Spring Talks Sex

SPRING TALKS SEX - Pap registries: Do it right

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By Lyba Spring

Well, it turns out I don’t have cervical cancer. At least, that’s what Cancer Care Ontario (CCO) has told me in an unsolicited letter. Like many women, I usually expect to hear from my doctor if there are abnormal results. No news has been good news in the past. Getting my Pap test results from CCO in the mail was a bit of a shock.

I had heard about these letters from Ayesha Adhami, who runs a women’s sexual health centre in Toronto. She was concerned for her teenage clients, some of whom have little privacy. Lots of moms would find it difficult to resist opening a letter with the word “cancer” in the return address. So a young woman may find that her Pap test results have already been read by a snoopy parent or guardian—and that’s not good.

I called the number provided to ask some questions and to give them feedback about the letter and its accompanying pamphlet. The woman I spoke to was pleasant and took notes.

I first expressed surprise at receiving a letter from the provincial government about my Pap test results.

She said women were supposed to receive an initial letter to advise them of follow-up letters. I didn’t. Like cable companies who operate on an “opt out” system, if you don’t call when you receive the first letter, you will continue to receive them.

I shared my above concerns about confidentiality. She commiserated.

Then I painstakingly reviewed the letter and pamphlet while she listened patiently.

SPRING TALKS SEX - Treating pelvic pain

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By Lyba Spring

My file on vulvar pain stretches back several decades. One thing has not changed: a woman may seek up to 10 medical opinions before getting a correct diagnosis and possible help. In the absence of pathogens or a clear physical ailment, a woman’s concerns tend to be dismissed as being “all in your head.”

At a meeting of the Sexual Health Network of Ontario in September, I was absolutely floored to learn about the use of physiotherapy to treat chronic pelvic pain (CPP). A sex therapist, a physiotherapist and a health advocate talked about pelvic pain, which can include vestibulodynia (pain at the "front porch" of the vagina), vulvodynia (pain in the superficial tissues of the vulva, also used as a general term for vulvar pain), clitordynia (pain at the clitoris) vaginismus, (the inability to have penetration into the vagina) clitoral pain, pain from endometriosis (where uterine tissue grows outside the uterus) and interstitial cystitis (a condition that involves pain, frequency and urgency). (More about these conditions).

I was entirely ignorant that physiotherapists could be rostered by their college to do a manual pelvic exam and treat CPP. According to Pelvic Health Solutions, research has shown that treatments carried out by a physiotherapist for pelvic floor problems are highly successful, and should be the first line of defense for both pelvic pain and incontinence.

Many of us were told that we should do our Kegels (pelvic floor exercises) to prevent some of these issues. But Kegels are not a one-size-fits-all exercise. There are Kegels where you tighten and relax; and reverse Kegels where the goal is to relax and open the pelvic muscles. The prescribed exercise depends on the condition.

SPRING TALKS SEX - There’s an app for that

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By Lyba Spring

Having worked in a sexual health clinic for so many years, I thought I had seen and heard it all, including imaginative self treatment for various bumps and secretions—following self-diagnosis. Only when these treatments repeatedly failed, would they come to the clinic, saying, “I researched it.”This usually meant they had done a Google search and landed in Wiki land. However, I applauded the do-it-yourself approach when a client told me she was using an app on her smart phone to chart her menstrual cycles (e.g., Justisse Charting App). I also approved heartily when some Public Health Units started using e-cards to inform infected partners they should get tested.

But an app for diagnosing sexually transmitted infections (STIs)? That’s where DIY may cross the line.

Wired Magazine interviewed the Swedish orthopedic surgeon who developed an app that would allow users to take pictures of suspicious spots on the skin (e.g., unusual moles) and send them for interpretation to a licensed dermatologist in Europe. One dermatologist interviewed on CBC about this technology dismissed it as highly unreliable for finding precancerous conditions. But while this may discourage some from using the app for serious dermatological problems, others have found a different use:  sending pictures of unusual spots on their genitals, specifically to diagnose STIs.

SPRING TALKS SEX - Oral sex – is the getting still good?

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By Lyba Spring

Besides Human Papillomavirus (HPV), there are other issues that should be raised following Michael Douglas’ oral sex and throat cancer theory.

Who’s giving, who’s getting, who’s at risk and who cares?

Let’s start with cunnilingus (a very good place to start, some would say). There have always been negative attitudes about oral sex on women because of repugnance towards female genitals. Apparently, we smell, we’re dirty; and we don’t look the way we should. Feminine hygiene products included Lysol in the early days of making women feel bad about their genital scent. Female genital cosmetic cutting and anal bleaching are the contemporary equivalents. However, it would appear that some people have gotten over that prejudice, because in films and on TV, men are going down on women in droves, not to mention woman on woman action as well. However, I’ve met many young men who gave their female partners oral sex, but didn’t want their male friends to know; it was considered unmanly.

Interestingly, there are also prejudices against oral sex on a man. I worked with young women who said they could never kiss their baby after they had put their mouth on a man’s penis.

SPRING TALKS SEX - Sex ed: Let’s get real

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By Lyba Spring

Sexual health curricula. Who writes them, and for whom?  Is a curriculum written for the benefit of students; or is their language carefully edited to assuage dissenting organizations and reassure jittery bureaucrats? When new curricula are published, opponents of sexual health education will inevitably be poised to cherry pick material to discredit the contents. Provincial governments worry about political backlash to progressive sex education that teaches about pleasure, choice, inclusion and current sexual realities.

And yet, that is the job of a sex educator.

Comprehensive sexuality education is critical to society. In Canada, it has been partly responsible for the dramatic drop in adolescent pregnancy since the 1970s, the other factors being increased availability of effective birth control, and access to abortion. But sexual health education must go far beyond birth control and sexually transmitted infections. The World Health Organization defines sexual health as “a state of physical, mental and social well-being in relation to sexuality” requiring “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.”

How does sexuality education support children’s development so they become sexually healthy individuals? The Canadian guidelines to sexual health education are a good start and required reading for anyone planning on offering it. But there are a few contemporary issues I would like to address.

SPRING TALKS SEX - Confused about Pap tests?

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By Lyba Spring

When the Canadian Medical Association recommendations on new guidelines for screening for cervical cancer came out recently several of my sexual health colleagues were aghast. They asked me if it was part of an austerity program—cutbacks on screening programs. In my opinion, not this time.

Women and health-care providers are well aware that regular Pap testing is essential to women’s health. Pap screening has reduced deaths from cervical cancer by 70 per cent. The reason it has been so effective is that when irregular cells are detected, a woman can be followed and treated when necessary to prevent these cells from becoming cancer. Cervical cancer is very slow growing (10 to 20 years).

Until recently, most women were told they needed an annual Pap test. It was often done at the annual health exam. Some clinics tied it to birth control pill renewal to ensure that women were screened.

The most notable changes from the CMA are the recommended age to begin testing and the interval between tests.

According to the CMA, testing should begin at age 25. Regular screening should take place at three-year intervals until age 70. There are, of course, exceptions, in particular for women with symptoms of cervical cancer or previous abnormal test results on cervical screening; and for immunosuppressed women (e.g., women with HIV/AIDS).

The CMA’s reasoning is that while there is strong evidence for screening women 30 to 69, the value of screening and the balance of benefits and harms for women outside this age group is unclear. That is why the recommendation for routine screening for women 25 to 29 is weaker; and the recommendation for women 20 to 24 is for not routinely screening for cervical cancer; the CMA also recommends ending screening at the age of 70.

SPRING TALKS SEX - Birth control – whose choice?

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By Lyba Spring

Ask a woman if she is using birth control and she will likely tell you whether or not she is taking “the pill.” For most women, they are synonymous. Often, she’ll ask her doctor to “put” her on the birth control pill, which conjures the image of a five-minute consultation, prescription pad at the ready. Do the words “informed consent” have any real meaning when it comes to birth control?

Women who need birth control are likely to change methods several times during their reproductive years depending on their age, health status, income, partner(s) and number of children. Knowing those circumstances is key to assisting a woman in finding the method that suits her at that particular time in her life. While health-care providers may have prejudices and biases regarding certain methods, the operative word should always be “choice”: hers.

SPRING TALKS SEX - Adolescent sexuality: Out of hand?

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By Lyba Spring

Actually, it seems to be in their hands. Handheld devices give teenagers access to sexual images—including unsolicited images of their peers—as well as anything they could possibly want to know about sex, both positive and negative. The unsolicited photos are an obvious negative, but some of the positives are that they can find a clinic, text a health agency for information, even let a partner know anonymously that they have an STI and need to get tested.

With the increase in information from all sources, there have been some real advances in sexual health for adolescents and young adults; but there are still serious problems. So what are they really up to?

Media messages mislead adults about adolescent sexual activity, giving the impression that they are having sex at increasingly younger ages. Federal and provincial health surveys seem to tell a different story. In 1996, 32 per cent of 15- to 17-year-olds reported that they had had (vaginal) intercourse; in 2003 and 2009, it was 30 per cent. Moreover, for 18- to 19-year-olds, fewer are reporting having had intercourse than previously. In 1996, it was 70 per cent; in 2009, it dropped to 68 per cent.

SPRING TALKS SEX - Body hair

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... when shiny and full are not the operative words

By Lyba Spring

In the shampoo ads on television, “a woman’s glory” shines and shimmies. She runs her hands through it, swishing it back and forth like a living mane, mesmerizing viewers, inviting them to get their hands on it too. But if your legs are like a pelt, no one seems to want to run their hands through that, at least not in the ads.

Standards of beauty vary of course through eras and cultures. In North America, hair removal has extended to men, too. These days “bears” (hairy men) have become a specific category for their mostly male admirers.

It has been argued that the prevalence of pornographic images of hairless women with girlish vulvas sparked the current mass removal of pubic hair. Whatever the reason, women are taking off their body hair in droves—if the proliferation of waxing salons in my neighbourhood is any indication.

In the changing room at my local gym, where most of women are not at all shy, I have seen everything from naked vulvas, to a “landing strip”, to the full, classic look. And yes, there’s fashion when it comes to vulvas. I have also seen a few women with lush leg hair. I freely admit, although that look was more common in the 60s and 70s, it’s a shocker to see, because it is so far from the current norm.

Women choose many ways to remove hair, some permanent and some painful. Each method also comes with some health risks. Laser hair removal is a medical procedure that requires training to perform and usually needs multiple sessions. Women are told to expect discomfort and temporary skin discoloration.

SPRING TALKS SEX - Women, sex and substance use: chicken and egg?

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By Lyba Spring

The risk of developing alcohol or marijuana “dependence disorders” for young people is linked to the number of sex partners they have, according to a recent article published in the Archives of Sexual Behavior.

The researchers say that alcohol and marijuana use may encourage sexual behaviour.

There’s a shocker. The reason they link multiple sex partners and later substance abuse is because they are both part of a cluster of risk-taking behaviours that happen in adolescence and young adulthood. The association in the research was stronger for women. They added that the alcohol industry encourages the view that alcohol is entertainment, and that young women are encouraged to keep up with the boys.

The study was done in New Zealand where the ads for alcohol mirror our own in their intent. Ann Dowsett Johnston in her article “Women and Alcohol: To Your Health?” published in Network magazine refers to Mike’s Hard Pink Lemonade, Smirnoff Ice Light, wines like MommyJuice and Stepping Up to the Plate, berry-flavoured vodkas, Vex Strawberry Smoothies, coolers in flavours like kiwi mango, green apple, wild grape; and alcopop, also known as the cooler, “chick beer” or “starter drinks.” Judging from the statistics of alcohol consumption for young women, the ads have been very successful.

While the Archives article also discusses anxiety and depression, what interests me is the notion of “risk-taking behaviours.”

People who lack the basics for good health tend to have risky health behaviours, like tobacco and alcohol abuse. So do people who are survivors of sexual abuse.

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