Oct 122015
 
Human Papilloma Virus

Human Papilloma Virus

Little is known about reproductive cancer risks among cisgender lesbian and bisexual women. Cancer registries generally don’t ask about sexual orientation. Studies suggest so far that lesbian and bisexual women are less likely to get a pelvic exam and pap smear when it’s recommended. Pap smears help to detect cancer in its earlier, most easily treated and cured stages. Logically, lesbian and bisexual women may be at risk for having more developed (and potentially incurable) cancers. The data confirming that aren’t in yet, but it seems likely.

And now we have HPV vaccines. The human papilloma virus is a major cause of cervical cancer, along with anal cancer, penile cancer, and mouth/throat cancers. Human papilloma virus spreads by skin-to-skin sexual contact regardless of biological sex or gender. Along with pap smears, the HPV vaccine has been a great tool for preventing advanced cervical cancers.

This week I looked at a study of survey data from 15-25 year old women from the National Survey of Family Growth, from 2006-2010. They asked the questions: “Have you heard of the HPV vaccine?” and “Have you received the HPV vaccine?”

The results were rather spectacular. Lesbian, bisexual, and straight women had heard of the HPV vaccine. There was no difference there. However, 28% of straight women, 33% of bisexual women and 8.5% of lesbian women received the HPV vaccine.

That’s 8.5% of lesbians vs 28-33% of non-lesbian women.

Why?? Lesbians are at risk for HPV infection too!

Before looking at what the authors thought, I have some thoughts of my own.

2006, the earliest year this study had data on, isn’t too far off from when I graduated high school. I remember the sex ed class we had. We were lucky to have sex ed at all. It was a one-day class focused on the effectiveness of birth control options, how to put a condom on a banana (or maybe it was a cucumber?), and sexually transmitted diseases that can be passed between men and women in penis-in-vagina sex. There was no discussion of sexually transmitted diseases that are passed between men who have sex with men or women who have sex with women. I remember walking out of the class feeling confused and alone — what STDs were passable between women, and how can women protect themselves and their partners? Were there diseases that women could spread? Was protection warranted? I had no idea.

The study authors discuss similar problems and attributed the difference between lesbian HPV vaccine and bisexual/heterosexual HPV vaccine to misinformation. The idea that lesbian women who have never had sexual contact with men don’t need pap smears or HPV vaccines is old and incorrect, but still persists. I remember when pap smears were recommended starting at first sexual contact with men — if a woman never had sexual contact with a man then she didn’t ever need a pap, right? Wrong!

But it takes time to correct misinformation. As the authors correctly point out, important changes have happened since 2010. HPV vaccine is now recommended for all young people regardless of sex, sexual activity, sexual orientation, or gender identity. It’s not just a vaccine for a sexually transmitted disease — it’s a vaccine against some forms of cancer. Pap smears are now recommended for everyone with a cervix every 3-5 years or so.

So can you be part of the change? Help spread the word about HPV vaccine for *all* people, and pap smears for people cervixes!

The study was published in the Annals of Internal Medicine. The abstract is publicly available.

May 082014
 

CC BY 2.0) - flickr user stevendepoloA little belated, but here’s the GSM health news that came out around April this year, in no particular order…

  • There was a new meta analysis of intestinal vaginoplasties published in April. This meta analysis overall found that rate and severity of complications was “low”, with stenosis the most common complication. There were no reports of cancer. Sexual satisfaction was high, but there were no quality of life measures reported. Quality of studies were reported to be low, though, and there was a distinct lack of use of standardized measures. Source.
  • Oncology Times released a review of cancer and cancer screenings in transgender people. Highly recommend you take a look at the source.
  • A study finds that trans men on testosterone have lower levels of anxiety, depression and anger than trans men not on testosterone. Source.
  • A review of current hormonal transition effects and aging determined that, based on current data, “Older [trans people] can commence cross-sex hormone treatment without disproportionate risks.” They note that monitoring for cardiovascular health is especially important for trans women, especially those who are on progesterones. Strength or type of hormones may need to be modified in order to minimize risk. Source.
  • As much of the sex positive community has known for a long time, the BMI of cis women is (in general) not correlated with sexual activity. Source.
  • In Croatian medical students knowledge about homosexuality was correlated with positive attitudes. Source.
  • Science is awesome! The Lancet reported success in engineering vaginas for 4 women with MRKHS. No complications over the 8 years of follow up, and satisfaction with sexual functioning. Fingers crossed that this technique can be used in the future for many more women! Source.
  • Remember that sexual orientation is not the same as behavior? In a recent analysis of previously collected data, 11.2% of heterosexual-identified sexually active (presumably cisgender) women reported ever having a same-sex partner. Another way of looking at it: 1 in 10 straight women have had sex with another woman. Source.
  • Don’t forget about aftercare and cuddling! Post-sex affection appears to be correlated with relationship satisfaction. Source.
  • Unsurprising but sad: Young LGB people are more likely to binge drink alcohol when they’ve been exposed to discrimination and homophobia. Source.

 

Oct 192012
 

Data from a University of Maryland School of Medicine survey were just released showing that nearly four out of ten lesbians do not get regular pap smears. Pap smears screen for cervical cancer, among other things. Cervical cancer is usually caused by the human papilloma virus (HPV). HPV can be spread by skin-to-skin contact, so lesbians are just as much at risk for getting HPV as bisexual or heterosexual women. Screening is important to detect precancerous changes and cancer in their earliest stages so that treatment can be done when it’s most effective, preventing deaths.

Why do so few lesbians get their screenings? The primary reasons cited in the survey were: a) not having a physician referral, and b) not having a physician. Together, these two reasons account for 34.8% of study participants. We already know that lack of access to care is a big problem in gender and sexual minority communities. This just helps to confirm it. The survey authors note that lesbians who were open with their physicians about their sexual orientation were more likely to be screened than those who weren’t open.

There has been a recent change to pap smear recommendations. Pap smears are no longer recommended every year for most people. Screening starts at 3 years after first sexual activity, or age 21, whichever is first. From age 21-30, screen every 3 years, then from age 30-65, screen and do an HPV test every 5 years. After 65, no screening is recommended. If a pap smear is abnormal, screenings become more frequent. I should also note that these guidelines apply to everyone with a cervix, regardless of gender identity.

I, personally, think it’s highly advisable for everyone to know their HPV status and get vaccinated if possible, in addition to regular pap smears. HPV vaccines are not a replacement for pap smears because they don’t vaccinate for all HPV strains which cause cervical cancer. However, vaccines do protect against some.

EDIT (10/21/2012): I should also note that during a pap smear, a physician can do other screenings. This includes gonorrhea/chlamydia screening, looking for signs of other STDs or vaginal cancer, and checking the ovaries for lumps.

Jul 052011
 

A new study looking at transsexual health just came out. This one looked at the well-being and sexual health of transmen after sex reassignment surgery ( SRS – phalloplasty in this case). Unfortunately, I don’t have access to the full article so I can’t go into too much detail.

The study was conducted in the Netherlands, with 49 transmen. Most of the men had had phalloplasty on average eight years before the study and reported an increase in sexual activity after transition/surgery. They report that they can have orgasms, and that the quality of their orgasms has changed as a result of transition. Despite high rates of surgical complications, most were happy with the results of their sexual reassignment surgeries. They were also generally happy people.

These things may seem like, “Well… duh.” But this is the first study I’ve seen that confirms that “common sense” idea. I’m glad to see it. What do you think?

Apr 032011
 

Besides feeling good and being great fun, foreplay is important! Foreplay allows more time and stimulation for full arousal, which will likely make whatever activity you’re going to do easier and more pleasurable. Psychologically, foreplay helps lower inhibitions and increases emotional connectedness.

What physically goes on during arousal in foreplay?

For men, the most obvious change is the erection of the penis. Not all penises become erect when a man is aroused – this is especially true for older men. The glans (tip) of his penis may swell, and the foreskin, if he has one, may retract. He will also produce pre-ejaculatory fluid (pre-cum) which comes out through his urethra – this is produced by the bulbourethral glands (also known as Cowper’s glands), near the base of the penis. Why does this happen? Erection and foreskin retraction allow for easier penetration. Pre-ejaculatory fluid helps lubricate the urethra. It also contains chemicals that neutralize any remaining urine in the urethra (Urine is acidic and could be damaging to sperm).

For women, the most obvious changes are lubrication of her vagina (this is produced by the cervix of the uterus). Her vagina expands and the cervix lifts, creating more room in her vagina. Her labia change shape and color in response to increased blood flow, and her clitoris becomes swollen. Why does this happen? Largely to make vaginal penetration easier. Lubrication eases movement within the vagina, and the enlargement of the vagina allows larger items to penetrate. Also, for women, it may help with achievement of orgasm.

There are a bunch of ideas surrounding foreplay that may or may not be true. Here are a few:

  • “Men don’t really need foreplay, and women do.” I don’t think so. A fairly recent study found that both men and women need about ten minutes to reach (physical) peak arousal (Source). So physically, I’d say no. The study didn’t, however, look at mental arousal which could be a factor.
  • “Foreplay increases sexual satisfaction and chance of orgasm.” Maybe….maybe not. While the popular media and personal anecdotes definitely support this idea, a study of Czech women found that duration of sex was more important than the duration of foreplay. So the jury’s out on this one. My money, though, is on the statement being true.
  • “One technique is guaranteed to work on everybody.” Not true! Everyone is different. This is where communication is crucial.
  • “Aim for these erogenous zones.” Not as easy as it sounds. An erogenous zone is supposed to be one with heightened sensitivity…but it’s different for every person and for each situation. For a common example, look at feet. Some people find their feet to be very sensual and erotic. Others don’t feel much with their feet, and some can’t stand having their feet touched at all because they’re too sensitive. The best way to find out where they are? Explore!

What counts as foreplay? That depends very much on the people involved. I think I’ve managed to come up with a few categories of activities, though…

  • Sensual touch: including with  hands, fur, leather, metal, lips (kissing), body paint, temperature (ice/hot wax, etc) and breath. Massage (with or without oils). Includes pain and impact play (e.g., flogging).
  • Psychological play: including dirty talk, humiliation, and roleplaying.
  • Erotic dress and teasing: including strip teases, erotic clothing,
  • Preparatory: Getting ready for a “special night” – cooking, eating special foods (or feeding them to someone), getting dressed up all nice, bathing with extra care, etc.
  • Bondage: including rope, chains, leather, and handcuffs…and anything else you can think of.
  • Voyeurism: watching others having sex – whether with pornography or live.
  • Misc: talking, erotic games, tantra

All of this brings up what is probably the most important part of foreplay (or, heck, any relationship-based act): Communication. Your partner(s) are not psychic, so communicate, communicate, communicate! Even if it’s embarrassing.

There are a couple of things that may cause problems with foreplay or arousal that I feel I should mention. Physical problems or illnesses can make some foreplay activities difficult if not impossible. Nerve damage can affect otherwise sensitive areas. Erectile dysfunction and vaginal dryness are relatively common, especially as we get older. Psychology can also affect everyone’s foreplay (not just women!). Trauma especially can have debilitating effects on sexuality. Some medications or drugs can also affect sexuality. If you’re having troubles with anything like what I’ve mentioned, start by talking with your partner(s). Still need help? Try talking with your doctor or a qualified sex therapist – they ought to be able to help.

The take-away message? Foreplay is good for your sex, good for your relationship(s), and good for you. Go have fun!