Speaking Out!

SPRING TALKS SEX - Oral sex – is the getting still good?
Tue, 2013-09-10 14:45

By Lyba Spring

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

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

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

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

Oral sex has been on the menu for a long time, soon to be replaced in popularity, at least according to the media, by anal sex, even though statistics do not bear this out. We have some statistics regarding oral sex for adolescents. They mirror age-related statistics on vaginal intercourse—about half of the teen population are having vaginal and oral sex by age 17. The “epidemic” of teen oral sex never did materialize since the first hysterical media stories more than 15 years ago. Unfortunately, we can only guess at who’s giving and who’s getting. As sexualityandu.ca suggests, “It is sometimes assumed that with respect to teen oral sex there is a gender discrepancy in which females are more likely to be giving (fellatio) rather than receiving (cunnilingus) oral sex from their male partners.”

It is a fair assumption that for young women, oral sex on a young male partner is one way of preventing pregnancy and postponing vaginal intercourse. A lot of ink has been spilled over whether young women find it enjoyable and/or empowering to give oral sex to a male partner. I’d like to see a good study on that.

These days, adults are seeing oral sex in a different light: will it give me cancer?

Oddly, there has not been much discussion about a risk that is much more common: genital herpes. A person with a history of cold sores (even when no sore is present) can pass herpes simplex virus 1 (HSV-1) to a partner’s genitals. Part of my health promotion message has been that is it a courtesy to tell a person you have a history of cold sores, offering to cover your partner’s genitals before oral sex. Part of someone’s decision might include the fact that HSV-1 tends to recur less frequently than HSV- 2 on the genitals and tends to be less painful. I was recently called “sexist” for suggesting that men would tend to dismiss such protection in a nanosecond. A propos, I have never met a woman, no matter with whom she had sex, who used an oral latex barrier to receive oral sex.

Men having unprotected oral sex with multiple male partners are at risk for syphilis. My clinic experience tells me that, like heterosexuals and women who have sex with women, they are not likely to use protection for oral sex. They need to be tested more frequently, since untreated syphilis puts them at higher risk for HIV.

But Iet’s get back to Michael Douglas and throat cancer.

I have been following the HPV and oral sex story for several years. Although there has been speculation that the increase in HPV-related mouth and throat cancers (which is on the rise) may be related to the increase in oral sex in earlier decades, there has been no definitive proof. The non-HPV-related head and neck cancers are related to alcohol and tobacco abuse.

HPV is only a problem when it is persistent. Most people clear the virus in the first or second year after infection.

This information leaves people with some decisions to make.

The Public Health message, which I consider unrealistic, has always been to use a latex barrier for oral sex. People don’t, and then they feel guilty.

Unfortunately, there are no screening tests for HPV in Canada; i.e., although a Pap test may indicate the presence of HPV, it does not test for it. Genital warts are generally diagnosed on visual examination. The overwhelming majority of adults will have been infected with some strain or other of HPV in their lifetime. Most of them will have gotten rid of it.

So here are your homework questions:

If you always use condoms with a male partner for intercourse (or at least, until you’ve both been tested), does that also apply for oral sex?

If someone tells you they have a history of cold sores, are you going to politely decline oral sex, use a latex barrier or say, just do it?

Will fear of cancer mean you’re going to cover your next lover’s genitals with latex before you give them oral sex, even though the numbers of these cancers are still relatively low?

If you’ve ever had a bout of genital warts, do you need to tell a partner before they put their lips on yours (the other ones) even though genital warts are more a nuisance than a danger?

Bottom line, we need to decide on the level of risk we are willing to take.

Talk to me: springtalks1@gmail.com

Spring Talks Sex

SPRING TALKS SEX - Sex ed: Let’s get real
Thu, 2013-08-01 19:09

By Lyba Spring

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

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

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

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

The best curriculum in the world is useless for someone who has no control over their life.

Good sexual health education acknowledges that people’s ability to control their sexual lives does not take place in a vacuum. The realities of young people’s lives—such as prior sexual abuse, low socio-economic status, sexism and racism—must also be acknowledged and addressed. The best curriculum in the world is useless for someone who has no control over their life. For example, any curriculum worth its salt will include education about sexual abuse, sexual trauma and compassion for survivors. How else can we counter the messaging on social media that turns a gang rape into entertainment?

I have written previously in this space about parents’ roles in raising sexually healthy children. But it is schools that must be courageous and accept the challenge of helping children and youth to deal with the confusing realities of a hypersexualized and sometimes vicious world.

This means discussing pornography and pornographic images starting in puberty classes. Children by age 10 will freely admit that they have seen pornographic images (generally inadvertently). What has changed since the 1980s when research suggested that for 12-to-17-year-old boys, pornography was sex education? The answer is the increased availability and explicitness of sexual images for any child with access to the Internet. These images inculcate young minds with misogyny, the association of sex and violence, while ignoring safety, the notion of consent and the potential for equitable relationships.

Some critics of sex education bemoan a lack of values in sex ed curricula. What they mean is the lack of their values. I think the values young people need to learn are honesty, respect, acceptance, fairness and integrity. These values would inform their relationships. They may even become a backdrop to any future erotic and pornographic materials that fuel their pleasure as adults.

I admit that sex education has come a long way from talking exclusively about what a married (heterosexual) couple does in bed presumably with the intention of making a baby. Sex educators began to use gender neutral language decades ago, replacing “husband,” “wife,” “man” and “woman” with “person” or “partner.” Educators have steadily moved towards broad inclusion ever since. But we must also learn to avoid the language of a hierarchy of sexual couplings with marriage as the ideal. Adults know that one need not be “in love” or in a committed relationship to enjoy the pleasures of sexual intimacy. Would we be censured for allowing that some young adults may consider as viable options a one night stand, a casual sexual relationship, like the occasional “booty call,” or “friend with benefits” arrangement? We need to acknowledge reality—their reality—rather than insist on a societal ideal.

One cannot attain a “state of physical, mental and social well-being in relation to sexuality” and the possibility of “pleasurable and safe sexual experiences” without learning about pleasure. Students have complained bitterly for years that they want to learn more than plumbing.

While progressive sex educators do not teach how to masturbate, we tell them that it is common for people to pleasure themselves. We talk about orgasm. We answer their questions about why some women use dildos and why some people are very noisy lovers.

In order to be a credible sex educator, when we say we will answer all of their questions, we should. Some curricula discourage educators from answering questions that are not directly addressed in the curriculum. Do the curriculum creators prefer that students rely on popular media images rather than receiving clear information from reliable sources? Probably not.

We’ve come a long way from just teaching how to make babies; but we haven’t come far enough. Sexual health education must teach about life. It is personal, but oh so political.

Talk to me: springtalks1@gmail.com

Spring Talks Sex

SPRING TALKS SEX - Confused about Pap tests?
Tue, 2013-07-02 06:21

By Lyba Spring

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

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

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

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

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

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

Two fundamental developments motivated the new guidelines.

We have known for more than a decade that cervical cancer is caused by persistent Human Papillomavirus (HPV) infection, combined with other factors such as smoking. What we have learned since then is how the body deals with the virus. Not only do most people clear HPV from their bodies without medical intervention, but the majority of women under the age of 30 (especially if they do not smoke) will have a normal result after a finding of Atypical Squamous Cells of Undetermined Significance (ASCUS), a Low-Grade Intraepithelial Lesion (LSIL) and even, in some cases, after a high-grade lesion is found. Current management of irregular results (recalls for Pap testing and repeated colposcopy) was deemed to cause more harm than good. Like breast self-examination, what appeared to be abnormalities, resulted in over-testing and anxiety for the women being tested, without reducing sickness and death.

The second change was the advent of HPV testing. Because there are certain strains associated with cervical cancer, it began to make sense to limit further testing like colposcopy to the women who had these strains. For over a decade, panels of researchers have been trying to decide how to integrate HPV testing into Pap screening. In some provinces, women over 30 are offered HPV testing following a specific abnormal result.

As the research evolved, the management of abnormal results in the sexual health clinic where I worked also evolved. Sending women for colposcopy became more selective depending on the result, as did the frequency of recall for abnormal Pap tests.

While I consider the new recommended guidelines to be a step in the right direction, my only disappointment is the lack of discussion about risky sexual activity and sexually transmitted infections (STIs). In my experience, women often think they are being tested for STIs when they have a Pap test; and think that when they have a Pap test, they are also being tested for STIs. This is not necessarily the case.

Women under 25 may or may not be having sexual activity. For that reason the CMA acknowledges that a woman who has not had had oral, vaginal, or digital sexual activity before age 25 need not start Pap screening.

However, women who have had unprotected sexual activity need to be tested for Chlamydia, gonorrhea and HIV. Women who share needles or crack pipes need to be tested for Hepatitis C. Women who notice unusual symptoms (or whose partner has unusual symptoms) need to see their health-care provider. While a Pap test may uncover HPV or herpes on the cervix, it is not an STI test.

So here are the take home messages:

Anyone with a cervix needs Pap testing. If you have sex with women or if you are a trans man with a cervix, this includes you.

Get tested for STIs as necessary—new partner, unusual symptoms, broken condom...

Information changes practice. Rightly so.

Talk to me: springtalks1@gmail.com

Spring Talks Sex

SPRING TALKS SEX - Birth control – whose choice?
Mon, 2013-06-03 17:35

By Lyba Spring

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

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

Oral contraceptives (the pill) are clearly the method of choice for most health practitioners because of the effectiveness when used as prescribed. The copper IUD (intrauterine device) is nearly as effective; but it is only recently that health-care providers changed their prescribing practices due to its updated safety record, resulting in increased use, including for women who have never been pregnant. The cheaper, non hormonal IUD is often overlooked by health-care providers in favour of the Mirena Intra Uterine System (IUS), an IUD that releases a progestin. It was originally designed to help women with very heavy bleeding, but it soon became commonly prescribed, possibly due to aggressive marketing. A woman on social assistance in some provinces, like Ontario, is more likely to use Mirena than the copper IUD, even if she prefers a non-hormonal method, because she has to pay for the copper IUD whereas Mirena is covered by the government. This is illogical and wasteful, as the Mirena actually costs about four times more than the IUD (when obtained in publicly funded clinics); it is usually more expensive when inserted by a family doctor.

A woman who wants to use a combined hormonal method, but does not want to take a daily pill may opt for the patch or vaginal ring. The patch has a higher dose of hormones; the vaginal ring uses a “third generation” progestin (see below). Her remaining hormonal option is Depo Provera, a method that should include comprehensive counselling about potential side effects.

Otherwise, she can use condoms (male or female), withdrawal, Natural Family Planning or a combination. She is unlikely to find a clinic that still carries the diaphragm or the gel that accompanies it.

Teaching a woman the basics of her menstrual cycle—in particular, recognizing fertile mucus with a view to charting her fertile days—is a fundamental strategy in educating women about their bodies. There’s even an app for that. If she wants to use this knowledge to prevent pregnancy, she can use the Standard Days Method.

Understanding fertility can also increase the effectiveness of a method like withdrawal, which has a “perfect use” effectiveness rate of 96 per cent. Granted, with typical use, it drops to 73 per cent. If there’s a slip-up, she can take emergency contraceptive pills (or use a post-coital IUD). Although Plan B does not have a consistently high effectiveness rate, its availability over the counter has increased access. 

With regard to hormonal methods, there are safety issues which may not be raised by health-care providers.

Women who were already taking pills often wanted to buy them more cheaply from the sexual health clinic where I worked. Some had been prescribed Diane-35 by their doctor. This medication, which is  only approved for short-term use to treat serious acne and hirsutism, also has contraceptive properties. Pharmaceutical companies highlighted the latter application to doctors. So, although it has never been approved as a contraceptive, it is prescribed “off-label” as birth control. When women asked me about Diane-35, I directed them to the Health Canada website and warning because women using Diane-35 as birth control are likely not aware that its use as a contraceptive is off-label. Diane-35 is no longer prescribed in France because of four thrombosis related deaths, and Health Canada recently reminded prescribers ”that Diane-35 should not be used as an oral contraceptive."

Third and fourth generation birth control pills contain progestins that are associated with a higher risk of blood clots. The brand name drugs Yasmin and Yaz are currently named in lawsuits because of safety issues with the progestin, drospirenone. The vaginal ring uses a third generation progestin, desogesterel. Is there any discussion of that fact before a woman receives her prescription? Mea culpa: I never mentioned it.

Continuous oral contraceptives were first marketed to women by asking them if they wanted to have fewer periods, presumably with the intention of “liberating” them from this bodily function. Many women did switch to continuous oral contraceptives; however, I am unaware of any research into potential long-term consequences (for example to their breast health) of an increase in estrogen over the long term.

Health-care providers are charged with giving patients clear and up-to-date information so that they can make informed choices. Patients must demand nothing less.

Talk to me: springtalks1@gmail.com

Spring Talks Sex

SPRING TALKS SEX - Adolescent sexuality: Out of hand?
Fri, 2013-04-26 00:38

By Lyba Spring

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

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

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

Condom use is also increasing. Sixty-eight per cent of sexually active Canadians aged 15 to 24 reported using condoms in 2009-2010, compared to 62 per cent in 2003. However, older teenagers are less consistent in their condom use: for 18- to 19-year-olds (with one partner), 72.7 per cent used condoms the last time they had sex as compared to 81.2 per cent of 15- to 17-year-olds. The likely reason for the heterosexual teenagers is that the young women are on the Pill. Like deciding to postpone sex, condom use requires negotiation. In certain social groups, condoms are de rigueur.

When I worked in a sexual health clinic, I noticed that there were some young people who were more sophisticated than many adults I know in terms of their ability to make sexual decisions. For example, young men were coming in with their female partners for testing, a great new twist on a date.

The rates for adolescent pregnancy have plunged dramatically since the 1970s, with the increase in comprehensive sexual health education and access to birth control and safe abortion as back-up. The remaining pockets of adolescent pregnancy are still to be addressed by increased access to the basics: adequate food, shelter and safety, including sexual safety.

Another positive: adolescents are coming out to themselves at younger and younger ages about their sexual orientation and/or gender issues. So we’re getting some things right by changing the discourse at home and school to ensure that they hear lesbian/gay/bisexual/trans (LGBT) positive messages. 

But we still need to up our game.

The older adolescents who are no longer using condoms may not be getting pregnant, but they are getting STIs in record numbers.

The number of cases of Chlamydia for 15- to 24-year-olds, for example, continues to rise. This is in part due to more, and better, testing.  (Urine tests for males as opposed to swabs make it a lot easier to convince them to go.) As mentioned, heterosexual teenage girls and young women in longer term relationships (three weeks or more!) are starting to use hormonal contraception, such as the Pill, as their method of birth control. But they tend to start the Pill before they get tested for STIs. As soon as they go on the Pill, they stop using condoms. They may be unaware that they were already infected with an STI from a previous partner, or they may get infected by their steady, loving partner, who was himself unaware that he was infected.

To my mind, the most dramatic barrier to adolescent sexual health, as I reported in an earlier blog is the persistence of acquaintance rape and the apparent lack of empathy for its victims. Right alongside this phenomenon is intimate partner violence—emotional, physical and sexual abuse—that often starts in adolescence and persists into young adulthood, with the overwhelming majority of victims of intimate partner violence being female.

While I fully acknowledge that each one of these problems has many factors, including high-risk behaviors linked to economic and social disadvantages, education remains a key factor. With increased education and access to services, we will be able to keep pushing down the stats on STIs and teenage pregnancy; but it will take some phone smarts to turn those handheld devices to our advantage. Agents for change will have to learn to blast positive messages to each and every one of them. I propose a new Twitter tag: #goodteensex.  

Talk to me: springtalks1@gmail.com

Spring Talks Sex

Mon, 2013-04-01 23:13

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

By Lyba Spring

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

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

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

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

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

In a Toronto Public Health brochure on body hair removal, they make the case for avoiding shaving pubic hair in particular. Waxing avoids razor bumps, which some women self-diagnose “à la Google” as warts or herpes. To avoid contamination with other people’s viruses from waxing, salons have to follow specific procedures. They also recommend that women who remove their pubic hair—by whatever means—refrain from sexual activity for 48 hours afterwards; which, for some, may defeat the purpose.

When you ask why they do it, some women say they like the feeling, or that it’s more hygienic, or their partner prefers it that way. The feeling of smoothness is the come-on for both hair removal and skin product ads. A smooth woman is a desirable woman.

Nature would have it otherwise. Pubic and underarm hair are scent traps. We nuzzle into erotic smells as all mammals do—except that we have removed both our smells and the hairs that hold them there. Sex is naturally a messy, smelly affair, which we have done our best to sanitize.

In September 2012, a Sikh woman with facial hair defended herself and her religious beliefs after being publicly mocked: “Baptized Sikhs believe in the sacredness of the body...I realize that my gender is often confused and I look different from most women.” She goes on to say the body is a gift from the divine being and must be kept intact.

In a recent podcast in which I participated on female genital cosmetic cutting, sex therapist and psychologist Leonore Tiefer makes the point that when women augment their breasts or reduce their labia or clitoris, it exaggerates their femaleness and reduces their maleness. Women with body hair presumably remove it to look more feminine. (Listen to the podcast).

I remember a shtick from comic Tim Nutt. He said he liked to come up behind women with short hair and say, “Excuse me, sir.” He said it’s their own fault because when they cut their hair short it means they’re never having sex (with a man, one assumes) again. However, every stereotype is said to contain a grain of truth. Some women seem to choose a kind of sexlessness as they age. Others rage against age in a cosmetic frenzy. My friends know I am no fashion plate. Nonetheless, out of personal vanity, my old university friend and I made a pact some years ago. When we’re both in a seniors’ facility, she will pluck out my chin hairs and I will pluck hers as I did for my 90 year-old mother before she died. I suppose it will be an expression of our unwillingness to completely give up—or give in to the androgyny of old age. As for younger women, who are you taking it off for?

Talk to me: springtalks1@gmail.com

Spring Talks Sex

SPRING TALKS SEX - Women, sex and substance use: chicken and egg?
Fri, 2013-03-15 17:02

By Lyba Spring

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

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

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

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

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

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

The researchers had taken prior mental health status into consideration in the analysis of their findings. I doubt that they would consider child sexual abuse to be a mental health disorder; but of course it can provoke mental—and even physical—disorders. The body remembers even what the mind prefers to repress. For youth accessing treatment for both addiction and mental health problems at the Toronto Centre for Addiction and Mental Health (CAMH), it is frighteningly common for them to have histories of traumatic stress as well as sexual abuse.

I met Laura (not her real name) when she was 11.  She was a student in a Grade 6 class I was teaching about puberty. In those days, I spent six hours with each Grade 5 and 6 group, so I got to know the kids pretty well. I always ended with a session on sexual abuse. I remember listening to Laura’s teachers in the staff room. They were talking about her, making remarks akin to teenage boys’ comments about high school girls with a “reputation.” After the class on sexual abuse, Laura disclosed to me that she had been gang raped at nine and had been in an alcohol daze ever since. I should have figured it out from the teachers’ remarks. Precocious sexual behaviour can be a marker of sexual abuse.

I put Laura in touch with a child protection agency. A few years later, I saw her regularly in a sexual health clinic and eventually encouraged her to go into therapy. During her adolescence, Laura still abused alcohol and other drugs and was sexually assaulted more than once. I would accompany her to the sexual assault care centre to hold her hand.

A colleague of mine at the time said there was no point in treating substance abuse unless you dealt with the root causes first. She had expertise in both, professionally and personally.

Similarly, adolescent pregnancy is not as simple as asking why teens just don’t use condoms. Health professionals can plot adolescent pregnancies on a city map and see the links with lower socio-economic status. In other words, risky behaviours do not exist in a vacuum. They are linked to basic needs: food, shelter and freedom from sexual violence and racism.

Substance use, aside from being big business, serves multiple purposes. Alcohol removes inhibitions, which makes it the most common drug used for date rape. Alcohol and other substances including tobacco are used to self medicate. Dowsett Johnston says, “the strongest predictor of late onset drinking is childhood sexual abuse.” Laura was self-medicating throughout her adolescence: she was dulling the pain of a traumatized life. While the research may show an increase in substance abuse after having multiple partners, in Laura’s case—and for many women who are sexually abused as children—substance abuse came first.

Talk to me: springtalks1@gmail.com

Spring Talks Sex

SPRING TALKS SEX - The sticky question of pornography
Tue, 2013-03-05 12:36

By Lyba Spring

About 40 years ago, feminists were making a distinction between pornography and erotic films. Of course no one was able to quite put their finger on the difference, although it was easy to hate pornography after Deep Throat star Linda Lovelace revealed her abuse during the 1972 filming; or Bonnie Sherr Klein’s Not a Love Story showed us the shockingly exploitative side of adult entertainment. For some of us, all pornography is exploitative, demeaning and violent.

Enter women who began to make erotica for women, followed by women who started making porn for women. Today there are plenty of women who consider themselves feminist and who love their porn.

So what’s a girl to do?

As a sex educator, I believe that a big downside of pornography is the role it has played in the sex education of boys. I winced during a sexual health workshop with adolescents when a male student said, “it’s not like that in porn, miss.” I could just picture him playing out some of the common sexual acts in contemporary pornography without asking for consent. Pornography creates a script for adolescent sexuality as do music videos and reality shows. Not being a consumer, I had to do a lot of reading to familiarize myself with the current norms in pornography, such as “facials” and “double penetration.”

With the increase in availability, a kind of hunger for bigger and bigger shocks seems to drive the industry to a continual pushing of boundaries. The resulting outrage from feminists isn’t so much moral outrage as anger—and fear. A long-standing debate continues about whether or not pornography is directly linked with violence against women and children. According to some, research has never made a clear causal connection between pornography and sexual assault. Writer Debbie Nathan, in an interview by Dr. Joy Davidson says, “Research has shown that legalization and mass consumption of porn is correlated with declines in rape rates, not increases.” Yet, when we hear about someone convicted of sexual assault with a cache of violent pornography on their computer, it echoes other research that indicates a link between porn and attitudes that support violence against women.

I am reminded of another workshop, this time in a battered woman’s shelter, when a participant told the group about her husband who, after watching porn, would insist that she repeat the acts. When she refused, he would beat and rape her.

There are other issues. Some women who do not watch porn find it upsetting that their partners do and consider it a form of cheating. Sex columnist Dan Savage insists that all men watch pornography and the rest are lying. Some people are so used to getting off watching porn that they find it difficult to be intimate in flesh and blood.

Is there an upside?

There are couples who revel in watching porn together—and there is something for every gender, orientation and taste. People who may feel guilty about their sexual predilections may find comfort in the availability of their kinks online. They may find similar communities of people and even partners.

Nathan paints a positive picture:

“… to keep porn in the mix, we’d have to demystify it, to stop condemning it as immoral. If we could do that, we might not have pornography anymore. Instead, we’d have a gorgeous carnival of sexual imagery and sexual aids which would speak to everyone’s fantasies, desires and yearnings. … I think the solution [to stereotyping] is not making less of it but more. More, that is, if it’s produced by all kinds of people, and not just by big businesses catering to the mass market and trying to make mega-profits.”

Perhaps informed consumers of pornography can treat it like chocolate. They can seek out the equivalent of organic, fair trade porn (made by companies that pay their actors well, give them options about scenes and insist on their using protection) and get that good dopamine high—not as a guilty pleasure—but as a treat. If people patronized the ethical porn companies, it might start the process of shifting mainstream pornography to something more palatable ... for more of us.

Talk to me: springtalks1@gmail.com

Spring Talks Sex

GUEST COLUMN - Being proactive about your breast health
Fri, 2013-02-15 17:02

By Verna Hunt

Women and girls of all ages in today’s culture are stamped with the colour pink as the fantasy for the fairy princess lives they are lead to believe they should yearn for. It is like a plastic film that society puts over us at birth. Onward from birth they are made to think that nothing other than a fantasy life should ever happen to them. Never get old. Never get sick. Never be sad or mad or frightened. Women should be perfect—in pink. This is not reality. As a result women often feel that they are not “good enough” in the inevitable imperfect lives they lead, and their breasts are no exception.

Another unreality propagated by campaigns such as “the pink” is that there is a cure for every disease and that it can be discovered if the medical scientists just have enough money to discover this magic bullet cure.

Our culture does not teach coping strategies for tragedies such as someone near and dear to us or even ourselves developing a disease such as breast cancer. So, in an effort to turn our understandable emotional strife into something constructive, crusades such as the Pink Ribbon Campaign have evolved. Often they end up as a business enterprise unto themselves more interested in keeping the organization going than looking at how to serve humanity.

But what is the point of it all? Is the point to find the cure for breast cancer, or is the point to find the cause for lack of breast health? The Pink Ribbon Campaign is a distraction from what is really going on with breast health. All of the pink sound bites urge us to pitch in and find the cure like there is a missing link of knowledge, a holy grail, the one thing that will solve it all. Our society tries to commodify everything as if we all have the exact same disease. It is like assuming that we all wear the same size and style of shoes.

Another part of the pitch is that mammograms prevent breast cancer. They do not (See Mammography screening: Weighing the pros and cons). Mammograms detect structural masses that could be cancerous and this can only be confirmed with a biopsy examined by a pathologist. The key initial question should be: why and how do masses or tumours form in the first place and what can be monitored to discern if tissue is showing signs of building masses? Certainly the Pink Ribbon Campaign has raised awareness that there is something very significant going on when one in four women living around the Great Lakes of central eastern North America will have breast cancer in their lifetimes.

Cancer and our environment

The general scientific thought has been that breast cancer occurred in those with a genetic predisposition. While this is a factor, when we look at the world statistics available, the evidence  points to industrialized areas such as the Great Lakes of North America having one of the highest incidences. Why might that be so? The short answer is environmental pollution and the inability to neutralize its dangerous effects. For more information on this please read Living Downstream by Sandra Steingraber, and watch the film by the same name.

We need to look at the many factors  that contribute to  cancer because we live in a multifactorial environment.

The human body has abnormal or cancer cells in it all of the time but our immune system, largely via the white blood cells, spots the out-of-the-ordinary cells and kills them off (apoptosis). The immune system also cleans up dead abnormal cells, viruses, bacteria, pollution, old hormones all of the time, 24/7. The microcirculation via  lymph vessels then drains this lymph fluid and delivers the debris to our filters or “emunctories,” primarily the liver and kidneys although other organs have filtering functions as well.

Our filters break down the debris that the immune system has delivered but these organs can get clogged up just like the vacuum cleaner filter when you forget to clean it out. With clogging, the normal excretion via urine, stool, breath, skin and menses is incomplete and even the excretion routes can get clogged up. Constipation is an example of this and is more common than anyone wants to admit.

The miracle of the immune system is that each person develops an individualized non-specific immunity by six or seven years old and then a specific immunity largely complete by the age of puberty. That is, the immune system normally develops our defence system unless it is interfered with and interrupted from maturing. Interrupters could include but are not limited to adverse drug reactions, pollutants and pesticides such as xeno-estrogens (chemicals that mimic estrogen and attach to estrogen receptor sites causing abnormal reactions), lack of normal nutrients from empty processed foods and hormonal imbalances created through such things as prolonged stress.

Reducing the toxic load

Throughout recorded history every indigenous culture that existed for any length of time developed some sort of cyclical cleansing or detoxification method. They used what was available: fermented foods, herbs, water, sun, breath/air, saunas, bathing in hot springs and so on. Even in the animal kingdom you will see dogs for example eat fresh grass that contains chlorophyll and trace minerals to assist in the cleansing process. It is instinctual to clean our filters. The most obvious one in the human body is to exchange the normal 70% of body weight that is water.

We now live in a time of the greatest load of physical and non-physical toxins in recorded history. Chemically there are things going into the human body that were never made to be there such as petrochemical derivatives and asbestos. When the immune system and the filters do not know what to do with something, it can get parked in tissues. Over time, this load causes irritation and can lead to a dysfunction in the cells, resulting often in swelling and inflammation. Eventually these changes cause cellular mutations and can lead to cancer cells.

In addition to the physical toxic load, the non-physical load is mounting in terms of noise pollution, over-information from cyber space and on and on. We have to sort out all of these stimuli as well as sorting out the chemical soup toxifying our bodies. There is just too much sorting to do for all of our physical, emotional, cognitive and, some would say, energetic bodies. The filters are getting more and more clogged and our bodies are carrying around a load of rubble and debris that impair our immune resilience.

Women have a greater quantity of hormones to sort out and thus their load of sorting is larger, compounded by multiple roles as wage earner, child bearer and mother, food procurer and preparer, health care provider and decision maker, housekeeper and property organizer, and ringmaster of the modern family. Many of us are familiar with this chaos. Doing everything all of the time so that we experience everything except silence, stillness and relaxation. It is as if we are always breathing in and never breathing out. We need to exhale.

Research has shown that women who have breastfed have a lower incidence of breast cancer. While not all women choose to breastfeed, breasts need not become a parking lot for metabolic debris. We can avoid toxins to some degree through lifestyle choices such as: eating adequate fibre, healthy oils, additive free and non-overly processed foods, four or more cups of steamed or raw vegetables daily, seasonal fresh local raw fruit, drinking adequate amounts of clean water; adequate rest and relaxation; time in nature; enjoyable exercise and body movement; nurturing companionship and development of self-worth. Admittedly, these options are not readily available to all women.

Specific breast health therapy could include hands-on therapeutic breast massage techniques which are done by trained licensed professionals, usually a registered massage therapist. These specialized massage techniques assist in normalizing breast tissue function throughout a woman’s life, particularly pre and post breast feeding. The massage stimulates the lymph system in the breast to aid in drainage of any stored debris, and can aid in decreasing fibrocystic milk duct tissues and gently release adhesions.

Because of the compounding effects of environmental toxins in our bodies we need to cleanse now more than ever. However, it is not simple because of the complexity of toxins like toluenes, heavy metals, polyvinyl chlorides and dioxin all mixing together like soup and creating new reactions that we have no way as yet to measure. How can we safely get the body to excrete these “super toxins”?

Ideally detoxification, or cleansing, must be individualized to each person’s needs by a qualified health care professional, guided by a woman’s personal assessment of her means. In the case of breast health this professional would monitor breast health proactively in concert with the overall health picture of the individual. Tests using blood, hair, breath, heat (digital infra-red thermography), saliva, stool, etc. can indicate changes long before a pathological disease or even pronounced dysfunction is present. Results are correlated with a thorough consultation and physical examination, looking at findings that consider causation of symptoms and also determine how to improve total function on all levels. 

Although there are many licensed professionals trained and available to do this, such as naturopathic doctors, holistic medical doctors, etc., the cost for this out-of-pocket care is high for many. Our culture does not encourage people to invest in their health, but rather to pay vast quantities of  money to the disease care industry once people have a disease that is “treated” and “managed” with a patented prescription drug.

Being proactive

Proactive cyclical methods of cleaning our natural filters can be done safely at home to begin the necessary process of detoxification. Lifestyle choices that are affordable might include: eating only vegetable broth soup for a day, taking regular saunas, walking in a forest reserve, taking a one-to-seven-day break from cyber space including news, Internet, television and radio. Taking a pause from just being too busy and over stimulated. Although these efforts seem trivial, research has shown that something as accessible as a 30-minute walk in a forest can positively impact the immune system for up to one month after taking the walk.

Controversy abounds about breast self-examination [see Network article, Breasts Self-examination] but if you can wash your face every day and know if there is a new pimple just by touching, then saying “Hello girls” to your breasts as you shower or bathe will reveal changes. This friendly familiarity by touch will help you know if the breast texture pattern changes without terrifying yourself by looking for “the lump.”  Teaching girls at a young age what normal breasts look like will help pubescent girls to have normal acceptance and appreciation of their breasts. To educate girls using non-sexual pictures of breasts, check out the 007 Breasts website

Other proactive breast care choices include: avoiding body care products with harmful chemicals like those found in some deodorants and clothes detergents and fabric softeners that are potentially carcinogenic; and not wearing restrictive and in particular underwire bras that impede normal blood and lymph flow causing congestion of toxins.

So when you see the Pink Ribbon Campaign imploring you to walk for “the cure” I would offer you an alternative focus and direct you to the Pink and Green Ribbon Campaign, which focuses on the connection between breast health and the environment and what you can do to be proactive about your breast health [additional resources listed below].


Dr. Verna Hunt, B.Sc., D.C., N.D. has been practising as a chiropractic and naturopathic doctor, for over 30 years.  She owns and operates The Centre for Health and Well Being in Toronto established in 2005. She acts as a medical advisor to colleagues and companies, which service holistic health care. Dr. Hunt writes, speaks and teaches presenting through her organization Being Well Communications. She is a long time member and promoter of CWHN. Contact her through verna@healthandwellbeing.info or 416-604-8240.


Additional resources on breast cancer prevention:

Women, plastics and breast cancer section of CWHN website

CWHN – Get the Word Out! About breast cancer prevention

Breast Cancer Action Montreal (BCAM) 

Breast Cancer Fund in the United States 

To the point

SPRING TALKS SEX - I’ve been thinking about orgasm
Fri, 2013-02-15 16:44

By Lyba Spring

For years, women have been told we are responsible for our own orgasms; no one can hand it to us on a silver platter. And most of us can manage to get there very nicely on our own, thank you.

There are some obvious blocks to orgasm, like prior trauma, repressive sexual upbringing, shyness, overthinking, inability to relax, control issues, problems in the relationship or other stresses. What is a partner’s role in a woman’s desire or ability to come?

Two-thirds of women who have sex with men don’t have orgasms during vaginal intercourse. These women often minimize their desire for it, saying they enjoy the good feelings and intimacy that they get during sex. But women’s partners—male or female—sometimes feel cheated, both by women’s lack of desire for orgasm or because they don’t know how to get us there. There’s nothing new here. Shere Hite reported the same dilemma in the 1970s (The Hite Report, 1976). Communication is, of course, key. But “I really want you to come” may be perceived as pressure. “How can I get you there?” assumes that’s where you want to go. On the other hand (so to speak), “I want to come. Let me show/tell you what to do” sounds like a plan.

Most workshops about reaching orgasm focus first on familiarizing yourself with your own sexual response and eventually finding the type of stimulation that leads to orgasm. Some women have orgasm that is qualitatively different depending on whether there is anal, G-spot, or clitoral stimulation. You may like direct or indirect stimulation of the clitoris with a finger, vibrator, something inside your vagina or anus, anal stimulation, with lubricant or without, direct, strong pressure on the vulva, like a thigh or a pillow, or not.  Women may ejaculate or not, or only some of the time. We don’t always want—or are not always able—to come the same way every time; nor do our orgasms always feel the same, even when we have a session with several orgasms. 

Let’s say you can already have orgasm on your own. How comfortable are you having an orgasm in front of your partner? Is it exciting, embarrassing, eyes open, eyes closed, watching your partner watching you, getting off on their pleasure? Is there an alternate kind of stimulation that your partner can try? If you’re used to hard and fast stimulation with a finger or vibrator and your partner tries to bring you to orgasm with oral sex, do you feel the pressure to perform? Are you worried your partner will get tired or frustrated? And maybe more importantly: can you show your partner what works for you without detailing an exhaustive list? Sex is primarily for pleasure. If performance worries get in the way, where’s the fun?

A hilarious example of how sex can become too much work and turn off a partner appears in Carol Shield’s Republic of Love.

“He’d rather enter a life of celibate denial than go through the hard labor and humiliation of bringing Charlotte Downey to quality orgasm ... Quality orgasms were the only kind worth having, she told him”  (pp. 144 – 145).

Some women feel the need to stay in control of all aspects of their lives, which may impede erotic intimacy. What a gift to put yourself in your partner’s hands and allow the barriers to fall away. Sometimes I wonder if dealing with barriers to orgasm is as simple—and as complicated—as dealing with insomnia.  Instead of anxiously wanting it (orgasm or sleep), we just let go and it “comes”.

It would be lovely if two people could go with the flow. If it feels good, do it. If you or your partner gets tired, stop and do something else. And all of this can happen with a smile, a laugh, the conspiratorial joy of discovery. This is intimacy; it happens between the two of you.

And what about your partner’s orgasm? Again, it depends on how important it is to him/her. Is it your role to be The One who finds their magic formula? Answer: the magic is what happens between you, not between their legs. 

Talk to me: springtalks1@gmail.com

Spring Talks Sex