Speaking Out!

SPRING TALKS SEX - Sexual assault – Seeking a sea change
Tue, 2013-01-29 12:52

By Lyba Spring

At the end of 2012, when a 23-year-old woman in India was viciously attacked and later died of her injuries, it touched off a movement which will hopefully have a profound effect on their culture. Not surprisingly, there is no such movement in the Congo where rape continues to be used against both men and women as a weapon of war. During the last American presidential election, the absurd and enraging remarks about rape and pregnancy got a lot of press as well as more activity from women’s organizations in a long time. In a Toronto neighbourhood last summer, people came together after a series of sexual assaults, resulting in well-attended and well-publicized demonstrations.

And yet, despite decades of feminism and talk of “rape culture” we do not seem to have affected a fundamental shift in thinking in Canada.

Working in middle school and high school classrooms for three decades, I dedicated considerable time to issues of gender equality, including developing an education module on sexual assault specifically in a dating situation. 

Years ago, I was in a class of Grade 8 students, 13-year-olds. We were working through the first part of an exercise on sexual assault. I was asking them to respond to a list of statements. It was interesting that they often gave the thumbs up to what they thought was the “correct” answer. For example, “no always means no” almost universally got a yes. Then, I would explore why some girls and women may say no at first, but then seem to accept the advance. They understood that some girls and women don’t like to be considered “easy”; that they worry about their reputations. They also understood that the tone of voice or body language could lend their “no” a certain ambiguity, resulting in miscommunication, especially if alcohol was involved. 

Next statement: “a person never loses the right to say no.” One boy stood alone in his refusal to accept that notion. I asked the class under what circumstances someone might want to stop the action and the student responses included: experiencing pain if it was the first time, a change of mind, worries about STIs, etc. But this one male student steadfastly insisted that once you started you had to finish. I said, “what if you’re with a girl, you’re on top and you see that she’s in pain?”

“Turn her face away,” he said. 

I later found out from his teacher that he had trouble with female authority figures, which made sense in terms of his misogyny and lack of empathy; but it also made me fearful about his potential future behaviour.

It is an understatement to say that parents are raising children in a culture steeped in contradictory images of what it means to be a man, what it means to be a woman. What’s a parent to do?

One day when my children were young, I heard my young son and daughter fooling around in the living room. My daughter sounded unhappy about what was going on. I peeped in. My son had pinned her down and she was struggling to get up. I said to my daughter, “say, ‘get off me’ like you mean it”; and to my son, “and then you have to listen.”

Of course, using this kind of teachable moment can only happen in a context with all other things being equal. Statistically, a child who has been sexually abused is more likely to be sexually assaulted, especially in the absence of good therapy. The egregious ongoing assaults and murders of Aboriginal women are in a category by themselves based in the profoundly racist history of our relationship with First Nations people.

We live in a society that deems us responsible for our choices in health, including sexual health, without taking into consideration the factors over which we have no control, like abuse, poverty and racism. Yet, the potential for dealing with sexism remains the purview of the parent through education. What is taught—or not taught—in the home can have a profound effect on children’s ability to work through the issues despite the media barrage of sexist images, including pervasive violent sexual images.

After the 23-year-old Indian woman died of her injuries recently, men in India laid their bodies down in the street and called for a fundamental shift in culture. Our White Ribbon Campaign has made some significant inroads; and yet, the scourge of sexual assault remains statistically high. In 2011 more than 21,800 sexual assaults were reported in Canada. We know this represents only one in ten of the actual assaults, which are most commonly committed by someone we know.

Of the many challenges facing our quest for equality, this one runs deep.

Talk to me: springtalks1@gmail.com

Spring Talks Sex

SPRING TALKS SEX - Great sex
Wed, 2013-01-09 12:55

By Lyba Spring

Do you ever watch a movie, riveted by those slow, languorous, delicious lovemaking scenes; or the rip-your-clothes-off-and-get-sweaty-in-the-heat-of-the-moment scenes that make you want to howl at the moon: “I want that!”

Sex columnist, Dan Savage, says as partners, we are to be “good, giving and game.” I don’t know about you, but I think some more specific guidelines for good sex would be really useful.

A wonderful piece of research asked the question about great sex to an eclectic group of participants. I had jotted down the list below of the common themes that emerged, tucked it away and then forgotten where I’d seen it. 

  • being present
  • connection
  • deep sexual and erotic intimacy
  • communication
  • interpersonal risk-taking and exploration
  • authenticity
  • vulnerability
  • transcendence

So this is my personal take on these themes.  Feel free to compare them to the original research.

Being present: We hear more and more these days about the importance of being fully present in all of our activities. When you are with someone—here and now—and they are with you too, your presence creates the basis for physical and emotional intimacy. If you are truly there with each other, every move you make, every caress and kiss given and taken with deliberation resonates with both of you.

Connection: Presence forms the basis for connection because you are embarking on a journey together. Although our sensations are our own, being connected to another person sensually allows both to appreciate the other’s sensations.

Deep sexual and erotic intimacy: No matter how simple or complex your sexual activity, you may feel like you have never done this activity in this way with anyone else before. There is nothing but feeling and connection. Turning on a partner can be very erotic, as is stripping away layers to get to basic instincts.

Communication: Think about what turns you on. Ask yourself about the key elements of why it turns you on. Now try to express this to a partner. When your partner asks you to say or do certain things, if you find yourself wondering why and want to find out, try to ask them from the viewpoint of true curiosity rather than criticism.

Perhaps the best example of good communication happens when you are trying something different, like adding a potentially charged sexual activity to your erotic repertoire. A colleague of mine adds to this, saying that when there is a “high degree of communication due to embarrassment and pain there is also a nod to the high degree of intimacy from joint discovery, new pleasures and the communication of desires that may feel taboo.”

Interpersonal risk-taking and exploration: If your partner suggests something or starts to initiate a new position or activity, the basis of this exploration is trust. If you make it clear you are ready to go there, clear communication now plays a vital role. Do you like it? If not, perhaps there something you can do that will make it more enjoyable/comfortable. If you don’t like it and want to stop, it is important that you can count on your partner to continue to think well of you and desire you as before. The same holds true if there is something you suggest that they reject.

Authenticity: This is not a movie (even if you are recording it for future pleasure). You are being as real with this person as you know how to be. Even if you are role playing, it is with the part of you that you are willing to share with your partner. How unfortunate that people sometimes feel they need to pretend enthusiasm for something that gives them no pleasure, either personally or through their partner’s pleasure.

Vulnerability: Acknowledge that this incredibly intimate activity can end in physical or emotional distress—or joy. If you are a survivor of sexual or emotional trauma, your partner has to pay particular attention to your sensibilities. If you have a disability and must put your trust in your partner’s assistance and tender caring, you are opening yourself completely, trusting that you will come to no harm. Anyone engaged in sexual activity is wide open: with concerns about physical “imperfections” and the secrets of the most intimate parts of their bodies. Breaking down barriers and allowing your partner to see your vulnerabilities is a great gift.

Transcendence: Did the earth move? Perhaps not, but how wonderful if while being in your body and present with your partner, you are still able to go somewhere you have never been before, whether it be a spiritual experience or a letting go that is so powerful you feel lost—and found—at the same time.

Talk to me—not dirty, but let me know if what I have been writing resonates. There are lots of issues I want to cover, and if you have specific requests, I’d like to hear them. 

springtalks1@gmail.com

Spring Talks Sex

GUEST COLUMN - Unpacking the great mammography debate
Tue, 2012-12-18 22:42

By Cornelia J. Baines 

Since the late 1980s people have argued heatedly about the usefulness of mammography screening, especially in women aged 40 to 49. This unceasing controversy continues. Burgeoning new research in the first decade of 2000 clearly revealed that therapy was outweighing the impact of mammography in terms of mortality reduction. But the defence of screening persists. In September 2012, the Journal of Medical Screening (JMS) issued a supplement reporting that, based on European data, screening benefits were unquestionable. I document the flaws underlying this conclusion, but these flaws are more easily understood when framed by the controversy’s history. So I outline events up to 2000 and then critique the JMS message.

Since 2000, many downsides of screening have been widely reported. Twenty-one hundred (2,100) women aged 40 to 49 must be screened every two years for 11 years to avoid one breast cancer death. Of these, 700 women endure false-positive screens leading to unnecessary diagnostic work-up and anxiety, and ten to 15 will be over-diagnosed and receive unnecessary breast cancer treatment. (Having breast cancer, I am appalled that anyone might undergo unnecessary therapy.)  Importantly, contrary to expectations, screening has not reduced subsequent incidence of advanced cancers, a prerequisite for successful screening.

The good news is that even in jurisdictions without screening programs, breast cancer death rates have declined to the same extent as observed in screened populations, with declines even in women in their 30s to whom screening is not offered. The message is clear: breast cancer treatment has radically improved over the last few decades leaving little opportunity for screening to help. And downsides to screening are incontrovertible.

Why the continuing defence of screening? Let’s look at the history.

In the beginning, that is, in the last half of the 20th century, randomized controlled trials evaluated breast cancer screening. Women in a specific age group were either randomized to mammography or to be “controls” with no mammography. Of all the trials, two received much attention.

Trial A used signed informed consent for both groups. Trial B assumed consent with attendance for screening but controls were “un-informed.” 

Trial A randomized individuals. Trial B randomized clusters of women.

Trial A compared mammography to no intervention in women aged 40 to 49 and mammography plus clinical breast examination to clinical breast examination alone in women aged 50 to 59. Trial B compared mammography to no intervention.

In Trial A, 100% of participants complied at first screen. Not so for Trial B.

Trial A annually collected detailed demographic and medical information from both groups, for the trial’s duration. Trial B recorded only age at entry.

Trial A offered four to five rounds of screening. Trial B only two to four.

Trial A used two-view mammography; Trial B used single-view.

Trial A screened women every 12 months; Trial B every 24 to 33 months.

Trial A at first screen had smaller cancers and a higher cancer detection rate compared to Trial B.

Trial A over time published consistent numbers regarding trial outcomes such as cancers and deaths; only in 2011 did Trial B finalize its numbers.

Trial A audited mammography externally based on a randomized stratified sample. Trial B described no audit.

Trial A externally audited all tissue biopsies. Trial B did not.

Trial A externally reviewed causes of deaths for confirmed or probable breast cancer cases. Trial B reported their procedure 26 years after first publication.

Now it came to pass that Trial B reported that mammography hugely reduced breast cancer deaths in women aged 40 to 74 and the world rejoiced. Paradoxically, Trial B also revealed a 26% excess of breast cancer deaths in screened women aged 40 to 49; that was ignored. Trial A reported no screening benefit for women aged 50 to 59 and the world was sore aggrieved. Excess breast cancer deaths in screened women aged 40 to 49 (as in Trial B) was loudly condemned. Trial A (The Canadian National Breast Screening Study) was found to be flawed, while Trial B (The Swedish Two-County Trial) was praised and magnified. Forth went Two-County prophet Tabár with Mammography Education Incorporated  proclaiming “mammography saves lives” for nigh unto 30 years. Revered he preached in upscale hotels at touristic destinations for substantial fees, and new disciples spread his gospel. Corporations like GE Healthcare and Siemens (that make mammography units) gave their benediction, donating vast sums to the American College of Radiology to promulgate the prophet’s message. And so great was women’s fear of breast cancer, they too became converts steadfastly believing in screening mammography. Others following the new gospel were surgeons and pathologists, for lo their work-load increased! 

Evidence from all the trials comparing mammography to no mammography reveals a 15% reduction in breast cancer mortality for women aged 50 to 69. But North American women aged 40 to 49 insisted that they too be screened. Radiologists even persuaded the U.S. Senate that these women deserved no less, in spite of unbiased, expert opinion to the contrary. Those not endorsing screening for women under 50 included the Canadian Task Force on Periodic Health Examination, the Canadian Workshop Group (Canadian Cancer Society, Department of National Health and Welfare and the National Cancer Institute of Canada), the U.S. Preventive Services Task Force, the American College of Physicians, the U.K. Forrest Report, the International Union Against Cancer, the European Group for Breast Cancer Screening, the New Zealand Cancer Society, the British Medical Association, and national policies in Finland, Denmark and Holland. Such dissent was heresy. The public agreed the best available version of the truth came only from radiologists and their acolytes.

Despite the wave of more recent research showing fewer benefits than previously thought from screening, not surprisingly, screening advocates are strenuously defending themselves, most recently in a supplement to the Journal of Medical Screening (JMS), describing findings from the Euroscreen Working Group (ESWG). Where controversy prevails, the messengers as well as the message require scrutiny. JMS has a low impact factor of only 1.69, compared to the Journal of the National Cancer Institute (13.757), Annals of Internal Medicine (16.7), New England Journal of Medicine (51), Lancet (33.797) and BMJ (14.093). What could explain the choice of a low impact journal?

The JMS’ pro-screening message was praised in AuntMinnieMobile, an online entity offering "news, educational links, … and information for radiologists, technologists, administrators and medical imaging professionals.” AuntMinnieMobile is sponsored "in part" by Phillips Health Care, manufacturers of imaging systems. 

“The researchers found that mammography had a mortality reduction of 48% among women who were screened. What's more, the study found that the number of women whose lives were saved outnumbered by two to one the number who were ‘over-diagnosed,’ or who had cancers detected that might never cause symptoms or threaten their lives”  (Letter from the Editor, 13/09/12).

With these results, the editor declared, the breast screening controversy was finally over! 

However, according to objective expert panels, breast cancer screening does not remotely achieve a 48% mortality reduction and the number of over-diagnosed women vastly exceeds breast cancer deaths avoided. Why the huge divergence between ESWG findings and panels like the Canadian Task Force? Simply put, screen advocates dominate both ESWG and JMS; objective panels include a range of expertise and minimal opportunity for conflict of interest.

Scrutiny of JMS is revealing.

  • The JMS editor (ND) has for decades co-authored articles with Tabár (Two-County Trial).
  • SD, a JMS editorial board member co-authored many papers with Tabár, was ESWG Coordinator, and the supplement’s Guest Editor and Review Co-ordinator, authoring two of eight articles.
  • SM, a JMS board and ESWG member authored three articles.
  • Board member AKH wrote the editorial.
  • ESWG member (MB) acted as a Review Co-ordinator and authored four articles.

The overlapping roles are clear.

Turning finally and briefly to the JMS message, what are the flaws? 

  • Omitted from the text are studies demonstrating that breast cancer mortality has declined in the absence of screening, even in the too-young-to-be-screened.
  • Over-diagnosis is a much larger problem than claimed in JMS. A recent report in the high impact New England Journal of Medicine shows that more than a million U.S. women have been over-diagnosed in the last 30 years because of screening.
  • Totally overlooked is the 20% increased risk of mastectomy for screen-detected cancers.
  • Screening benefits are inflated. Long recognized as biased and inappropriate for evaluating screening, case-control studies that falsely inflate benefit are included in the ESWG analysis.
  • Incidence-based-mortality (IBM) partitions mortality by screening and further inflates benefit. “One must be cautious in interpreting the results (based on IBM), since factors like lead-time bias can influence these analyses, whereas they generally will not influence overall death certificate mortality.”  
  • Lead-time (earlier detection extending survival time backwards) and over-diagnosis both spuriously enhance benefit.
  • The JMS reports a 48% breast cancer mortality reduction in women attending screening, comparing attenders at lower risk of death (healthy screenee effect) inappropriately with non-attenders, at higher risk of death. A valid comparison requires two similar populations, one offered screening and the other not, each including attenders and non-attenders.
  • The potential for conflict of interest is evident.

Women have a choice: they can rejoice in the message they want to hear or they can consider whether the message is serving interests other than their own.

 

Cornelia Baines, MD, MSc, FACE, was co-principle investigator and deputy director of the Canadian National Breast Screening Study, a major trial of breast screening that enlisted 90,000 women across Canada in the 80s. She has closely followed screening outcomes research since then. Baines has also been involved in research respecting silicone breast implants and multiple chemical sensitivity. She is Professor Emerita at the Dalla Lana School of Public Health in Toronto.

To the point

SPRING TALKS SEX - Monogamy
Sun, 2012-12-16 00:11

By Lyba Spring

Recently in a radio interview, a sexologist suggested that flirting with other people could be a very positive addition to a monogamous relationship if both parties were confident in themselves and the relationship. Flirting can indeed be titillating for a couple, sparking their own romance and intimacy. It can be seen as complimentary (someone is interested in my partner, which means that my choice of partner is a desirable one). Or it can be just plain stressful: one more thing to fight or worry about.

We sometimes make the assumption that monogamous couples don’t step outside the relationship; but it depends entirely on their “deal.” The deal can be no stepping outside. Or it can be no stepping outside without telling me. Or no stepping outside without sharing all the details for our mutual enjoyment. Or no stepping outside without using protection. Any of these permutations can work—if you work it out beforehand. U.S. sex columnist Dan Savage likes to use the term “monogamish” for couples who are mostly monogamous.

Teenagers and young adults tend to engage in serial monogamy—one partner for a period of time, followed by a break-up, mourning period, and then a new relationship. 

There are other types of long-term relationships which are not monogamous.

Casual sexual relationships (CSRs) were the topic of two articles in recent issues of The Canadian Journal of Human Sexuality. They were identified as “one-night stands, booty calls, fuck buddies and friends with benefits.” CSRs are quite common amongst young adults. I haven’t read any studies on other age groups, but I can assure you, casual sexual relationships  exist at all ages from teenagers to seniors.

For young adults especially, the articles outlined two main concerns: emotional protection and physical protection. In terms of emotional concerns, the studies looked at participants’ desire for an increasing level of relationship intimacy, and whether they would engage in another casual sexual relationship  when one ends. Not surprisingly, women scored higher for the former and lower for the latter.

In examining the rules and scripts of these relationships, the article arrived at the second concern. If it is understood that you are not your partner’s only partner, given the prevalence of some sexually transmitted infections (STIs), you can negotiate barrier protection as well as getting tested to protect yourself. If there is no discussion about other partners, you are putting yourself at risk.

But casual sexual relationships are not the only alternative long-term relationships. There are also polyamorous relationships: what we used to call “open” relationships.  In my clinical work, I found (anecdotally) that people involved in relationships with more than one person, where the partner was aware and agreeable, tended to be much more careful than any other group in terms of physical safety (barrier protection and testing).

There are also couples who “swing” or “play.”

Any of the above can work when there is honesty, good communication and openness.

In the absence of frankness and trust, jealousy may creep in. I often paraphrased Maya Angelou to students when discussing jealousy: it’s like salt; a little can add flavour, but too much can hurt you, or even kill you. Once you start snooping in your partner’s computer or phone, it’s like the classic rifling through their pockets, looking at or smelling their clothes for clues. No matter what the original rules are, if you think one of you has broken them, it’s time to fix it—or end it. There are no guarantees in this game of love; there is only the expectation of good behaviour.

Talk to me: springtalks1@gmail.com

Spring Talks Sex

SPRING TALKS SEX - Sex after baby
Wed, 2012-11-28 19:07

By Lyba Spring

After my first baby (18-hour labour plus episiotomy without anesthetic) I thought I would never let anyone near me again—not even myself. The thought of peeing or having a bowel movement was inconceivable. And yet, we continue to pee, shit and have sex. How do we get back to that beautiful place?

Every woman, every delivery and every baby is different, as is a woman’s relationship status at delivery. What follows are some general remarks about sex after baby.

No matter how “easy” or difficult the delivery, every woman has to heal after childbirth. With a Caesarean section, clearly the healing period is longer: it is major surgery. Immediately, the baby’s needs are paramount. Anyone who has heard a newborn cry can attest to that. If there is a partner on the scene, hopefully they get it. You are sore. You are tired. If you are breastfeeding, your vagina (when it heals) tends to be dry. Your libido has been tamped down by all of the above.

You may not feel particularly gorgeous. Some women spend their pregnancies feeling undesirable, others highly sexual. If you are breastfeeding, you may feel closer to other mammals than any human except your baby. You probably feel “touched out” and want to get some of your body integrity back.

That said, if you have a partner and you want them to stay in your life while you go through this incredible adjustment, it means sharing tenderness. Everybody gets some.

Hopefully, you were still engaged in some way with your partner right up to the birth, whether with loving words, sweet kisses, warm embraces or other sexual activity. Some pregnant women prefer fingers or oral sex to other vaginal activity, especially close to the birth. For others, all physical contact may have come to a full stop long before.

For these women, the road back to feeling sexual may take longer. It starts with reminding yourself why you wanted to have a baby with this person in the first place (if, indeed this was a wanted pregnancy). You will need to re-establish some physical contact with your partner as a basis for future sexual intimacy.

When you first start feeling like some kind of lovemaking might be a real possibility, you have to progress very slowly. If you want to give your partner some pleasure, now is a good time to revisit your sexual repertoire. Use your hand, your breasts, your mouth—or whatever else feels good—to make your partner feel good. If the day comes when you want your genitals touched, touch yourself first. See how it feels. Take it slowly. Can you put in a finger without cringing? Is the lube handy? 

If you want to let your partner touch you, show them the way you did at the beginning of the relationship and say clearly, “this feels good, this not so much—oooh, that feels wonderful.” And just like having anal sex for the first time, you need to start small if anything is going to enter your vagina.

Some people are okay having sex with the baby in the room (some even have sex with the baby in the bed); but others find it easier to concentrate on their pleasure and their partner without having to worry about the baby waking up. So even though the baby may not be on a fixed schedule, try to find the most likely time to be alone. You may need to make a date and have someone take care of the baby while you and your partner rediscover each other.

If you are fully breastfeeding, you may not ovulate for several months. If you are not breastfeeding, you can get pregnant in six to seven weeks. That means finding a way to avoid a second pregnancy too soon after the first if you have a male partner.

One of these blogs, I’ll talk about birth control methods. In the meantime, let me know what other sexual health issues you would like me to write about. E-mail: springtalks1@gmail.com

Spring Talks Sex

SPRING TALKS SEX - Raising sexually healthy children – Part 2
Thu, 2012-11-08 14:55

By Lyba Spring

Welcome back and thanks for your comments.   

In parenting workshops, we like to use practice questions as a group to discuss possible answers. Here are a few examples for children aged 3 to 9.

Mummy, why are you bleeding?

Even if you close the door when you’re changing your pad, tampon or washing out your cup, three-year-olds haven’t quite grasped the concept of privacy. Although common guidelines suggest just answering what is asked, in this case, you may want to consider what is not being asked; namely, “are you hurt?”

“Honey, I didn’t cut myself. I’m not hurt. The blood is coming from inside and will stop in a few days. It’s normal.”

Of course, that still doesn’t answer the question: “Why?”  Until recently, I was suggesting, “Because my body is showing me I’m not going to have a baby”; but that doesn’t cover every woman’s situation.

In the same way, “Where do babies come from?” can be a minefield. Cory Silverberg’s book, What Makes a Baby? speaks to everyone, no matter how their child was “made.”  LGBTQ parents who use assisted reproduction or adopt will appreciate the way he leaves the details to the parent, while sticking to some very basic notions about sperm and egg.

Some people like to start with, “Where do you think they come from?” to tease out the correct information from the bizarre. In my experience, for a three-year-old, “They grow inside their mummy’s body” seems to be generally acceptable. If the next question is, “Where?” the answer can be, “In a special place called the uterus.”

“How does it get inside?”

“It grows from something very small.”

“Hunh?”

“To make a baby, you need something from a man and something from a woman.”

When you get to the part where the sperm and egg actually get together, you have some options besides sending your child to bed and calling your best friend. For those parents who specifically explain vaginal intercourse, some may want to emphasize choice and consent; for others, it’s love; for still others, it is based in norms around marriage. Whatever the option, what’s important is clarity, but not graphic detail. Many parents prefer telling the story in the third person. A biological child may not want those images in their heads.

“Why did the man in the park want to show me his penis?”

Again, the explanation may have to wait until you have dealt with the situation.

“He wasn’t supposed to do that. You didn’t do anything wrong, but we need to call the police. Do you remember what he looked like?”

After the dust settles, the explanation needs to avoid the suggestion of mental illness. Many parents say “he’s sick”, which is statistically not true. “He does it because it gives him pleasure” is more accurate; “but people can’t do everything that gives them pleasure, especially when it hurts others.”

“Why don’t girls have penises?” used to be a slam dunk before we became more aware of variations in gender. “Girls have something like a penis, but you can only see the tip of it and they don’t pee out of it” still works.  For some of us, it’s an opportunity to laud the clitoris. (Personally, I used to go on ad nauseum about how excellent this organ is.)

I did promise to cover, “When can I have sex?” which is a question more likely to come up when a child is entering puberty. The answer really depends on your philosophy. Do any of these answers sound like what you might say?

For girls who are likely to have sex with guys:

“You can have sex when your body is ready and you are ready to protect your body. That means waiting until about age 18 and using protection every time.”

For any child:

“You can have sex when you can talk openly and freely with your partner about your feelings, about the risks and about what you would do if there was a problem.”

“You can have sex when you’re married.”

“I guess it depends on what you mean by ‘sex’. There are some sexual things you can do that are quite safe and others that are higher risk.”

This is a good opportunity to start thinking about what you hope for your child in terms of their sexual life, and what kind of discussions will help get them there safely.

 Let me know what topics you’d like to see me cover in upcoming blogs. Write me: springtalks1@gmail.com

Spring Talks Sex

GUEST COLUMN - Looking my age
Wed, 2012-10-31 18:09

Sometimes we come across women’s health issues that are simply crying out for a response, be they from the world of research, from popular media, or from the experiences of individual women. At the CWHN we decided to create a space for that response here on our website, and to invite guest commentaries from people with health knowledge and expertise who are willing to speak out and get "To the point" about some of these issues. Watch this space for informed guest columns with a new topic every month. And let us know what you think by writing to us at cwhn@cwhn.ca.


By Abby Lippman

Nora Ephron felt bad about her neck; Shari Graydon edited a collection about women who "feel great about [their] hands." (Read the review). Connecting their reflections about body parts is how both explore the experience of aging for women.
 
Now, while it's still not at all clear to me why my neck or hands should matter in who I am or how others see me—despite all social pressures to the contrary—the commercial opportunities to keep anatomy from being women's destiny are quite apparent. And increasingly problematic.
 
 Among the latest—and in sharp contrast with the upbeat title of Graydon's book—are what are billed as "tips to prevent premature aging of the hands" aimed at "busy moms." Age spots and loss of volume are the targets for change by a growing list of interventions. Some are just common sense for ALL hands (wear gloves when washing dishes; use hand cream), but others, more intensive, propose to do for hands what is already done for faces and breasts (e.g., inject fillers to add volume), perhaps using fat removed during a liposuction treatment to "rebuild the lost shape" of the hand. This isn't quite the kind of recycling environmentalists encourage, but who knows? Perhaps a human handfill is ecologically wiser than dumping more into already worrisome landfills, polluting the environment.
 
 Anyway, it's both a this new approach and the rather cavalier way in which it's being promoted that raised particular alarms for me. First bell rang when I read an endorsement of “fractionated laser treatment” by a physicians' society, and another rang when I saw a full page story about it in the Globe and Mail a day or two later. This new tool for rejuvenating older women uses laser beams to target "small sections of the deep layers of the skin," with treatment needing to be repeated from two to six times to be effective. For reasons that are not explained, the American Academy of Dermatology seems to give a strong thumbs up to this "aesthetic technology."
 
This laser technology isn't just for hands, though, and likely this is behind the huge increase in its use reported by another professional society of physicians, this one the American Society of Plastic Surgeons (Globe & Mail, 25 August 2012). In fact, this group is using the approach to "resurface" faces by aiming the laser light deep into the skin to stimulate collagen while, at the same time, removing surface skin tissue. Goodbye (maybe) wrinkles and crow's feet without the puffed look Botox gives—if one can pay at least $400 per treatment (and a series is needed each time) with "maintenance visits" every six to 12 months. But hello swelling and redness afterwards, with possible burning and serious damage if the lasering is too intense.
 
This is called a "non-invasive" treatment, but this does seem to be a rather loose and problematic expansion of the term. It certainly seems “invasive” to me even if nothing is cut open. But worse: do hands or faces really need to be resurfaced like streets and highways? Cracks and crevices in the latter are really dangerous for pedestrians, bike riders, and drivers and demand immediate repair; the cracks and spots on my skin don't quite seem to have this need for attention, urgent or otherwise. So why are physicians so eager to apply this new toy to women? And do we need still to make aging seem such a horrible fate for women?
 
Some of this need-creation stems from greed. The technology may be expensive for physicians to buy, but it's more than likely to be a short-term outlay with great profit potential when sold to women told they need the latest tuck, fix, or fill to keep them looking younger than their birth certificates would indicate. Alice Dreger, who usually writes things I wish I’d written myself, took on the issue of physicians as cosmeticians three years ago and called for medicine to have a "declaration of independence from cosmetic procedures." (Hastings Center Bioethics Forum, 6 July 2009). Her call for doctors to stick to dealing with a woman's health and not her looks, with a special concern for when physicians become entrepreneurial merchants selling us cosmetic interventions in the name of medical treatments, doesn't seem to have been heeded. And aging women just continue to be vilified.
 
 Does it really matter that I have wrinkles, a saggy bottom, or patchy pigmented spots on my hands? Or that I see a drooping chin and eyelids when I look in the mirror?  Why isn't the statement, "you don't look your age," problematic and condemned as ageist? Would we be as accepting to be told—or even hear someone say about another, “you really don't look Black” (or disabled, or queer, or poor)? Wouldn't we immediately recognize this as the racist (ableist, homophobic, classist) statement it is?
 
 In their book on old women and aging, Look Me in the Eye, a book that should be on everyone's shelves, Barbara Macdonald and Cynthia Rich refer to old women who do all they can to make others not think about their age as trying to "pass." And they wisely note that "passing—except  as a consciously political tactic for carefully limited purposes—is one of the most serious threats to selfhood." Physicians selling and women buying allegedly anti-aging technologies are usefully seen from this perspective—as threats to our selfhoods.
 
 My hands, like those of many women, have become knobbier with age and stiffer to bend. Rings I used to love wearing on several fingers of both hands all at the same time now sit in boxes waiting to be recycled as dangles on a chain around my wrinkly neck or as brooches to be worn on a jacket draped on my curving shoulders—or just given to others with straighter fingers to enjoy. I'd like to think of the intricately patterned veins on the back of my hands as some ever-changing abstract body art, a kind of natural tattoo, perhaps.
 
 Of course there are aspects of aging, especially for marginalized women and women without privileges and power, that DO demand and warrant interventions: safe housing, financial resources, primary healthcare, universal design of places, spaces, and things, for example. But these aren't pretences to stop aging but, rather, to make it possible and respectful for all women.
 
If aging really is about hands, it should be about the women in manicure salons using highly toxic products known to be harmful to health to attach fake nails on customers. These women, mostly—if not totally—non-unionized and without proper regulatory systems to ensure the products they use are handled in safe ways, warrant our concern much more than any spots on a hand to which they will glue some glitzy nails. And if aging is at all about necks: then let's admire the older women who stick theirs out and fight for reproductive and social justice.

Abby Lippman is a longtime feminist activist with special interests in women's health and women's health policies. Also an academic based at McGill University and passionate about writing, Abby is past president of the CWHN, and is now on the board of the FQPN where she works closely with them in building an inclusive reproductive justice movement in Québec.

To the point

SPRING TALKS SEX - Raising sexually healthy children – Part 1
Thu, 2012-10-25 23:25

The CWHN is happy to introduce to those who don’t already know her, Lyba Spring, a sexual health educator who spent nearly 30 years with Toronto Public Health. Working in schools with children and teens, counselling in a sexual health clinic, giving workshops, university lectures and doing guest spots on TV, Lyba has addressed every aspect of sexuality from safer sex and gender identity, to raising sexually healthy children and female ejaculation.  From sex workers and principals, to staff in long term care facilities, she has worked with them all—in English, French and Spanish.

Lyba will be blogging for us every two weeks on a range of topics relating to women and sexual health. She welcomes your feedback and suggestions

We think Lyba is a treasure. We hope you will, too.

You can contact Lyba at: springtalks1@gmail.com


Information provided by the CWHN is not a substitute for professional medical advice. If you feel you need medical attention, please see your health care provider.


By Lyba Spring

In workshops, when we ask parents when sexuality education should begin, they often answer  “age 10, 12 or more.” But it doesn’t take long before someone in the group will point out that it’s much too late. With some girls beginning puberty at age seven, and sexual images at every turn, we need to reconsider.

Sexuality begins at birth; even in the womb a male fetus will have erections. The moment a baby is born and held, the lessons have begun. “Someone who loves me is holding me. I like getting my back stroked. Is that a nipple in my mouth?  Oh, heaven.”

Changing a baby, we talk to them. This is a great time to start using dictionary words for their genitals such as penis and vulva instead of wiener and flower. Building a vocabulary opens the door to communication about sexuality as they grow.

A six-month-old is likely to discover their genitals. How parents react to this may vary greatly; but the message needs to be clearly thought out. If you say, “Don’t touch!” you are telling them it is not okay to have access to that part of their body, and that the pleasure they feel is not okay. If you let them explore, they are learning about the pleasures of the body, and that every part belongs to them. There will be time for them to learn that it’s not okay to have that pleasure in the supermarket.

They may accept their gender, which is congruent with the way they look, or they may not. Current research suggests that parents/guardians should take the lead from the child when there is dramatic variation in their gender behaviour.

Sexual exploration (playing house, doctor, etc.) with other children often starts around age three. It is very common. Some parents/guardians wonder about the difference between expected and unexpected sexual exploration. For those who were sexually abused as children, they may feel even more protective. An important message is that there should never be any secret touching. Children also need to know that if they have that “uh-oh” feeling, they need to tell you. If a child reports unusual sexual behaviour with another child or with someone older that concerns you, call your local child protection agency for advice. (See: www.boostforkids.org for more information.)

By this age, children are also asking questions. The rule of thumb is: answer what they ask in age appropriate terms. Include your parental message along with the factual information. For example, an answer to, “What are balls for?” may be, “They’re called testicles. They make sperm. When you grow up, if you want to make a baby, that’s what you’d need.” 

You may also want to find out what they already know. So when a child asks where babies come from, you may want to ask, “Where do you think they come from?” and work with their information.

If an older child asks, “When can I have sex?” your answer may be rooted in simple physiological facts, your religious values or your personal politics.

In part two, I’ll write about some key issues for children up to nine and then some more for children going through puberty. Do you have any good ideas to share?  Send me an e-mail at: springtalks1@gmail.com

Spring Talks Sex

SPRING TALKS SEX - NEW blog
Wed, 2012-10-17 11:15

The CWHN is happy to introduce to those who don’t already know her, Lyba Spring, a sexual health educator who spent nearly 30 years with Toronto Public Health. Working in schools with children and teens, counselling in a sexual health clinic, giving workshops, university lectures and doing guest spots on TV, Lyba has addressed every aspect of sexuality from safer sex and gender identity, to raising sexually healthy children and female ejaculation.  From sex workers and principals, to staff in long term care facilities, she has worked with them all—in English, French and Spanish.

Lyba will be blogging for us every two weeks on a range of topics relating to women and sexual health. She welcomes your feedback and suggestions

We think Lyba is a treasure. We hope you will, too.

You can contact Lyba at: springtalks1@gmail.com


Information provided by the CWHN is not a substitute for professional medical advice. If you feel you need medical attention, please see your health care provider.



By Lyba Spring
After nearly 30 years working as a sexual health educator in the public sector for Toronto Public Health, I realized that I wanted to “keep a hand in” after retirement. But posting medical articles on my professional Facebook page to help keep former colleagues up to date has not been enough. Although I have continued to do media work and present at the occasional conference, the need to make a difference remains unsatisfied. 

I became a feminist in 1968 in what was then called the Women’s Liberation Movement. Women’s sexuality was very political—and still is. The recent dust-up over an American politician’s ignorant remarks on rape and abortion got me posting and tweeting more than ever. The Canadian MP looking for the back door into recriminalizing abortion reminded me how important it is to be vigilant.

Although every aspect of sexual health is political, some are just fascinating to discuss: raising sexually healthy children, adolescent sexual health, romantic and sexual relationships, pregnancy, sexually transmitted infections (STIs), gender and orientation issues, late blooming boomers, seniors’ sexual health—all the beautiful and not so beautiful aspects of our sexuality—and who’s in control of it.

The World Health Organization definition of sexual health underlines the fact that sexuality crosses the lifespan.  Our sexual selves start with erections in the womb or a baby’s vagina lubricating at birth; it moves from the exploration of one’s genitals in that first year, to deliberate self pleasuring during puberty; from gender confusion to gender clarity; from attractions as a child to lustful desire in adolescence; from admonishments about safer sex from home and school, to the realization that we can have some control over our sexual expression; from sexual abuse or sexual assault to healing; from initial intimacy to longer relationships; from the desire for parenting to raising a child; from coupledom to singledom; from sexual maturity to sexual seniority; from ability to reduced ability; or from disability to full sexual expression...

I want to talk with you about any and every aspect of our sexual selves, starting with a piece on raising sexually healthy children.  While I take interest in the broader issues, like reproductive technologies or hormone replacement therapies, I will keep my focus narrow. For articles on the broader issues, see the rest of this site; or visit my Facebook page.

This is where you come in. If you have a comment about any of my blog articles, please send it to:  springtalks1@gmail.com.

More importantly, if there are other topics you want to discuss, let me know at the above link. I won’t be responding to any personal questions, but I would like to write about what interests you. I would like to include some of your comment(s) in my upcoming blogs.  

Looking forward to hearing from you.

Spring Talks Sex