Speaking Out!

SPRING TALKS SEX: Menopause – whose information do you trust?
Wed, 2014-10-22 12:51

By Lyba Spring

A friend asked me if I was going to talk about menopause during aworkshop I am offering on sexuality and aging. She is 68 and still getting hot flashes. News “flash”: I’m 66 and still getting them too. It made me wonder what has been going on in the world of menopause since I first started getting hot flashes in my late 40s.

I was lucky. Apart from driving everyone around me insane with my perimenopausal moodiness, I was not disturbed by night sweats. For many women, night sweats are debilitating, because they affect sleep and therefore the ability to function.

Thank Google; there is lots of useful information out there. The website 34 Menopause Symtoms gives a plausible explanation about later life symptoms and some common sense advice about relief.

Common sense advice is not the approach you are likely to get when you visit your doctor. Big Pharma continues to dominate the discussion, and Big Pharma probably has your doctor’s ear.

Back in the day, I found common sense in every issue of Janine O’Leary Cobb’s newsletter A Friend Indeed and her book Understanding Menopause, reading both from cover to cover. Other books, like Menopause Naturally by Dr. Carolyn Dean, put this natural part of a woman’s life into perspective. But doctors were offering women hormones like they were candy.

The Women’s Health Initiative (WHI), a.k.a. the nurses’ study in the States, made great headway in debunking the dangerous practice of offering HRT to every woman with symptoms (and in many cases those without).

“Consistent with WHI randomized trial findings, estrogen plus progestin use is associated with increased breast cancer incidence. Because prognosis after diagnosis on combined hormone therapy is similar to that of nonusers, increased breast cancer mortality can be expected.” (Estrogen Plus Progestin and Breast Cancer Incidence and Mortality in the Women’s Health Initiative Observational Study, 2013).

The problems with hormone replacement therapy (HRT) are well documented, yet the controversy continues. Women’s health advocates had thought the WHI results represented definitive research that was universally accepted. But in 2013, Anne Rochon Ford, executive director of the Canadian Women’s Health Network and editor of the book The Push to Prescribe, was reported as saying she’d like to see most women abstain from HRT altogether; that the new push to prescribe hormone replacements is being driven in part by the drug manufacturers that make them.

“There is a strong current . . . of concern and skepticism for taking potentially problematic medications for natural life events,” she said.

“Menopause is not a disease. Menopause is a natural life event in every single woman on this planet and the move to medicate it had a tremendous marketing machine behind it going back to the 1940s.”

But hormonal prescriptions were just being refined.

“Menopausal hormone therapy remains the most effective treatment for vasomotor symptoms, which are experienced by more than half of menopausal women and are most likely to be bothersome during late perimenopause and early menopause with mean duration >10 years (NEJM Journal Watch, Women’s Health May 12 2011). This long-term analysis confirms that the risk–benefit ratio of HT is most favorable when initiated in younger menopausal women, and for estrogen-only versus estrogen-progestin therapy. While HT should not be used to prevent cardiovascular disease, use of low-dose HT specifically to prevent osteoporosis is appropriate in selected women at elevated risk for this condition [my emphasis].

There is a great difference between “bothersome” and debilitating. Moreover, women with an elevated risk for osteoporosis have non-hormonal (and non-pharmaceutical) options. Osteoporosis experts have long recommended weight bearing exercise and adequate intake of calcium and vitamin D to prevent osteoporosis. Other drugs with questionable results are bisphosphonates, which have also been widely prescribed for people with osteoporosis (Read the Therapeutics Initiative Letter 78).

Women were sold a bill of goods in hormone therapy. Hormone replacement therapy (HRT) was portrayed as a panacea, at first touted as relief for menopausal symptoms, and then as prevention for heart disease, osteoporosis, Alzheimer’s - you name it. And, lest we forget, staying young. Feminine Forever was first published nearly 50 years ago. The author, Dr. Robert A. Wilson, warned that a woman’s body “ultimately betrays her. At the very moment when she is most able and eager to enjoy her achievements, her femininity – the very basis of her selfhood – crumbles in ruin.  But now, at last, medicine offers a practical escape from this fateful dilemma.”

Have attitudes towards support for perimenopausal women changed at all? I recently posted a Medscape article on my professional Facebook page about “treating menopause” [sic]. I was hoping that the discussion had evolved. But no. Even though it wasn’t all hormones all the time, treatment of menopausal symptoms still translated into drug prescriptions.

Sadly, even the North American Menopause Society has chimed in regarding support for the prescription of hormone therapy (HT) be it estrogen therapy (ET) or estrogen and progestin therapy (EPT). Their position paper concludes:

Recent data support the initiation of HT around the time of menopause to treat menopause-related symptoms and to prevent osteoporosis in women at high risk of fracture. The more favorable benefit-risk ratio for ET allows more flexibility in extending the duration of use compared with EPT, where the earlier appearance of increased breast cancer risk precludes a recommendation for use beyond 3 to 5 years.”

Drug companies are aware that women have become more wary of hormonal treatments and have developed new drugs to maintain their market share. Since some women’s menopausal symptoms include extreme vaginal dryness and a loss of vaginal elasticity, a drug company in the United States developed Osphena, a drug that does not contain estrogen to treat painful intercourse, vulvar and vaginal atrophy. It acts on estrogen receptors without actually being an estrogen. Osphena is a selective estrogen receptor modulator (SERM), like tamoxifen. It has been approved for use in the US. Like any medication, it is not risk free. American women would be well advised to read the boxed warning about the possible serious adverse effects, including stroke, blood clots, as well as common side effects including hot flashes.

The advice to “use it or lose it” as well as lubricants and rehydration products are a reasonable and safe starting point for dealing with vaginal dryness. This is the first line of advice one would hope to hear from a health-care provider.

I recognize that some women will choose the big hormonal guns for a limited period of time having tried other less risky remedies with no relief. As for me, I’ll throw off the covers when I feel hot at night; I’ll stick my head out the window during the day; I’ll drink my coffee and eat my spicy food because I love them even if they trigger a hot flash. I’ll continue to go to the Y and pretend to work out to maintain bone health. And one way or another I’ll ensure that my vagina continues to function.

But I do wonder what my 70s will hold?

Talk to me: springtalks1@gmail.com


CWHN FAQ on Menopause

Healthsharing magazine

Network article on Older women and sexuality

Hers Foundation: Hysterectomy

Our Bodies Ourselves: Menopause

Spring Talks Sex

GUEST COLUMN: We Are All Out of Africa!
Fri, 2014-10-03 17:15

By Carol Amaratunga

Forty-five years ago, as a student, I had the incomparable privilege of being accepted as a volunteer with Operation Crossroads Africa. In the summer of 1969 I was sent to the remote village of Bendaja, Liberia to help build a rural health clinic.

I have a vivid, startling memory from that summer of the Apollo 11 moon landing on July 20, 1969, an event that is no doubt seared into the minds of those of us who are a bit older. As Neil Armstrong said, it was “a giant leap for mankind.” Seated around an open fire on that dark and cloudy evening, my Crossroads team and the villagers of Bendaja glanced up to the heavens as we listened to the Apollo mission being broadcast by the Voice of America. When the broadcast ended, one of village elders turned to me and said, “It is just an American trick.” For my part however, I was both awe-struck and devastated. How could we spend millions of dollars to send men to the moon while down here, in the villages of Africa, people were sick, destitute and hungry?

You may wonder what this story has to do with women’s health. Bear with me for my memoire has everything to do with women’s health, humanitarianism, and the current Ebola crisis in Africa. The real question is:  what can we do to help? 

It was the rainy season and the women, children and families of Bendaja Village were essentially cut off from the rest of the world. The laterite roads were awash with a blood-red mud slurry and were impassable. There were no stores, no Loblaws or President’s Choice. It was a lucky hunter who could provision his family with wild meat. The night of the moon landing, the villagers brought us some of their valued hunt. It was a feast they shared with selfless generosity.

Recognized as the “worst Ebola epidemic in history,” without a major global effort and an immediate infusion of human and material resources, African countries may lose the battle.

Today the Ebola outbreak is out of control in a number of West African countries. In Liberia, Guinea, and Sierra Leone specifically, the epidemic is rapidly escalating and outstripping national health capacity. It is spreading through direct contact with infected persons and sometimes through the consumption of Ebola-infected wild meat. Such meat remains a necessary staple for people living in remote and rural areas. Bats are believed to be the vector for Ebola, and given that they often infect wild game such as monkeys, wild meat can sometimes be a deadly source of food.

The acute surveillance programs of international and national public service agencies such as the World Health Organization, the US Centers for Disease Control and Prevention, the Canadian Public Health Agency, all acknowledge that Ebola poses a critical and serious threat. NGOs, such as Doctors Without Borders, are critical of the inadequate response on the part of the so-called “developed world.” Recognized as the “worst Ebola epidemic in history,” without a major global effort and an immediate infusion of human and material resources, African countries may lose the battle. The NGOs are making a Herculean effort, but without significant and ongoing international donor support, many aid agencies, like their African counterparts, are stretched beyond the limit. 

In Canada, editorials assert there may be lessons from SARS that can be applied to the Ebola outbreak. What we learned from our team’s SARS research at the University of Ottawa was that it was essentially public health education that helped us to defeat SARS (See Caring for Nurses in Public Health Emergencies). The message was first proselytized by Florence Nightingale in the 1850s, when she admonished the British generals in the Crimea to get their horses out of the drinking water. Yes, it was old- fashioned public health and public education that had made a difference in defeating SARS. And thanks to Florence Nightingale, hand washing and social distancing are cornerstones of public health today. But SARS, in my view, is not necessarily a helpful model for Ebola. The health infrastructure and socio-economic context of Toronto and Vancouver are vastly different from the conditions facing an Ebola patient trying to survive in the slums of Monrovia or Conakry.

HIV & AIDS may yield better lessons for Ebola than SARS as Africa served as the testing ground for combatting HIV & AIDS. As we learned from AIDS, progress can be made when the design and delivery of public health education and interventions are tailored to specific needs, demographics, and local infrastructure. And while Canadian and US public health and pharmaceutical interests are developing one or more potentially efficacious Ebola vaccines, supplies of experimental vaccines to date are severely limited. It will take considerable time to produce the required quantities of Ebola vaccine for health-care workers and the general public. In the meantime, African hospitals and rural health-care centres need immediate support and a vast infusion of resources.

It is my personal view that West African university departments, i.e., Nursing, Medicine, Home Science and Agricultural Extension, have been an underutilized resource. In some countries, universities and colleges are currently closed due to Ebola but their faculties and students could be more mobilized. These local centres of knowledge are trusted. They are also experienced and best equipped to reach out to rural populations. Popular education such as radio farm forums are also trusted media sources and could serve as key players in promoting and delivering Ebola education, public health and prevention campaigns.

As of mid September 2014, more than 2,400 have died. It is estimated that there are already more than 1,000 orphans (UNICEF Rapid Assessment: Ebola Outbreak Impact on Children in Liberia). We can predict with confidence that based on past performance, the Ebola crisis will continue to threaten civil society, food security, good governance, law and order. As is typical in natural and human-made disasters, we will also see higher rates of drug abuse, more domestic violence against women and girls, ongoing school closures, hunger and artificial famine caused by food hoarding, and rabid inflation. Sadly, the Ebola crisis today is contributing to the increased geographical isolation and social quarantine of Africa, not only through the cancellation of commercial flights but also as a result of increased stigma and discrimination. In short, the Ebola epidemic and its burden on local infrastructure will bring about short, medium and long-term suffering to these affected nations and their populations.

We must admire the stunning courage and commitment of local health-care workers. Almost 150 front line workers have succumbed to Ebola, including several doctors, most recently Sierra Leonean physician Dr. Olivet Buck. However, there is another shining light in the Ebola story. National and international non-governmental organizations or NGOs are making an important difference. One international NGO of note in West Africa is IBIS from Denmark. Read the heart-rending blog of Anne Catherine, a Canadian IBIS staff member who, until recently, was stationed in Monrovia, Liberia. Last week, Anne Catherine and her co-workers were evacuated to Ghana for safety reasons and from there they will continue to work to mitigate the epidemic.

From Anne Catherine’s experience in Liberia we hear, in real time, the horrendous impact of Ebola on women, children and families. We know from front-line workers and from UNICEF briefing reports that the majority of health-care facilities are not operating, schools and universities are closed, quarantines are being enforced, and sporadic violence, civil unrest and demonstrations are taking place with greater frequency and severity. UNICEF has also confirmed that 75 per cent of those infected with Ebola are women—mothers and girls. What is particularly tragic is the fact that 20 per cent of all fatalities are children. The disproportionate rate of female infection is understandable given women’s gender roles as family caregivers, health-care professionals and as paraprofessionals. Culturally assigned gender roles require women and girls to tend to the sick and dying, bathe and ready the deceased for burial, clean homes and hospitals.

At the moment however, the Ebola-affected nations of Africa are very much on their own. They are figuratively and effectively quarantined from the rest of the world.

As mentioned above, given that Ebola is transmitted through direct personal contact, caregivers of all kinds are at great risk. We learned from the gender-based analyses of natural and human-made disasters (e.g., the Asian Tsunami, the New Orleans flood, the Haiti earthquake, and HIV &AIDS), that women and girls are more vulnerable and disproportionately affected because of their gender roles. There are many reasons for this, but as already mentioned, most have to do with women’s and girls’ social, domestic and employment roles. We also know from our past work on HIV & AIDS with the Commonwealth Secretariat that “education and treatment approaches that do not take into account gender, cultural, or social disparities do not use resources efficiently or effectively and fail to improve long-term population health outcomes.”(See Gender Mainstreaming in HIV/AIDS: Taking a Multisectoral Approach). Gender considerations are urgently required to address the Ebola outbreak. A gendered approach needs to be “mainstreamed” into all interventions—health, education, and economics—to ensure that women and girls, men and boys are treated equally and equitably.

UNICEF’s 2014 Generation 2030/AFRICA – Child Demographics in Africa report presents a worrisome forecast:  Africa’s population is anticipated to double in the next 35 years to 2 billion people—and almost 1 billion of those will be children and babies. Unless Ebola education and prevention programs can be developed and delivered by African states themselves, the long-term effects of Ebola will have a serious impact on the well-being of future generations. Given the historical mistrust that sometimes accompanies foreign aid interventions, it is essential that African nations be supported to develop their own health-care capacity and human resources.

At the moment however, the Ebola-affected nations of Africa are very much on their own. They are figuratively and effectively quarantined from the rest of the world. If the worst case scenario forecasts are realized—with as many as 20,000+ predicted fatalities, these affected West African states will no doubt descend into even greater desperation and suffering.

Because the Ebola crisis is raging, it is the time for extraordinary measures by ordinary people—not only in Africa but around the world. A dollar from every person in Canada would contribute more than $35,427,524 towards public health delivery systems. Our contributions would provide urgently needed resources in support of family caregivers, teachers, schools, public education and health-care delivery. On the critical list we need to invest directly in field hospitals, health-care professionals, laboratory and testing infrastructure, and the delivery of training and public health education, especially for rural and remote areas. Assistance will also be required to develop vaccine delivery systems to people living in remote communities.

As Canadians, we pride ourselves on helping others in time of crisis. We can reach deep into our pockets. We also need to emphatically inform our country’s leadership that both human and material resources to combat Ebola are needed—now!

In closing, a Lancet journal editorial recently referenced the UNICEF Generation 2030 report for Africa. The authors concluded quite rightly:  “The time has come to acknowledge our shared responsibility to the future of Africa and to take the policy decisions needed for all of Africa’s children, present and future, to finally realize all of their rights and potential.”

Post Script

In 1969, when I returned to Canada from my Crossroads experience in Liberia, I told my grandmother about my experience in Liberia listening to the Apollo moon landing. And remarkably, just like the Liberian village elder, my grandmother looked at me quizzically and in all seriousness said:  “It was just an American trick.” 

And so Dear Reader, I conclude my guest editorial with the phrase:  “We are all out of Africa” and we share a common humanity. Surely, if we could land a man on the moon 45 years ago, we can find the political commitment and the financial resources to help our fellow human beings to defeat Ebola!  Let us work together and make this effort another giant leap for mankind!

For more information

The Ebola Situation in Liberia, blog by Anne Catherine Bajard, August 2014

UNICEF’s 2014 Generation 2030/AFRICA – Child Demographics in Africa. August 2014

UNICEF Rapid Assessment:  Ebola Outbreak Impact on Children in Liberia, September 2014


Carol Amaratunga is a Women’s Health researcher, writer and activist. In former lives, she served as the Executive Director of the Atlantic Centre of Excellence for Women’s Health (Dalhousie University) 1996 – 2003. In 2003 she was awarded the Ontario Women’s Health Council (OWHC) Chair in Women’s Health Research, University of Ottawa. In 2008, Carol was recruited as the inaugural Dean, Applied Research, Justice Institute of British Columbia. Carol recently retired from academic life and now resides in Victoria, BC where she has re-invented herself as a social scribe and journalist.


To the point

SPRING TALKS SEX: Disordered eating and sexuality
Fri, 2014-10-03 16:50

By Lyba Spring

In preparation for some upcoming workshops, I’ve been learning more about barriers to healthy sexual functioning, including age, disability and eating disorders. For this month’s blog, I am focusing on eating disorders and trying to understand the complex physical, emotional and psychological issues involved. The literature is extensive and theories about causation abound; but there is less written about their effects on sexual functioning.

What is food preoccupation, how common is it, when does it become a concern and how does it affect relationships and sexual health?

If considered on a continuum, food and weight preoccupation runs from concern about weight to compulsive dieting to compulsive over-eating to anorexia nervosa and bulimia nervosa. Eating disorders such as anorexia, bulimia and binge eating can persist for years, even an entire lifetime. An estimated 10 per cent of individuals with anorexia nervosa die within 10 years of their first episodes. In 2002, 1.5 per cent of 15 to 24-year-old Canadian women surveyed had an eating disorder.

Weight preoccupation can begin at an early age. Twenty-eight per cent of girls in grade nine and 29 per cent in grade 10 have engaged in weight-loss behaviours. Thirty-seven percent of girls in grade nine and 40 per cent in grade 10 perceived themselves as too fat. Even among students of “normal-weight” (based on BMI), 19 per cent believed that they were too fat, and 12 per cent of students reported attempting to lose weight (see Public Health Agency of Canada information).

How does weight preoccupation affect sexual functioning?

While there is a big gap between a perception that one is “too fat” and a behaviour that is compulsive, it is a truism that media images feed in to girls’ and women’s desire to be thin. In the general population, negative body image can affect self-esteem and the ability to enjoy one’s sexuality. Body image issues that plague many of us are clearly magnified for women with eating disorders. But the physiological effects go much deeper.

A study published in 2010 found that nearly two-thirds of women with eating disorders reported loss of libido and sexual anxiety.

“One consistently observed finding across sexual functioning domains was the association between low lifetime minimum BMI and loss of libido, sexual anxiety and sexual relationships. These findings are consistent with the explanation that low body weight impairs the physiological functioning of sexual organs…” 

The researchers conclude that “independent of physical changes, individuals with lower BMIs experience a more severe presentation of the eating disorder” which “may be associated with more profound body dissatisfaction, distortion, depression and discomfort with physical contact, all of which may be associated with loss of libido and elevated sexual anxiety…” In other words, sexual intimacy is a fundamental aspect of healthy relationships that can be disrupted by an eating disorder.

How does dissatisfaction with one’s body and low self-esteem evolve into a full blown compulsion with its associated effects on sexuality?

We understand from the literature that women with eating disorders primarily seek to have control over their bodies. What triggers this loss of control?

A controlling family, a traumatic series of events like sexual trauma and even the arrival of puberty may all contribute to a feeling of lost control.

For someone living in a controlling family, for example, food intake and weight are areas of their life they believe they can bring under their own control. Anorexia may be triggered by this realization. The National Eating Disorder Information Centre (NEDIC) sees control as the “central paradox.”

Faced with high social expectations and a “shaky sense of self,” a woman assumes that she can at least gain approval by being thin. The ideal thin body holds promise. But controlling the body becomes a precarious substitute for real control in her life. “Women feel in control of their lives through controlling their bodies, yet the need to establish this false and precarious control suggests they are desperately out of control.

Another potential trigger is childhood sexual abuse. Mary Anne Cohen suggests women who were sexually abused as children may develop an eating disorder because of guilt, shame or self-punishment. She says sexual abuse survivors may also be trying to de-sexualize themselves—becoming either tiny and childlike or obese. They may try to make their bodies “perfect” and thus “more powerful, invulnerable, and in control, so as not to re-experience the powerlessness they felt as children… Some survivors of sexual abuse are afraid [my emphasis] to lose weight because it will render them feeling smaller and childlike… Binge eating, purging or starving then becomes their ongoing self-induced punishment.” 

How does this loss of control and attempt to regain it play out in a relationship aside from the physiological factors described above?

A woman who is preoccupied with her relationship with food, may be less likely to develop the skills that are essential for successful intimate relationships, including maintaining her status in a relationship as well as her ability to negotiate sexual activities and safety. Women who feel powerless; i.e., have lost control, may be less likely to be able to protect themselves from emotional or sexual abuse or from unsafe sexual practices.

If we are desperately attempting to control our bodies, we may feel ashamed of our “imperfections.” Then how can we believe someone loves us? How can we be honest with a lover when we practise secretive behaviours? How can we demand respect or communicate openly? How can we say what we want sexually, what we prefer not to do sexually and insist on sexual safety?

Treatment for women with an eating disorder will, like treatment for substance abuse, need to examine root causes—if they can be identified—as part of their treatment. The upside is that for women who recover, the prognosis for their sexual lives is positive.

I like to imagine a woman who learns to accept her body, to see it as attractive, and begin to take pleasure in it. I imagine her learning to share her body with another for mutual pleasure and admiration; and I imagine her gradual return to herself along with the desire, and ability, to love and take care of herself.

According to the website Eating Disorders Recovery Today: “in general, interest in, and pleasure from, sexual activity has been shown to decrease at the onset of the disorder and increase during weight restoration. Several explanations for this change in libido are a return to natural (and normal) hormone levels during weight restoration, and the women’s growing comfort with body acceptance and expression during recovery.” It is clear that the effects of an eating disorder are not only psychological and emotional, but physiological as well.

So the good news is, sexual health can be restored. The bad news is, eating disorders and weight preoccupation in general are increasing. We have work to do.

Talk to me: springtalks1@gmail.com


National Eating Disorder Information Centre (NEDIC)

Spring Talks Sex

SPRING TALKS SEX: When sex gets boring
Fri, 2014-09-05 20:15

By Lyba Spring

I guess it depends on what you call “sex,” but sexual routines, even when they work, can become repetitive.

Although you may get off with partnered sex, you may also find yourself observing your pleasure rather than mindfully enjoying it. Author Carol Shields called it, “going through the motions of love.” If the running internal commentary sounds like this: “Now they’re going to move to the other nipple; now they’re going to check to see if I’m wet...” it doesn’t sound like fun. Recognizing that it’s no fun is a good place to start.  

When boredom sets in, it may affect frequency of sexual contact, resulting in a discrepancy of desire in the couple. Of course, there may already be other relationship issues requiring attention. Avoidance, or a shoulder shrugging “let’s get it over with” attitude; or worse, the possibility of a real or implied threat of coercive sex, may lead to the end of the relationship entirely.

An article in The Walrus quotes the 2011 Canadian Living Intimacy Survey regarding frequency and mismatched desire. The study found that 53 per cent of Canadians would like to have sex a few times a week, but that 39 per cent are having sex a few times a month, and even less for 23 per cent of people surveyed. Amy Muise is lead author on the paper, Keeping the Spark Alive: Being Motivated to Meet a Partner’s Sexual Needs Sustains Sexual Desire in Long-Term Romantic Relationships which discusses this decline of sexual desire over the course of a relationship. The authors suggest that when desire decreases, couples should focus more on their partner’s needs. They call this “communally oriented sex” or “communal motivation:” “Being motivated to meet a partner’s sexual needs is beneficial to the self.” This approach differs from simply being accommodating; it means actively seeking to find out more about your partner’s needs, which involves better and more specific communication.

So let’s talk--about fun. Fun often includes excitement. I’ve sometimes wondered why some people find sexual role play so alluring. Then it struck me: it’s the ultimate “let’s pretend” that we enjoyed as children. It may bring back the thrill we get with a new partner and a new situation.

So, let’s pretend that you are with someone who may be open to a new game. How do you raise it? If you have always been sexually frank, it won’t be a problem. But if shyness and embarrassment are part of the reason you have not been able to say that you are bored with your routine, you may welcome a few tricks. In a professional workshop I attended years ago, a sex therapist gave the following suggestion: use the metaphor of treats. If you just feel like having a cuddle, slip a note under your partner’s pillow that says something like “cookie.” If you are looking for the whole shebang (sorry), write “Bavarian chocolate cake” or whatever your equivalent baked desire might be. Notes these days are more likely to be texts. An erotic text like, “let’s play a game tonight…” may open the door to a new experience.

The next time you are getting ready to be intimate, start small. “Do you remember when we first met? Do you remember where we were? Let’s pretend it’s that first time.” Then you can explore memories to set the scene. Some couples who are titillated by this first scene may want to move on to others.

Another possibility is playing “don’t touch me there.” Sex therapists often forbid certain sexual activities when there is a problem with orgasm in order to allow individuals and couples to explore other parts of the body with more attention. You can tell your partner that you want to play a game. They can only do X, Y or Z but not A, B or C. You could make it more exciting by begging them when you get really excited, to pl-e-e-ease touch you there (or to do A, B, or C) with the understanding that they are not supposed to give in.

There may be a sexual activity you’ve always wanted to try but you have been unable to ask for it. Again, a note or text might work, or you can do something out of character like renting a video that demonstrates it in great and graphic detail.

But some of you are shaking your head. You just want to be able to talk openly about an aspect of your sexual relationship that--you feel--needs work. Aside from overcoming the obstacle of finding the words and getting them out, you may be worried about hurting your partner’s feelings. Perhaps the next time you set out to be intimate, start with expressing appreciation. “I love it when you/we…Let’s do that some more the next time.” Or, “I remember once you did X. I fantasized about that for days. I’d love you to do that again.” Or, “you would probably enjoy Y and I would love to give you that pleasure.”

If you like your routine, fine. If you’re bored, fix it. Or at least enjoy trying.

Talk to me: springtalks1@gmail.com


UBC Sexual Health Laboratory

Spring Talks Sex

SPRING TALKS SEX: Personal Puff Piece: The fabulous world of online dating
Fri, 2014-08-01 09:27

By Lyba Spring

Everyone knows someone who has tried online dating. Was it fabulous for them? Perhaps from the outside looking in. From inside, it can be rather dingy and depressing. Speaking personally, there may be other 65-year-old women who are having a blast. I am not.

It’s been a year since my last online dating experience. A promising (somewhat younger) man who was clearly turned on to me, disappeared in a puff of smoke after a very brief affair.

Here’s how it works. You begin with a profile, trying to make yourself stand out from the crowd—cheerful, attractive and interesting. You are encouraged to post pictures of yourself doing fun stuff. In my age bracket, there are lots of photos of men with their cars, their dogs, their children and their grandchildren. Of course, when you begin to read through the profiles of the potentials whose photos are appealing (in my case, no dogs or cars), they seem dismally similar. Comfortable in a tux or jeans. Loves to cuddle by the fire drinking wine (does everyone have a functioning fireplace?). Works out every day, cycles, skis, loves to travel…

Then, if you finally find someone literate and interesting, you work up the courage to send a message and… Well, like my last go round, it may result in a rushed first coffee date with enthusiastic follow-up. Or, you get nothing. If you’re lucky, you get a civil “thanks, but no thanks.” What feels worse is a flurry of messaging back and forth, and then nothing. I am told that the lack of etiquette is the etiquette of online dating.

Sometimes you get a date—or a few with the same person. Sometimes you have a short-term or even longer-term relationship; and then it’s back to online dating, unless you meet a real, honest-to-goodness long-term partner, which for some is the ultimate, seemingly unattainable end game.

So what does all this have to do with sexual health?

Well, for one thing, it can be very hard on one’s self-esteem. Unless you have a very thick skin, being ignored—or worse, rejected—can be hard to take. Some people check their sites obsessively to see who has looked at their profile, or to scroll through potentials; others casually take a peek from time to time. Lately, I’ve been weaning myself off, only checking in when there is some action (So and so wants to meet you! You’ve got a new message!).

The other issue is safety. I don’t mean avoiding axe murderers or con men/women, but sexual safety. If you do meet someone, and go the “first base, second base” route ending up in bed, there is the tricky question of protection. Being a sexual health educator, I am more aware than most of the risks of non-condom use. Having preached communication for my entire career, I can finally discuss both condom use and testing with someone quite easily. I can also weigh the risks of activities like oral sex without a condom. I doubt that this is the case for most women who are relatively new to the dating game.

As I explained in my article on older women and sexuality, while it is hard enough for younger people to negotiate safer sex because of embarrassment or an inability to assert themselves, an older woman whose long-term relationship ended because of separation or death, has not had to deal with STI prevention for years, if ever. One cannot make the assumption that this previous long-term relationship was necessarily mutually monogamous. That, and a newly discovered zest for hanky-panky have resulted in an increase in STIs for baby boomers.

One should not entirely dismiss the potential for sexual assault or emotional abuse. I shocked a friend once by putting myself in a risky situation. Google can give you some sense of a person after you meet on a site and you eventually exchange full names and e-mail addresses. I recently visited a potential’s Facebook page and discovered he was a right-wing racist. That certainly killed the mood. Of course, a really good con man or woman can create a fictional bio with relative ease. There are many cases of people being bilked of their pensions by imaginative suitors. It can be hard to find a reasonable balance between vigilance—watching for red flags—and relaxing into what seems like a trustworthy relationship.

It isn’t easy to meet a potential partner offline—as in real life. You have to ascertain that the person is interested at some level and then figure out if they are attached. Attempting to find that out can be embarrassing and tip your hand. And while you may want someone to “fix you up” with their dentist, for others it’s the kiss of death.

Yes, it sounds like a game and I suppose, in some ways it is. But games are supposed to be fun. The online dating game: not so much. The bottom line is that you already have a life. A partner will not create your life, although they may enrich what you have. So, approach your keyboard with caution and a sense of irony. Getting lucky may end up being no more than maintaining your status quo.

Talk to me: springtalks1@gmail.com

Spring Talks Sex

SPRING TALKS SEX: Murder by misogyny?
Wed, 2014-06-25 13:50

By Lyba Spring

mi∙sog∙y∙ny  noun.  1. a hatred of women (Merriam-Webster).

Laci Green, self-described sex-ed activist, uses the phrase “misogyny as murder” in her YouTube rant about the May 2014 murder of six people and wounding of 13 others by Elliott Rodger in California. People seeking out the definitive answer to “how could this have happened” fall all along the blame continuum that runs from blaming his family life and early mental health issues, to the medications that he was prescribed, to his blatant hatred of women, and to easy access to guns and ammunition. The latter is of course refuted by the gun lobbyists who continue to assert that guns don’t kill, people do—citing their right to bear arms. Interestingly, in their effort to deflect attention from Rodger’s modus operandi, some gun lobbyists have put all the blame on prescription medication.

Rodger’s particular form of male entitlement—expecting the world to work entirely in his favour—is exemplified by his hate-filled video in which he blamed women for his persistent state of virginity. Yet despite this evidence, we will never really know the reason why he carried out this heinous crime. Despite all the “ink spilled” over his and similar crimes, it is time for a more nuanced discussion that does not attribute blame to a single issue, although misogyny continues to figure large in this picture. It is also time to start putting together a prevention package.

Zoe Mintz’s article in the International Business Times is not, in my opinion, part of that package. She states, “In the field of ‘threat assessment’, which is dedicated to studying school shootings and other school-based attacks, notable outcroppings in personal histories is known as ‘leakage.’ An individual may indicate his distress long before the crime is committed…Elliot Rodger created YouTube videos and a 140-page manifesto that shed light on his mind-set before the killings.”  She never once mentions misogyny, aside from this oblique reference to Rodger’s “mind-set.”

On the other hand, Anne Theriault’s response to male entitlement in her May 31st Belle Jar blog explores the negative feelings she experienced about her own late entry into partnered sex:

“And you know what? Literally at no time ever did I think, gee, I should go on a killing spree.

I never felt entitled to men’s bodies just because I wanted them.

I never blamed all men everywhere for my inability to get it on.

Never. Not once.”

I agree with Laci Green and Anne Theriault. We need to begin building our prevention package by addressing male sexual entitlement. Readers of this blog may be tired of hearing it, but healthy sexuality education begins at home. This is where societal mores begin, and where they begin to change. From infancy, relaxing and blurring rigid gender roles, expectations and responsibilities promotes much more than the achievement of a child’s full potential; it is an integral part of crime prevention.

Boys need to learn about girls’ essential humanity to develop into empathic individuals. Girls need to learn how to have agency in their lives. Young people need to fully comprehend the horror of denying and violating that agency.

I was profoundly shocked to read more than one story these past few years about sexual assaults of young women that had been filmed and posted on the Internet. Why did they not empathize with the victim/survivor? Perhaps because rape culture promotes sexual violence as entertainment. Reasoning that it was crucial to teach students the potential reactions and harms suffered by someone who is sexually assaulted, I included a list of these after-effects in sexual health education materials intended for the use of educators across the country. I only hope that they accept the challenge of this particular call to arms.   

Few would dispute that a sense of male entitlement and rage has fuelled sexual assault, physical assault and murder. Rape culture starts with the objectification of women, promoting both the notion of the right to unlimited access to women’s bodies and its subsequent violent expression. This twisted ideology will flourish as long as we continue to ignore its impact; namely, distrust and fear, and ultimately, criminal acts. Interestingly, those very social media platforms that allow the promotion of rape culture have found their match on Twitter (See #YesAllWomen).

The International Campaign to Stop Rape and Gender Violence in Conflict extends this analysis to a broader context: the use of women (and men) as pawns of war. The “othering” of one’s enemies was raised decades ago in Susan Brownmiller’s book Against Our Will (1975). It is much easier to hurt, and kill, what has been objectified. The recent kidnapping of Nigerian girls and young women may very well result in sexual abuse, as Boko Haram has threatened to sell them in “marriage.”

The theme of women as property is echoed in the rallying cry of men who kill their partners, “If I can’t have you, no one can.” I have often quoted Maya Angelou to students over the years:

“Jealousy in romance is like salt in food. A little can enhance the savor, but too much can spoil the pleasure and, under certain circumstances, can be life-threatening.”

Elliott Rodger was steeped in misogyny, blaming and hating women for not wanting to be with him. Aside from his legal access to firearms and ammunition, as mentioned above, the question has also been raised about his use of anti-depressant medication. Because psychotropic medications alter brain chemistry, an overdosing of—or a rapid withdrawal—from a number of medications in this class can lead to behaviour that is out of character for the person taking them. This may include erratic or even homicidal behaviours. Although the latter may be rare, for the many people who take these medications and feel they are being helped by them, it is often hard to believe in or make that connection.

Consider the following conclusion to the online article published in PLoS Medicine, “Antidepressants and Violence: Problems at the Interface of Medicine and Law”:

“The association of antidepressant treatment with aggression and violence reported here calls for more clinical trial and epidemiological data to be made available and for good clinical descriptions of the adverse outcomes of treatment. Legal systems are likely to continue to be faced with cases of violence associated with the use of psychotropic drugs, and it may fall to the courts to demand access to currently unavailable data. The problem is international and calls for an international response.”

Which brings me back to that other prescription, the one for prevention. We need:

  • improved education for health care providers about psychotropic medications, and better monitoring of their patients;
  • sexual health education that promotes equity in all its forms;
  • campaigns targeting male entitlement that engage men as allies (#AllMenCan);
  • comprehensive gun control on both sides of the border.

Rx: #NotOneMore.

Talk to me: springtalks1@gmail.com

Additional Resource:

Robert Whitaker on Psychiatric Drugs, The Sunday Edition on CBC Radio


Spring Talks Sex

SPRING TALKS SEX - Choice denied
Mon, 2014-06-02 17:46

By Lyba Spring

A law with teeth is only as good as its enforcement. But when a law is struck down, politics determines how it will play out in society.

When the Supreme Court struck down the law on abortion in 1988—the famous Morgentaler decision—a woman’s right to choose was enshrined in Canadian society. In 1989, the argument of “fetus as person” was rejected, as was the attempt by men in three provinces (Ontario, Quebec and Manitoba) to stop their partners from having abortions. These legal decisions left the right to choose firmly in the hands of individual women.

But a woman’s ability to exercise her choice is limited by several factors: location (it is hardest to get an abortion in the eastern part of Canada); cost, when a woman has to travel to get an abortion or a province does not fund the procedure; and by people, including doctors, who push their anti-choice agenda on a pregnant woman trying to make her decision. (Read more about which provinces cover hospital and/or clinic abortions and which ones do not).

Only 17.8 per cent of Canadian hospitals provide abortion services. Even hospitals that provide abortions may place obstacles in the way of women who try to obtain one, especially if their administration is anti-choice.

Women’s Legal Education and Action Fund (LEAF) decries these obstacles, particularly for women in rural areas, New Brunswick, Prince Edward Island and the North. They explain that provinces are able to limit access because abortion is on a list of “excluded services” in reciprocal provincial billing agreements. This means that women temporarily living outside their home province may not have access to publicly funded abortion care. Waiting for coverage is not feasible for a woman who chooses to terminate. For a woman who does not want to continue her pregnancy, every day that passes can be excruciating.

The Morgentaler Clinic in New Brunswick announced it would close its doors at the end of July 2014 after a lengthy losing battle to have that province fund clinic abortions, leaving local women bereft of an essential medical service. Moreover, for women in Prince Edward Island, the only province in Canada with no local access to abortion, women have had two choices: the Termination of Pregnancy Unit at the QEII Hospital in Halifax, where the costs of the procedure (but not those of travel or accommodations) are paid by the Province. At the Morgentaler Clinic in Fredericton, all costs have been privately paid by the woman (with many Island women accessing the Clinic’s subsidies). Over the years, roughly half of PEI women seeking abortions have used the services of the private clinic in Fredericton. The clinic was the only private option in the Maritime provinces. After the closure of the Fredericton private clinic, only one option will remain for Prince Edward Island women seeking a surgical abortion: travelling to the hospital in Halifax. (Read more about the current situation in PEI).

Why is this service essential?

It is estimated that 40 per cent of pregnancies in Canada are unplanned. A condom may break or slip, a pill may be forgotten, a woman may be sexually assaulted; or people may be unequipped to gain access to, negotiate or use contraception.

The decision to end a pregnancy is often based on economics, especially when she already has children and simply cannot afford to have another one. When money is tight and jobs are scarce, women think first of their existing children. When I had my abortion, we already had two children; the younger was a year and a half and our financial situation was precarious. Amongst the scores of pregnant women seeking help with their decision whom I counselled in sexual health clinics over the years, their distress was often financial.

But there were also more dramatic cases.

I vividly remember the woman who said she wanted to continue the pregnancy, but was afraid to. Her husband, who refused to allow her to use any form of birth control, had kicked her during a previous pregnancy. She had miscarried.

I remember the young woman who started having sex at 13 who had had three abortions and was a crack cocaine user. I am guessing that prior sexual abuse predisposed her to ongoing risk-taking.

I remember the 28-year-old who had been drugged and raped; the 16-year-old whose boyfriend wanted to trick her into getting pregnant. 

These women all lived in a city where there was good access to services. But even when there is adequate access to the procedure, there is another component to the process which is as essential as the service itself. Every pregnant woman who came to the sexual health clinic where I worked was given the time to consider and explore her options. The counselling component is integral to the service of abortion referral and abortion provision. Counselling often leads to other service referrals, as in the case of the woman who was abused by her husband. It is expensive to pay people to help women make a fully informed choice. Whatever a woman chooses, she needs to feel that it is the right choice for her at that moment in her life. This can take time—and time is money. Counsellors who work in abortion clinics are supporting a woman who is facing a life-changing dilemma.

But health dollars are scarce and their distribution is political. For example, there is currently a lobby to extend HPV vaccination to boys despite the lack of evidence that it will save money in the long run. HPV DNA testing, which is part of good management for women over 30 is not covered by every province and territory. Pap screening and follow-up is not available to the women who are most at risk for cervical cancer. Mammography programs are not cost effective in terms of lives saved. Moreover, “potential harms considered by the [Canadian] Task Force [on Preventive Health Care] focus on over-diagnosis of breast cancer which can lead to additional imaging, biopsies and procedures, distress and other psychological responses, and additional radiation exposure from mammograms.” Yet women continue to be screened on a regular basis.

Women’s health facilities tend to be cash poor while hospitals are well-funded and able to raise huge amounts through donations.

Although the current federal government insists it will never reintroduce abortion legislation, they are choking funds for abortion services the same way they starve women’s organizations and women’s health clinics. If there was genuine concern about bringing wanted children into this country, there would be a national child care program and universal student nutrition programs.

Abortion is a medical procedure which should be accessible and fully funded—everywhere. It should be a priority for women to be able to choose when they want to continue a pregnancy and when they want to terminate one.

Women’s reproductive rights are central to their ability to control their lives. Without access to services and funding, the abrogation of a law is toothless.

Talk to me: springtalks1@gmail.com

Read more here:

CWHN Health FAQ on abortion

History of abortion in Canada, National Abortion Federation

Access to hospital abortions, Reality Check, Canadians for Choice report, 2006

Access to abortion in Canada, Women's Legal Education and Action Fund (LEAF), April 2014

Abortion access for women in PEI, CBC website, April 2014


Spring Talks Sex

GUEST COLUMN: (Not) Shopping our way to safety
Wed, 2014-04-30 18:34

By Robyn Lee and Dayna Nadine Scott

Media coverage of the risks posed by brominated flame retardants (BFRs) and phthalates almost always includes advice on how to limit exposure to these chemicals in the home. Those seeking policy change often call for effective labelling of consumer products, including  “green consumer” campaigns such as “wallet cards” with long lists of chemical names for shoppers to avoid. Apparently, consumers are expected to pull these out of their wallets in the grocery aisle, at the drugstore, in the electronics superstore. These campaigns attempt to address a lack of effective government regulation of chemicals; however, they overlook the extent to which women carry out the majority of household cleaning, shopping, food preparation, and caring for the health of family members. Attempts to limit household exposure to BFRs and phthalates require additional work that consistently and disproportionately falls to women.

Brominated flame retardants (BFRs) are widely used in consumer products—plastics for electronics, foams and textiles—to prevent household fires. Human breast milk is the leading source of lifetime exposure to BFRs and house dust is the highest source of exposure for adults. BFRs are “persistent” chemicals (they do not break down in the body or the environment), and dietary sources are the next highest source for adults as they contaminate ecosystems and agricultural food systems. The “body burden” of BFRs in North Americans has risen sharply since the early 1990s reaching levels among the highest in the world.
BFRs are among the group of chemicals implicated as endocrine-disrupting compounds. Elevated levels of BFRs in breast milk have been linked with lower birth weights and birth sizes. As with other endocrine disruptors, exposure to BFRs is linked with abnormal development of reproductive systems, affecting individual health but also potentially the health of future generations.
Phthalates are a principal component of a wide variety of consumer products: construction materials, cables and wires, floorings, clothing, furnishings, car interiors and car underbody coatings, products made of flexible polyvinyl chloride plastic (PVC), cosmetics and other personal care goods, pesticides, lubricants, adhesives, film, toys and food contact materials. Diet is a major source of phthalate exposure in the general population as a result of food packaging and contamination of the environment. Because of the multitude of phthalate sources and the difficulty in controlling these sources, conventionally and organically produced food products may be similarly contaminated with phthalates. Breast milk is a source of phthalate exposure for infants.
Phthalates have also been identified as endocrine disrupters. In utero exposures can result in abnormal development of the male reproductive system. There have also been studies suggesting a possible link between phthalates and increased rates of asthma, obesity, and decreased IQ. The general population is widely and continuously exposed to phthalates, as a result of worldwide ecosystem contamination and direct contact with products containing phthalates.

Since women assume primary responsibility for the running of the household and the health of family members, campaigns to reduce chemical exposures from consumer goods must account for women’s share of work related to “dodging the toxic bullet.” Looking at BFRs and phthalates demonstrate that campaigns aimed at labelling as a policy solution, even as a stop-gap measure, are not only futile but actually increase gender disparities related to toxic chemicals in the environment. We will clearly not “shop our way out” of this problem.

Emerging evidence on our “body burdens” of BFRs and phthalates demonstrates that a key assumption in the promotion of labelling as a policy solution—that individuals will actually be able to reduce their exposures—is questionable.  But even putting this aside, and assuming that individuals are able to reduce their exposures through their own so-called “precautionary consumption,” the promotion of labelling as a policy response can have negative results. It is likely to actually increase the uneven distribution of harms (according to age, sex, race and socioeconomic status) stemming from long-term chronic exposures to toxic chemicals. Worse, our individual attempts to limit exposures may detract from the collective action needed to help bring about regulatory changes. Practising precautionary consumption leaves women with less time and energy to engage in environmental and political action aimed at changing chemical management policies.

The precautionary principle sanctions (or mandates, depending on which version you subscribe to) action in the face of scientific uncertainty to prevent potential harm to human health or the environment. Ultimately, in chemicals management policy, this means that governments should prevent, or minimize, public exposures to chemicals for which there is some evidence of harm, even where that evidence is uncertain. The precautionary principle challenges the conventional “permissive approach” to chemicals regulation, which was founded on the assumption that toxicology can predict the health impacts associated with everyday exposures.

“Precautionary consumption” is a term coined by Norah MacKendrick to describe the practices of individuals trying to reduce their body burdens by purchasing environmentally friendly products. The premise is that individual consumer action is the primary mode of responding to these risks  as opposed to changing government regulation.

Whenever we read stories in the media about toxins, they almost always include advice on how to limit our exposure to these chemicals. BFRs and phthalates are no exception. Advice on how to reduce exposure to BFRs usually focuses on frequent dusting and vacuuming, eating fewer animal products, frequent hand washing, and avoiding purchasing new products containing flame retardants or even suggesting the replacement of existing products with products that do not contain BFRs.

Common advice on reducing exposure to phthalates includes: limiting the amount of personal care products used on children; choosing personal care products that do not contain phthalates (however, phthalates may not be labelled as such, so you may have to call the company or visit the website to find out); finding out if the container the product is sold in contains phthalates (again, you will have to contact the company in order to know for sure); avoiding plastic baby bottles or water bottles or trying to buy phthalate-free bottles; and avoiding heating plastic containers in the microwave or dishwasher. Since phthalates can become airborne and wind up in dust in the home, wet mopping is also suggested.

Most of the advice around minimizing exposure to BFRs and phthalates revolves around food preparation, household cleaning, and smart shopping—all activities disproportionately performed by women, especially mothers. When  this work is not performed by mothers, it is often contracted out to other women, who are usually of lower socioeconomic status and often racialized.

Women also do most of the work of caring for family members’ health. As a result, the responsibility of illness linked to pollution may be blamed on women’s bad housekeeping practices rather than attempting to reduce pollution at the source.

Women increasingly make household purchasing decisions, and engage in more environmentally friendly behaviours, such as recycling than men. Women are also more likely to be the ones reading product labels. As household purchasing decisions become more complex (requiring more and more research and reading of labels), women are spending more time to carry them out.

Green products are generally pricier than mainstream brands, and more time is needed to shop for them because they are often only available at smaller, specialty stores. Even the authors of fact sheets on how to avoid BFRs and phthalates admit that it can be difficult and often hardly realistic to follow all of their advice. In one study, student interns took an average of five minutes per product to wade through ingredient lists and environmental and health claims.

Contacting product manufacturers to inquire about ingredients is time-consuming and often of little to no use. Researchers in Massachusetts found that most manufacturers contacted did not provide complete responses, and of 24 conventional product manufacturers contacted, 70 per cent provided no information at all. The Campaign for Safe Cosmetics reported in 2002 that phthalates in 52 of the 72 personal care products tested, even though none of the 52 phthalate-containing products listed the offending chemical on its ingredient label.

Precautionary consumption is a gendered labour practice, yet it’s clear that not all women are affected to the same extent. Women’s capacity to be a precautious consumer varies according to socio-economic status and level of education. It assumes that mothers are free to choose among desirable mothering practices and protective commodities. However, research shows that the choice is highly dependent on having the financial resources.

Significantly higher levels of BFRs have been measured in people with low socio-economic status compared with those of higher socio-economic status. As well, US research has documented racial differences in BFR body burdens, with lower levels of BFR body burdens among whites compared to blacks and Mexican Americans. The researchers suggest that these differences may be due to differences in housing and furniture quality, and in the quality of diet consumed. With phthalates there are also differences in exposure depending on sex and race. Women in the study tended to have a higher level than men and non-Hispanic blacks had higher levels than non-Hispanic whites or Mexican Americans.

Our own federal government’s new and highly touted Chemicals Management Plan (CMP) proclaimed itself to be “tough on toxics.” It includes a program called “The Challenge” aimed at taking quick, decisive action on 200 of the most worrisome substances in commercial use in Canada. But critics now question the extent to which the CMP actually marked a shift towards a “precautionary” chemicals management policy in Canada.  A recent assessment (see also Environmenal Challenges and Opportunities) concludes that, despite the government’s initial stated intention to use the new scheme to designate high priority substances as “toxic,” only a minority of substances assessed in The Challenge were listed as such, and corresponding risk management measures have been inadequate and slow in coming. The result is that the ultimate goal of the CMP—reductions in exposures to these substances for everyone—is unlikely in the near future. 

When faced by a huge number of toxic and potentially toxic chemicals to be avoided, consumers may only make only a few symbolic changes.  These include switching to other products that are perceived to be “greener” but may still contain the undesired chemicals, or switching one or two products but continuing to use many others containing the chemicals. Because BFRs and phthalates are so pervasive in consumer products, are rarely clearly labelled, and alternative products can be difficult or expensive to obtain, consumers are unlikely to be able to avoid exposures. Individual changes in consumption, although important, cannot replace collective action. Education of consumers and pressure applied by consumers to manufacturers are important for change; however it is essential that government take more responsibility for effectively regulating toxic chemicals. We cannot shop our way to safety if there are no (or at least not enough) safe options.

See also the guest column by Abby Lippman and the Network article on "body burden" by Dolon Chakravartty and Robyn Lee

Robyn Lee has a PhD from York University in Social and Political Thought and is a team member of Canadian Institutes for Health Research (CIHR) team grants on Brominated Flame Retardants and Phthalates.

Dayna Nadine Scott is an Associate Professor of Law and Environmental Studies at York University. She is the Director of the National Network on Environments and Women’s Health.

Additional resources:

More work for mother: Chemical body burdens as a maternal responsibility, Norah McKendrick, published in Gender & Society, April 2014.

To the point

SPRING TALKS SEX - Female genital modification
Wed, 2014-04-30 17:36

...the cutting edge of a double standard

By Lyba Spring

In February, 2014, the Ontario’s Sexual Health Network organized an update on “female genital mutilation” (also known as “female genital cutting”). At the meeting, I raised the question that was so eloquently discussed in a paper on intersex surgeries about the cultural parallels between genital cutting practices in “developing” countries and genital surgery in “developed” countries. This issue was raised again in a recent discussion on CBC Radio’s program, The Current to which I listened attentively (yes, I took notes) as I am interested in these surgeries and have participated in two public discussions on the subject.

Listen to the CWHN podcast on "designer genitalia"

The Current invited the CEO of the Society of Obstetricians and Gynecologists of Canada (SOGC), Dr. Jennifer Blake, to speak about the SOGC guidelines on both female genital mutilation/cutting and female genital cosmetic surgery. They also invited Dr. Sean Rice, a plastic surgeon who performs labiaplasty as well as a triathlete who had requested—and was satisfied with—the surgery.

Labiaplasty involves reducing or removing the labia minora—or inner lips—of the vulva. Another common surgery is the reduction of the clitoral hood. The motivation for this surgery on a functional part of the body is generally either dissatisfaction with the appearance of the vulva or, in the case of labial reduction or removal, its interference with comfort, as was the case with the triathlete.

In the interview, Dr. Blake argued that women are made to feel inadequate about whether or not they look “normal.” In her practice, Dr. Blake tells adolescent patients that their inner labia will fill out and look more proportional as they continue the changes of puberty. She applauds initiatives like the Great Wall of Vagina for normalizing the diversity in genital appearance. Dr. Blake blames pornography in particular, for playing on women’s anxieties about what the vulva is supposed to look like. One wonders if this body anxiety can eventually lead to body dysmorphic disorder (where people think about their real or perceived flaws for hours each day); and whether this disorder is entirely a cultural creation of our society.

People associate female genital mutilation/cutting with Islam although it is practised by other religions and cultures as well. Although Muslim scholars are divided about the particulars, there is no Islamic religious basis to these practices. (“No verse of the Quran, or deeds or sayings of the Prophet, support FGM/C”). The practices are culturally driven.

In a film about female genital mutilation/cutting interviewees explain the norm for women’s genitals in their cultures; one woman interviewed in the film said the vulva must look “smooth and clean.” The societal implication for a woman who is not cut is tremendous in some cultures: in Somalia or Sudan, for example, she is not considered marriageable. Dr. Blake made the point that the same type of language is used with female genital cosmetic surgery. “The Barbie”—also known as “The Clam”—is a surgically created smooth version of a woman’s genitals. During the interview on The Current, the surgeon, Dr. Rice, took offense at this comparison between genital mutilation and genital cosmetic surgery, insisting that the issue of consent was central to cosmetic surgeries.

As a women’s health advocate since 1970, and formerly a counsellor in a sexual health clinic, consent—informed consent—has been paramount to my practice. On what basis does a woman make her decision about modifying her genitals? Where does she get her information aside from media images and biased advertisements for the surgeries? Part of the larger picture is our rigid cultural description of male and female genitals. What should they look like to be considered properly male or female?

In Ehrenreich and Barr’s article about the “selective condemnation of ‘cultural practices,’” they explore and critique the binary definitions of genitals and discuss how decisions are made about whether or not to modify the genitals of an intersex baby. The basis of the decision is shockingly simplistic.

If the penis of an intersex baby is too small (defined as under 2.5 cm stretched), the child is likely to undergo surgery to be transformed into a girl. Not surprisingly, the authors consider this rigid definition of biological male sexuality to be heteronormative. Similarly, a baby with what is considered to be an abnormally large clitoris would undergo a clitoroplasty to reduce the size of the clitoris.

These surgeries of “genital normalization” for intersex babies—an average of 3 to 5 surgeries per child—not only have repercussions emotionally, but also can impair sexual functioning because of scarring and nerve damage. Vaginoplasty to create an opening for an intersex child has a high failure rate in terms of the person’s ability to have/enjoy vaginal sex as an adult. Ehrenreich and Barr argue that North American medical practice as it applies to intersex children is not strictly based in science; nor is it culture-free. The authors make the point that we condemn the “cultural” practices of cutting in other countries while refusing to be self-critical about the cutting practices in North America, acknowledging them as a cultural practice as well.

Intersex children rely on their parents’ consent to the surgeries. Is a woman giving informed consent when she opts for labiaplasty if she does not know whether she will experience negative health effects when she reaches menopause, like a potential increase in vaginal atrophy? Moreover, clinics offering “mother/daughter specials” on genital cosmetic surgery are unlikely to discuss with either mother or daughter the potential damage to sexual sensation due to possible scarring and nerve damage.

In the article “Aesthetic Surgery of the Female Genitalia” published in Seminars in Plastic Surgery, the authors comment:

“The vulvar epithelium of labia minora is highly innervated and sensitive. During sexual arousal, the labia evert and contribute to erotic sensation and pleasure. Incision to any part of the genitalia could compromise this sensitivity and its sexual importance. Neuroma-like hypersensitivity has been reported after surgery.” In other words, when you cut during surgery, the result may be either insensitivity or hypersensitivity, neither of which is expected as part of the package.

In the 1970s, at a Geneva conference of the World Health Organization, feminists publicly decried female genital mutilation practices. Their sisters from countries where genital mutilation took place told them to stay out of it; that they would deal with the issue themselves. And they have been. In countries where genital mutilation/cutting is practised, slowly but surely, women are finding allies, including religious leaders, to put an end to these practices. Surely women in “developed” countries who long for designer genitals have something important to learn from them.

Talk to me: springtalks1@gmail.com


Spring Talks Sex

GUEST COLUMN: Another silicone bracelet?
Wed, 2014-04-09 17:33

This one claims to measure toxic exposures

By Abby Lippman  

It seems that my tendency to see glasses half filled, if not empty, when others are happily seeing them brimming with new possibilities only increases with time. With this advance warning, I want to outline why I am not going to rush to get—nor to suggest others rush out to get—the newest of the wide array of color-coded silicone rubber bracelets which will likely soon become hot-ticket and heavily marketed items.

It used to be that a person could be said to wear her heart on her sleeve when her feelings for a new love were obvious to all. Of late, it has become more a case of sporting a cause on one's wrist. And to do so, one can sample—if not wear examples of—a full palette of color-tinted rubber circles on an arm: red (heart disease); yellow (testicular cancer); blue (arthritis); teal (cervical cancer); ; green (liver cancer); purple (Alzheimer’s disease); a rainbow braid (LGBTQI); and the almost omnipresent pink (breast cancer).

These designer accessories—the products of feel-good cause marketing campaigns—have, to date, offered individuals an outlet for their “political” self-identification. But for the future, it seems they are possibly to be restyled to also become technologically enhanced forms of “arm candy.”

In brief, some clever researchers appear to be taking  advantage of silicone's ability to absorb compounds to which it is exposed. By developing a way to measure what is captured in the silicone, they may then be able to determine what chemicals are probably entering an individual’s body and subsequently link these exposures to conditions and diseases she may later develop.

See also, the guest column on "precautionary consumption" by Robyn Lee and Dayna Nadine Scott

I do not doubt how welcome this may be for epidemiologists and public health policy makers who have long sought to avoid the traps of applying population-based and ecological data (e.g., kilograms of pesticide used on a farm; measurements of air pollutants in a city; endocrine disruptor levels in an automobile manufacturing plant) to the individual worker or commuter. If the kind of bracelet tried out can absorb exposures, it might be able to record what any one individual actually experiences herself and provide specific information over a period of time. With flick-of-the-wrist analyses, these bracelets could then allow researchers to replace studies of association (weak) with studies of causality (the biomedical holy grail).

So why am I concerned?

To explain, it may be useful to think of the critiques that have previously been addressed to what is in many ways an earlier, allegedly “empowering,” approach to strengthening individuals. I refer here to the calls from many in the environmental movements to "buy green" and thereby have a way to reduce their personal exposure to toxic substances. Might the exposure-measuring bracelets be yet another "feel good" but status-quo-supporting gesture. Or, even worse, a source of guilt if we were to blame ourselves when we know what we may have let ourselves be exposed to? At the least, both situations seem to presume that all women are able to make choices (about household and personal care products; about where they can work and live and what they may be exposed to) and change from the “worst” to a “better” option.

Moreover, I do seriously doubt whether measuring personal exposures will really be a no-risk advantage for bracelet wearers. Is having the information sufficient to protect our health? Or, as with checking labels so as to buy only “green” products, might not reading the outputs from bracelets also lead primarily to attempts (by those who have the resources to do so) to buy their way out of danger—thereby simply shifting the focus of consumerism but doing nothing to change the capitalist system which will merely churn out new stuff to market (and to harm us). And this may lead to guilt feelings among those for whom buying “green” is not a “choice” because of price, availability, or other constraints on their available options. (For a detailed analysis of this “precautionary consumption” see the excellent work of Dayna Scott and read the report, Sex, Gender and Chemicals).

It seems to me that wearing a potentially warning bracelet can turn us into our own canaries in the mines in which we live and work, signalling danger but not giving us the power to change the system creating the danger. In fact, might these adornments work paradoxically to decrease changes by making us feel individually guilty about how and where we live and work, reinforcing notions of personal responsibility for being exposed, and distracting us from creating the collective approaches needed to fight and advocate for upstream political change.

Caveat emptor….

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 and Concordia Universities and passionate about writing, Abby is past president of the CWHN, and is now on the boards of the FQPN and Centre for Gender Advocacy where she works in solidarity to build an inclusive reproductive justice movement in Québec. Read another column by Abby Lippman.


To the point