2009

Shame 101

Posted on October 14, 2009 at 11:50 am in

Shame is useful. It tells us when we’ve done something that violates our notions of right and wrong. It’s that little voice that tells us someone may be watching; some one will know about that bad thing we’ve done and there will be consequences. By listening to that voice, we navigate the intersection of what we want and what we should do.

What gets sticky is when the internal programing (the “should”) has bugs. When what we think is wrong is in fact harmless. Debugging that programming can be the work of years of exploration. It’s complicated to extricate a harmless desire from its framework of harmful or socially problematic corollaries.

This is a sexual health blog so, shockingly enough, we’ll take sex as an example. I’d love to be able to say to you “sex is Great! Anything you want to do is awesome! Go out and put the bunnies to shame!” but I can’t. Because, not all sex is awesome. The sex where one or more partners feels pressured or is hurt more than he or she desires is not awesome. If you’re having that kind of sex, if you’re pressuring your partner or hurting your partner more than your partner wants you should feel bad. Put that useful shame to it’s good purpose. Feel bad that you’re doing something wrong and stop doing it.

On the other hand, what if you’re feeling shame when everything is good? What if:

*you are doing what you want to be doing
*and*
*your partner is doing what he or she wants to be doing
*and*
*you’ve talked about what kind of safer sex practices work for you both
*and*
*you’re using them
*and*
*what you’re doing isn’t going to hurt anyone else (no one’s being cheated on, you aren’t using your roommate’s bed/vibrator/towels/hamster without permission, etc.)

and you’re still feeling shame? Now’s the time to do that debugging. Get outside of your head. Talk to people you trust about what you’re doing and check in that what you’re doing is in fact meeting the basic criteria above.

Done that? Still feeling shame about harmless pleasure? Can’t let it go on your own? Get some therapy. With a therapist. Please do not, for the love of all that’s holy, use your partners for therapy. It’s not fair to them, it’s not helpful to you, and it does nothing to bring more beauty into the world.

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“orgasm a day keeps the doctor away”… consent, pleasure, and responsibility

Posted on July 16, 2009 at 10:16 pm in

One of the things we do in TheTalk workshops is to reinforce the idea that sex is about feeling good. If what you’re doing doesn’t feel good then it’s ok to stop. If the person who wants to have sex with you doesn’t make you feel good, it’s ok to not have sex with that person. And it’s not just about feeling good in the moment. The choices you make about what kind of sex to have, if any, affect your whole self’s well-being so we teach people how to make informed choices that keep their whole selves well and happy.

In a nutshell, that’s what the Sheffield Centre is getting at with its new pamphlet “Pleasure”. Teens have sex (in broad scope) for two reasons, because they want to and because they think they should. Sheffield Centre for HIV & Sexual Health is trying to shift the focus away from social pressures and make the choice between being sexually active or inactive about whether or not the person wants to be. Not because it’s cool, not because his/her partner wants it, and certainly not because some jerk gets off on making other people do what they don’t want to do. By centering the locus of control inside the individual, they are hoping to reduce the rate of unwanted pregnancies, sexually transmitted infections, and sexual abuse.

To a lot of people the idea of talking about sex as a good and positive thing in order to reduce harmful outcomes is oxymoronic. This latest kerfuffle seems to be drawing two main arguments: that if we tell kids sex is fun they’ll be more likely to have it and that telling folks they have a right to sex will lead to more abuse.

That first argument is patently absurd. Sex is fun? No, really? Like any person in the first world over the age of 10 doesn’t have a pretty good idea that sex is -at least in theory- something desirable. Western authorities have been preaching that sex is dangerous for at least 2,500 years. If that message was going to work it would have caught on by now. Let’s try a new tactic, hm?

The second argument is just a variant on the first. If we acknowledge that sex is fun and that everyone has a right to make the choice to have it or not, then everyone is going to want to have it and therefore force others to have it with them, say the proponents of the increased-abuse argument. Presuming that they are correct in asserting that everyone is going to want to have sex - and I know a few monastics and celibates that would have words to say about that- we’d have to assume that wanting a thing and taking it were logical equivalents. What this argument ignores is the very real shift in internal motivations when someone who has little power gains more. When people who feel they have no control over what happens to their bodies come to understand that not only do they have a choice in what they do but that those choices are based on what they want, they *make better choices*. This is shown over and over again in domestic abuse programs, addiction recovery programs, and in whole-life sexuality education programs such as Our Whole Lives and the curricula presented in schools in the Netherlands.

It can not be overstated that the reason those programs are successful is that they co-emphasize the roles of choice, information, and personal responsibility. I can’t help but wonder if the people who are so deeply afraid of giving young people access to information about their choices are threatened by their own ignorance and feelings of powerlessness. Are the people who shout about the end of the world being brought about through young people’s sex lives healthy and happy in their own? Are they comfortable in the process of getting and giving consent? Do they know what they enjoy and how to get those needs met in a safe and healthy way? What do you think?

So, to the Sheffield Centre for HIV & Sexual Health I say “good job!” Thanks for putting a bit more power in the hands of those who need it.

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Kids and cold sores.

Posted on June 22, 2009 at 12:29 pm in

My five-year-old has a playmate from our neighborhood, who she loves to play with. Last week, we went to this other little girl’s house, met her parents, and agreed that the girls could go back and forth and play in each other’s houses if they wanted to. My daughter was elated, but I was worried. Why? Because her little friend had a large cold sore over her lip. By a stroke of luck, no one in my family has picked up HSV-1 yet. I’m not very concerned about avoiding it, but all else being equal, I’d prefer not. I also know I can’t police all my daughters interactions with other children, nor would I want to.

Should I be concerned about my daughter sharing food or roughhousing with a kid who has an open cold sore? If that is a real concern, how can I communicate with her about it without seeming scary or discriminatory? Do I just need to strengthen my rules about physical play with all kids?

Thanks for the advice,

S

Hey, 

That’s a really good question!

HSV (both 1 and 2) can be transmitted through non-direct contact. So, kid-friend drinks out of a cup + your daughter drinks out of the same cup within a few hours = transmission is likely. Hands, cups, utensils, and toys are the things I’d really worry about.

 What I do with my kids who have cold sores is to remind them that they have a “boo-boo lip” (it evolved, I’m not sure that’s the terminology I’d foster now) and that washing their hands and not sharing things that touch their mouths are really important. For the kids that don’t have them, I have the same reinforcements plus the knowledge that the first few cold sores really, really hurt and it’s best to avoid them if possible.

In this instance, I’d talk to the kid’s parents. Ask them how they deal with the idea of transmission with their daughter so that you can supplement and re-enforce them. I would talk to your daughter about how the virus that causes those sores is really strong, and can survive outside of a person’s body for several hours. Reinforce that it’s important to keep track of what has been in her mouth and what has been in her friend’s, and that washing her hands thoroughly and often is important. That should be easy for your daughter to grasp and isn’t judgemental at all.

In short, I wouldn’t limit their playtime but I would make sure that they’re supervised when they’re eating so that they can be supported in keeping their germs to themselves.

Hope that helps!

Jessica

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Oh, what fools these mortals be…

Posted on May 27, 2009 at 9:18 pm in

Syphilis is a stupendous badass.

Nothing as successful as our dear old friend Treponema pallidum is going to just up and die out. It’s gonna mutate, it’s gonna evolve! So we’ve learned to recognize a painless ulcer around the genitals or the rash on palms and soles? Well, then it’ll show up as lesions that look like herpes or flat, shiny, patches on the tongue, or even as joint pain reminiscent of Lyme disease. And it’s gonna team up with our new friend HIV so that having either one increases your risk of getting the other. Take that, you silly penicillin-inventing primates!

So, because of all these factors, after nearly disappearing for 30 years, syphilis infection is on the rise.

As with the other bacterial STIs, the key to not catching syphilis is to use barriers for any genital contact. Yes, for that. And yes, for that too. Yes, dental dams and condoms for oral sex. Yes, gloves for fingering. And- despite the complete illogic of having to do it- pester your primary care provider to test you regularly.

You’re not going to get a doctor who graduated in the last ten years say, “huh, you know, that could be syphilis. Let’s test you for it.” In fact, large numbers of docs think it’s pretty well dead and gone. Oh, foolish, foolish vertebrates. What great strides we could be making in keeping STI rates low if more care providers followed my midwife’s advice and tested for everything, all the time instead of arguing with patients about whether or not they need testing. Come, on y’all: the tests are easy, generally inexpensive and pretty reliable. (Except for the blood test for HSV, which needs a whole post of its own.) Just test your patients and lets all get on with our lives, ok?

That way, we can keep being the most stupendous badasses on the block.

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Who wraps it with what?

Posted on May 15, 2009 at 10:46 am in

There are a couple of really interesting things out on the web this morning regarding men’s sexual health. The first is a study out of Sexually Transmitted Diseases concerning condom use amongst men who have sex with men. The second study, on perceptions of condom fit, comes to us from Sexually Transmitted Infections.

It’s a hard world to be bi in, boys and girls. (For a really fascinating read on being bi in the US, check out Current Research on Bisexuality. Folks generally rank bisexuals lower on the social totem pole than IV drug users.) But, Flores, Bakeman, Millett, and Peterson tell us that men who have sex with men and women (MSM/W) are less likely to have or report unprotected anal sex than men who only have sex with other men (MSM/O). This is despite men who have sex with men and women (MSM/W) reporting lower social support than MSM/O. And, men who have sex with men and women are less likely to be counseled toward getting tested for HIV and what their treatment options are if they do test positive. . Even with all that stacked against them bi men are still making good choices about barrier use. You go, boys!

For those of you not wrapping it up before you dip it, why not? Reece, Herbenick, and Dodge found that found that most men find condoms fit just fine but that many still have the notion that condoms are one size for all. Oh, how untrue, my factory-original brothers! For one thing, there are TheyFits. You measure, they make, it fits. Simple as pie. For another, there are female condoms. These lovely little polyurethane (read “non-latex”) pouches take a bit of getting used to but it’s worth it. They insert into the vagina or anus (which can be done up to two hours ahead so that when you get to the moment, you’re already covered), hold lube like a dream, and warm to body temperature quickly. Plus all the other wide variety of condom brands, styles, fits, colors, flavors, and textures available.

Most health departments, clinics, college health services, and –ahem!- local health educators stock assorted barriers. We have them so you’ll use them, so take advantage of the bounty.

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Why?

Posted on May 14, 2009 at 8:12 pm in

Why do we have sex?

When I ask that question during The Talk workshops, the answers I get are as varied as what just went through your mind - and then some. People have sex to connect. They have sex to lose themselves or to find themselves again. They want to lose track of time or gain a sense of the moment. They have it for pleasure. They have it for a sense of power or to give power over to another person. Sometimes they have sex for food, or a safe place to stay, or to feel wanted and secure.

People have sex with people they like and people they’d rather not talk to. They have sex with people they know and with strangers. They have sex with people they’re afraid of and with people who keep them safe and respect them.

What we’re trying to foster through this blog and through outreach in our local community is a system of thought about sex that allows people to realize that, no matter the reason, no matter the partner, or the number of partners, they can have super-hot sex with positive outcomes. It’s within their power to choose what amount of risk they want to take on. It’s our job as health educators to help them understand what those risks are.

So, let’s talk about it. Why do you have sex?

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Welcome!

Posted on April 1, 2009 at 11:02 am in

Hello, fine and gentle readers, and welcome to The Talk. We are here to give you information on sexual health issues in a fun, engaging, and irreverent way. Buckle in, sit back, and enjoy the ride.

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