy concept…. my thanks to the professor who taught me that in my undergraduate years.

What kinds of mental un-wellness are gender and sexual minority people susceptible to? Mostly those that have to do with stress. This has to do with the minority stress hypothesis – that simply by being a member of a minority group, your stress levels are higher, and you’re more susceptible to certain problems. So what kind of things are associated with stress?

  • Depression, which can manifest as low mood, hopelessness, low energy, lack of enthusiasm and enjoyment, and suicidality.
  • Anxiety, feeling “on the edge” or panicky
  • If the stress becomes traumatic, something like post-traumatic stress disorder or acute stress disorder can result. This is a state of hyperarousal, hypervigilence, and “flashbacks” to traumatic events.
  • The use of “escapes” or other coping mechanisms that can cause problems in and of themselves. These can be chemical (drugs), behavioral (self injury, over-exercise, under-eating), or psychological (dissociation). Other “addictions” may also fall into this grouping.
  • Psychosomatic illnesses. Sometimes mental distress manifests physically. Chronic headaches, stomach aches, fatigue, and other nonspecific symptoms may actually be psychological in origin. However! Please do see a physician and get their thoughts about symptoms like that because they could be physical in origin.

Many of these forms of mental un-wellness are categorized as a mental illness. However, not all mental illnesses are more common in minorities. Schizophrenia and autism are two prime examples.

If you are psychologically struggling, don’t despair. There are things that can help. Beware, though, because there are plenty of scams out there too.

  • Normally the #1 thing everyone says is to get help. Let me say this, though: If you don’t want to get better, you’re not going to. There are no magic pills, and nobody can crawl into your head and force you to feel better. It just doesn’t exist. But… if you want to get better? Cool! Let’s keep going then!
  • Definitely do consider getting help. Your social network may be able to help. Your physician may be able to refer you to local resources.
  • Consider therapy carefully, and choose your therapist carefully. Remember – not all therapists can deal with gender and sexual minority issues. Check out the listings on our resource pages for some starting places, and don’t forget your local resources. Outside of the therapist him/herself, there are techniques to consider too. The psychotherapy technique best supported by research is generally Cognitive Behavioral Therapy, or a variant of it (e.g., Dialectical Behavior Therapy). Cognitive Behavioral Therapy (CBT – yes, go ahead and giggle. I did.) is based on altering the way you think about things and the way you act toward things in such a way that you improve your mental outlook. Numerous other psychotherapy forms exist though.
  • Consider medications very carefully. Despite the commercials, research indicates that they may not be any better than placebo. And they come with side effects, including sexual side effects. Some, like benzodiazepines, are addictive. The exception to this caution is if you’ve been on a medication and it’s working, or if taking a medication is recommended by your physician. Please, follow your physician’s guidance and do not stop taking prescription medications that help. Only take prescribed medications as prescribed!
  • If you’re not already, start exercising and improve your diet. If you need to/want to lose a few pounds, go for it!
  • If you have a coping method that isn’t working, or that is causing problems in your life, it’s time to reconsider it. This will likely be hard for you. If you, for example, self-injure nearly every night because you feel overwhelmed… you need to look at that carefully. Does it actually help? Is it causing you any problems (e.g., people stare at the wounds, having trouble affording bandages, etc)? Are there other ways you can handle the stress? Are you addicted to the behavior, and if so do you want to stay addicted? Remember too that continuing the behavior may prevent you from accessing resources (e.g., a therapist may refuse to treat someone who self injures) or opportunities (e.g., scars may limit your job opportunities). And please also be aware that those behaviors can have life-long psychological effects.
  • If you have chosen to stop a coping method that was causing you problems, you may have a rough road for a little bit. Stopping any kind of addictive chemical or behavior can be hard. Where appropriate do reach out for help but remember to stay responsible for your own wellness. You can do it. Kick that thing’s butt!
  • Sometimes coping methods and sexual minority behaviors overlap. A person with a history of self-injury may practice sadomasochism as a way to “scratch” the proverbial itch. A person may seek out someone to dominant them to help them solve their eating problems. I am not at all saying that that’s why people practice BDSM, nor that it’s common…. but it does happen.
  • If you’re struggling because of trauma… I really, really strongly urge you to find supportive resources. One that will help you not only deal with immediate effects but help you transcend them. One of my favorite quotes, which may apply to you, is “The best revenge is living well.” Go get some serious revenge.
  • Evaluate your life. What’s working? What isn’t working? Do you need to cut off contact with your transphobic family? Are you getting harassed at work because of the collar you wear? Stressed because you can’t bring both your lovers and your children to your family reunion? Figure it out. Fix the problem areas and increase the areas that work well for you.
  • Be very suspicious of anything over-the-counter that implies it will make you feel better. Chances are it either doesn’t work (like homeopathy) or has the potential to be problematic (like alcohol).
  • If you are actively suicidal, please don’t commit suicide. Please. Please reach out and get help.
  • Give yourself some TLC – some tender, loving care. Seriously. Kids stressing you out? Save some pennies and send them off to a babysitter for the evening. Go see a movie. Soak in a bubble bath. Whatever makes you feel good about yourself (that does not have negative effects on your life like I described above).

Even if you aren’t diagnosed with any mental illnesses or don’t have specific symptoms, it’s important to take care of your mental health. How? Everyone’s ideas about mental health vary, but here are my personal ideas of mental health: I want to keep myself balanced. I want to be able to cope with anything life may throw my way. I want to be happy, or at least content, have things I enjoy doing that I do frequently.

So what are some specific things you can do to maintain your mental health? Here are some of my thoughts…

  • Maintain your support network. Pick up that phone and call your family. Go hang out with your friends. Help them when they’re struggling. Keep in touch with your physician. Know where you can find help if you need it.
  • Get/stay physically healthy. Exercise, eat well, keep a weight that’s healthy for you. Remember – physical things can affect your mental outlook. So however you choose to exercise, do it! Don’t eat fast food all day. All that good stuff I’m sure you’ve heard this a million times before. If you haven’t heard them, your physician can help.
  • Keep doing whatever it is you’re doing. Wonderful job? Keep at it! Good outlook? Hold onto it! Awesome community that supports you and cheered when you were finally able to marry? Stay there! You’re doing well so obviously something there is working.
  • Every once in a while, stop and reflect on all the aspects of your life. What are you doing that’s working? What are you doing that’s not? What should change? Maybe you’ve been drinking alcohol a little more frequently recently and it’s time to cut back.

This blog entry is in no way complete. I’m sure I missed a lot, simply because I’m only in my head. I can’t be in yours or know what worked for you. I really encourage you to comment and let me know what’s worked for you or your loved ones. Do you have good mental health? If so, why and how? Bad mental health? Why? How? And have you been able to do anything to improve it? Let me know in the comments and let’s get that conversation rockin’!

And another friendly reminder: I am NOT a mental health professional. Don’t take this as medical advice.

As always…  Stay healthy, stay safe, and have fun!

Aug 152011

Felching is the act of sucking semen out of an anus or vagina. It can be accompanied by “snowballing”, where the semen is shared between people orally. Felching can be done by both straight and gay partners. Felching is also relatively common in the gay male barebacking community. A recent study found roughly one in sex men who bareback also do felching.

There is relatively little information about felching in the academic literature. The greatest risk with felching or snowballing is the potential to spread STDs, including HIV and hepatitis. These diseases are spread most often from the inserting partner to the receptive partner. There is also a risk of spreading intestinal parasites, if the receptive partner has one. For that reason, it’s considered a “high risk sexual behavior”.

There is no way to use barriers to reduce risk with felching. The best way to protect oneself is to get all potential sexual partners STD tested before felching. Keep in mind that HIV can take up to three months to show up on an HIV test, so you may wish to wait until a test at three months is clean.


Jun 252011

Bondage(noun): the state or practice of being physically restrained, as by being tied up, chained, or put in handcuffs, for sexual gratification. Bondage can be done with many materials, including: rope, chains, body wraps, and cuffs (whether metal, leather, hand- or thumb-). Today we’re focusing on rope bondage.

A few notes before we begin: First, remember BDSM should never be done without consent. Also, consider using a safeword. Second, some acts may be illegal in your jurisdiction. Please check your laws and choose your actions accordingly. Third, I won’t be talking about suspension, or self-bondage. Those are topics for another time. And lastly, for simplicity’s sake, I’m going to use the term “top” for the person doing the tying, and “bottom” for the person being tied.

Rope? Yep, rope. What kind? Many kinds! Multifilament, nylon, and hemp are common materials for rope. Natural materials usually need some conditioning before use. Make sure the rope doesn’t have the potential to splinter, stretch or shrink.

A warning: Do Not use things like ribbons, scarves, or ties instead of rope. They narrow as they tighten and can end up cutting through skin. Ow!! Essentially: don’t use ribbons/scarves/etc any place you wouldn’t be willing to use dental floss.

Safety concerns:

  • Falling: Restrained arms and legs limit how well the bottom can balance. This increases the chance of a fall. If the bottom’s arms or hands are tied, they may not be able to catch themselves. Falls can be avoided by: a) having the bottom sitting, lying down, or leaning, b) watching the bottom carefully, c) making sure they don’t get lightheaded, d) tying certain areas but not others (e.g., the ankles, but not the hands).
  • Fainting. Yes, bottoms can and do faint. Some people are more prone to fainting than others. Bondage can create a light-headed sensation. Be careful when doing bondage with those at higher risk.
  • Joint issues. The positions involved in some bondage can make some joint problems worse. Choose positions accordingly, and change positions as needed. Discomfort should be taken seriously, since it can signal an imminent problem, like torn ligaments or dislocated joints. Ow!
  • Restricted blood flow. Without fresh oxygen, provided by blood flow, tissue can die. Dead tissue cannot magically recover. Check bound extremities (hands and feet) frequently. If they are cool to the touch or pale in color, loosen the binding. Also watch out for tingling and burning sensations.
  • Rope burn. Rope can burn skin when it’s dragged across it, just like a carpet burn. Synthetic fibers are particularly prone to this. Slow down.
  • Nerve damage. Tingling and/or numbness in a limb? Loosen the rope immediately! The best way to help prevent this is to communicate frequently.
  • Breathing constrictions. Some positions can make breathing difficult – avoid these or limit the bottom’s time in them and communicate frequently.
  • Emotional. Bondage can be a very emotional experience. Aftercare is highly recommended. If you think you might need professional help, there are bondage-friendly professionals you can turn to.

Special precautions may need to be taken with people with certain medical conditions, like diabetes (which affects circulation), fibromyalgia, or joint problems.

So… how can you improve the safety of rope bondage?

  • Frequent, open, and clear communication before, during and after the experience. Don’t just rely on a safeword!
  • Be careful about who you do bondage with. This goes for both tops and bottoms – both are vulnerable here.
  • Be very careful about mind-altering substances, like alcohol and marijuana. Many people avoid them altogether when doing BDSM. The ability to think and judge clearly is very important for safety.
  • Never tie certain areas of the body, like the neck and joints. I really do mean Never on this. Neck restriction can choke, and joint restriction can do a lot of damage. Just don’t do it.
  • Make sure the rope isn’t too tight. One way to tell is the “one finger” rule: Can you slide one finger between skin and rope?
  • Keep EMT (bandage) scissors nearby, just in case. They’re designed to cut fabric off skin without hurting the skin.

Curious? Want more information? Check out these resources (recommendations are always appreciated!):

  • SM 101 by Jay Wiseman. Has a good beginner’s section on bondage, including technique and rope selection.
  • Bondage safety on Wipi
  • Wikipedia’s article
  • has tutorials
  • Graydancer’s Ropecast (a podcast)
  • And, as always, your local BDSM community and its workshops. Can’t find your local group? Try your adult shops, or FetLife.
Jun 112011

Recent posts have been rather serious and depressing. So today it’s time for something completely different — genital piercings!

(By the way: All the links today are NSFW.)

Basic types

Genital piercings can be done for a variety of reasons. These include sexual pleasure, aesthetics, and individual expression. The types of piercing you can get depend on your anatomy. Not everyone can get every piercing type for their sex. Dydoes, foreskin piercings, triangles, and clitoris piercings are good examples of piercings that only certain people can have. In theory, people who have had genital surgery also may be able to get piercings, but should consult with a piercer and/or their physician. Additionally, people with certain medical conditions (like hemophilia), should not get these piercings.

For men, piercings can involve…

For women, piercings can involve…

There are, of course, other types of piercings, but I think this is a good generalization.

Healing, aftercare, and long-term care

Healing time varies depending on the type of piercing. Four to six weeks is the shortest healing time I’ve seen, and it’s generally for piercings that go through minimal tissue (e.g., inner labia, Prince Albert). The longest healing time can be six months or more! Generally, the more tissue the jewelry goes through, the longer the healing time.

The Association of Professional Piercers has very clear fliers with information on how to care for new piercings. It’s pretty simple: be hygienic and avoid trauma.

Potential problems include:

  • Infection. This is most likely during the early healing process. Good hygiene ought to help prevent infections. Viral infections, like hepatitis B, may be spread by the needles used in piercing… so please choose your piercer carefully!
  • Trauma. This can be caused by lots of tugging or jostling of the jewelry, Jewelry can even be torn out…Ow! The surrounding tissue can be torn, leaving an open wound vulnerable to infection. If that happens, head to the nearest urgent care center.
  • Migration and/or rejection. The jewelry can move around, and possibly even be pushed out of the body. This is most common with “surface” piercings (those that do not pass through. A belly button piercing is a surface piercing, as opposed to an earlobe piercing). Choosing surgical steel jewelry may help prevent rejection. Surgical steel should always been used for new piercings. Reducing trauma and pressure to the area may help prevent migration.

Genital piercings have a few special notes:

  • Barriers may be required for future sex, even for people who are fluid bonded. This is mostly relevant for penis piercings and vaginal or anal sex. The combination of the jewelry movement and contact with other fluids means potential infection. Barriers can help prevent that.
  • All urethral piercings (like the Prince Albert) may affect the way you pee. Some men, for example, may need to sit down to pee. For women, urethral piercings may increase the risk of urinary tract infections. Note that urine is sterile unless there is an active bladder infection, so it by itself usually doesn’t cause a problem.
  • Perineal piercings (like the Guiche) may need to be kept extra clean. They’re close to the anus and fecal matter, after all.

Got more questions? Ask! Or check out these resources:

Jun 102011

Some research has now been done examining the health consequences of hormone replacement therapy for transgender people. A study recently came out looking specifically at what’s called a “serum lipid profile”… or in other words, the fats (like cholesterol) normally floating around in blood. This was a somewhat long-term study. The reseachers were able to look at the lipid profile before hormones, 24, and 60 months after starting hormones. Both male-to-female and female-to-male transgender people had increases in triglycerides and total cholesterol. Trans women (male-to-female) had an increase in high-density lipoprotein (the “good” cholesterol). Trans men (female-to-male) had an increase in low-density lipoprotein (the “bad” cholesterol) and a decrease in high-density lipoprotein.

The authors conclude that trans men may be at a higher risk for cardiovascular health problems. Personally, I find these results to be a good reinforcement of the need for health monitoring during transition.

This study was published in The Journal of Sexual Medicine and its abstract is available free.