sexuality

Book Review: The Sex Myth

Kyla Bender-Baird on September 4, 2015

Reading Rachel Hills’ The Sex Myth was like reviewing my Sociology of Sexualities syllabus. Application of Foucault’s theory of power and social regulation? Check. Discussion of heteronormativity? Check. Mention Gayle Rubin’s charmed circle of sex? Three checks! Hills offers an analysis of contemporary sexual norms that is rich saturated with sociological research. She touches on many of the issues I unpack with my students at City College, but adds her own journalistic flare, making this book not only an informative but enjoyable read.

Hills argues that in this age of supposed sexual liberation and unprecedented freedom, sex has actually become heavy with significance, warping our perceptions and expectations. For instance, pressure has shifted from not having sex to having sex – and lots of it. Thus, the social denigration of virgins after a certain age or those with few sex partners. Hills finds that people tend to assume everyone around them is having more sex than them, and this becomes a race to keep up. She refers to this as a “gap between fantasy and reality.” One consequence is that folks become pre-occupied with whether or not they are having enough sex. The measurement of “enough” is based on assumptions and occasional check-ins with close friends on how much sex they are having. A better barometer of sexual satisfaction, though, would be asking yourself whether you’re having all the sex that you want. This may vary depending on what else is happening in your life.

This is just one of the many examples Hills offers us of the consequences of “the sex myth” – the belief that sex is all important, powerful, and indicative of how we’re doing as individuals and a society. She also points to the troubles caused by holding too precious ideas of “normality” when it comes to sex as well as the influence of masculinity and femininity in shaping sexual expectations.

Overall I found The Sex Myth to be a great read. I appreciated Hills’ generous use of sociological research to ground her arguments as she weaved in personal narratives from her life and the lives of people she interviewed. It was also refreshing to read many of the concepts I teach in academic settings covered with the delightful writing style of a journalist.

My only critique is the limited age range represented in the stories Hills highlights. One of the lies the sex myth promotes is that your sex life peaks in your twenties and it’s all down hill from there. Unfortunately, Hills inadvertently reinforces this myth by only featuring the stories of twenty-somethings. There were only two interviewees over the age of 30 featured, and one of them was experiencing a lengthy sexless period of their life. Perhaps selfishly, as someone migrating my way through my 30s, I wanted more representation of sexual experiences across the lifespan and how these experiences are shaped by or counter the sex myth. If Hills wanted to focus on sex-pectations for twenty-somethings, that’s fine, but that frame should be made clear from the start.

Other than this age caveat, I recommend without reservation this book to anyone looking for a fun subway read, an introduction to thinking critically about contemporary sexuality, or a book to offer your undergrads in human sexuality classes.

Oh God!

Feminists and anti-feminists: The Curious Case of Conservative Religious Women

Kelsy Burke on June 5, 2015

KelsyBurke.SpringHeadshotKelsy Burke is an assistant professor of sociology at St. Norbert College. Her first book is Christians Under Covers: Evangelicals and Sexual Pleasure on the Internet (forthcoming, University of California Press). 

The #DuggarScandal is rising once again to the top of media headlines as Jim Bob, the father of Josh who molested his sisters and other underage girls, explained away the incidents of sexual abuse in an interview with Fox News. “They didn’t even know he had done it,” he said about Josh “touching” his daughters after they were asleep.

CJ Pascoe and Sara Diefendorf explained earlier this week in another Girl w/ Pen post the rationale used by religious conservatives like the Duggars to make sense of sexual scandals. For these Christians, sexual sin is an expected and, as Jim Bob’s interview reveals, forgivable offense. Importantly, and outrageously, the sin of sexual abuse may be equivalent to the sin of consensual sex before marriage, pornography use, or masturbation. And while the liberal pundits may cry GOTCHA! in exposing the hypocrisy of fundamentalist families like the Duggars, their beliefs rely on a logic that does not see sexual sin as hypocritical, but rather as inevitable. All of us are sinners.

The long, long list of conservative Christian leaders caught in a sexual scandal is nearly all men (here is a story that details some recent examples). Not surprising, the critical-thinking feminist may observe, given that conservative Christian traditions believe in men’s headship and women’s submission. As one blogger described, the Quiverful movement of which the Duggars belong demands that women “never exercise a moment of sexual agency in her entire life.” Conservative Christian men may be hypocrites, but conservative Christian women are the victims or at least the dupes.

To be sure, the girls abused by Josh Duggar are victims of sexual assault. They did not choose it or deserve it. But let’s think for a moment, feminist readership, about the implication of the attitude that conservative Christian women have no agency or an ability to make choices on their own terms. (To be precise, the blog quoted above surmises that the Quiverful movement itself bars women’s agency, but even this isn’t an entirely fair assessment.) When feminist commentary on conservative religion deals almost exclusively with women’s victimization, we are left to believe that religious women indeed don’t have any agency. Is a feminist dismissal of conservative religious women actually endorsing the attitude of Jim Bob that these women don’t know any better?

What would happen if we acknowledged that women may make choices and feel empowered by them even if those choices seem to defy feminist logic? What would happen if we reimagined the plot lines in the typical feminist narrative of conservative Christianity? Instead of women as dupes or victims for believing in a patriarchal religion, how might these religions serve a purpose in these women’s lives?

Many scholarly accounts of conservative religious women suggest that they find some aspect of their religion to be empowering, all while believing they should submit to men. One of my favorite examples of this is a study of evangelical women who are married to “ex-gay” men (men who admit to, though do not necessarily act upon, same-sex attraction). Through interviews with these women, sociologist Michelle Wolkomir finds that they at first blame themselves for their inability to sexually entice their husbands. Yet Wolkomir finds that women overcome this guilt as they realize that their husbands are engaging in sin. This means that their wives are no longer obligated to submit to their husbands, but rather only to submit to God.

Evangelical women married to ex-gay men are certainly a small group, but the lesson here is far reaching: In patriarchal religions, God is the ultimate patriarch. Especially for religions in the Protestant tradition, women believe they connect directly with the final authority, the one who is In Charge. Converting to Christianity has the power to help women feel more, not less, in control of their lives: to have the strength to speak up to a cruel co-worker or to be optimistic about a recent divorce. Conservative Christianity may not change women’s life’s circumstances, but it can help women change their perception of those circumstances.

A common feminist mantra on the choices of other women, in the words of Amy Poehler in her book, Yes Please, is “Good for you, but not for me.” Yet feminists commenting on stories like the Josh Duggar scandal are quick to point to Christianity’s flaws, never its virtues for some of its followers. Women who are complicit in religions that appear to many feminists as anti-feminist seem to cross a line that has no defense. But why can’t feminists take up the attitude, “Good for you, but not for me.”? Of course there are obvious answers to this question: because these religions perpetuate ideas about gender and sexuality that harm us, especially women and queers. Gender-based violence, though, is a social problem that is not limited to fundamentalist Christianity. And don’t we live in a world where nearly all dominant ideas about gender and sexuality harm us? How can we defend Miley Cyrus and Kim Kardashian and nail art and not at least acknowledge that for some women, conservative religions are “good for you, but not for me.”? We may learn from these women that we all must make our own choices in a world that tries to limit them.

your ink

Call for Papers: Pleasure and Danger: Sexual Freedom and Feminism in the Twenty-First Century

Kyla Bender-Baird on February 12, 2015

Signs: Journal of Women in Culture and Society invites submissions for a special issue titled “Pleasure and Danger:  Sexual Freedom and Feminism in the Twenty-First Century,” slated for publication in the Autumn 2016 issue. The deadline for submissions is April 1, 2015.

At the heart of the feminist project is a persistent concern with thinking through the “powers of desire” (Snitow, Stansell, and Thompson 1983) and expanding the potential for sexual and gender freedom and self-determination at the same time that we combat sadly persistent forms of sexual danger and violence.  Exemplified in the US context by Carole Vance’’s landmark collection, Pleasure and Danger: Exploring Female Sexuality, feminist debates over sex, gender, and society have been incendiary.  First published in 1984, as proceedings of the infamous “Scholar and the Feminist” conference at Barnard, which initiated the equally infamous “sex wars,” this volume reproduced intense dialogue while also contributing to a much broader investigation of the politics (and pleasures, and dangers) of sexuality within feminist theory and culture. Articles that threw down gauntlets were subsequently canonized and celebrated.  Much has changed since that explosive conference and book. Even the subtitle, – “exploring female sexuality,” – would now be more deeply interrogated (biologically female? presumptively heterosexual?) and certainly pluralized.  But however reframed, the paradoxical joining that is “pleasure and danger” remains poignantly relevant.

For this special issue, we invite transdisciplinary and transnational submissions that address questions and debates provoked by the “pleasure and danger” couplet.  Submissions may engage with the historical (how different is our moment from that formative “sex wars” era? have the sex wars moved to new terrain such as trafficking and slut-shaming?); the representational (how does the digital era transform our sexual lives? what does “livestreaming” sexual assault do to/for feminist organizing? what possibilities are there for feminist and queer imagery in an era of prolific porn, commodified otherness, and everyday inclusion?); the structural (how do race, ethnicity, religion, and national cultures enable and constrain sexual freedoms? how do carceral and governance feminisms frame and perhaps contain earlier liberatory impulses?); and/or the intersectional (how do we analyze the mutually constituting relations of sexuality, gender, race, ethnicity, class, nationality, ability, age, and so on?). There are local and global questions to be asked and strategic arguments to be resolved.  And the very terms are themselves constantly debated (whose pleasure are we speaking of and for?  who is the “we” doing that speaking? who is imagined to be “in danger?” how does “gender” signify differently in that couplet from “sexuality?”).

We particularly encourage analyses from all regions of the globe that address pressing concerns and that do so in a way that is accessible and, well, passionate!  We encourage bold and big thinking that seeks to reckon with the conundrum still signaled by the pleasure/danger frame.  We especially seek submissions that attend to the couplet itself, to the centrality of pleasure/danger within the project of making feminism matter and resonate in ways both intimate and structural, deeply sensual and liberatory, simultaneously championing multiplicities of pleasures and a lasting freedom from violence and abuse.

Manuscripts may be submitted electronically through Signs Editorial Manager system at http://signs.edmgr.com.  Please choose the article type “Pleasure and Danger – Special Issue Article.” Guidelines for submission are available here. This Call for Papers is also available as a PDF. Please email the journal office with any questions.

References

Snitow, Ann Barr, Christine Stansell, and Sharon Thompson. 1983. Powers of Desire: The Politics of Sexuality. New York: Monthly Review.

Vance, Carole. S, ed. 1984.  Pleasure and Danger: Exploring Female Sexuality. Boston: Routledge & Kegan Paul.

Manly Musings

It turns out male sexuality is just as fluid as female sexuality

Jane Ward on February 4, 2015

Originally posted at The Conversation
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If women can kiss women and still be straight, what about men?

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When Madonna and Britney Spears kissed during the 2003 Video Music Awards, no one questioned their sexuality. Win McNamee/Reuters

Some scholars have argued that female sexual desires tend to be fluid and receptive, while men’s desires – regardless of whether men are gay or straight – tend to be inflexible and unchanging. Support for this notion permeates popular culture. There are countless examples of straight-identified female actresses and pop stars kissing or caressing other women – from Madonna and Britney to Iggy and J-Lo – with little concern about being perceived as lesbians. When the Christian pop star Katy Perry sang in 2008 that she kissed a girl and liked it, nobody seriously doubted her heterosexuality.

The story is different for men. The sexuality of straight men has long been understood by evolutionary biologists, and, subsequently, the general public, as subject to a visceral, nearly unstoppable impulse to reproduce with female partners. Consequently, when straight men do engage in same sex contact, these encounters are viewed as incompatible with the bio-evolutionary coding. It’s believed to signal an innate homosexual (or at least bisexual) orientation, and even just one known same-sex act can cast considerable doubt upon a man’s claim to heterosexuality. For instance, in 2007, Republican Senators Larry Craig and Bob Allen were both separately arrested on charges related to sex with men in public bathrooms. While both men remained married to their wives and tirelessly avowed their heterosexuality, the press skewered them as closeted hypocrites.

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Close quarters: sexual encounters between men and ‘fairies’ were commonplace in the dense neighborhoods of working class Manhattan in the late 19th and early 20th centuries. Jacob Riis

Despite the common belief in the rigidity of male heterosexuality, historians and sociologists have created a substantial body of well-documented evidence showing straight men – not “closeted” gay men – engaging in sexual contact with other men. In many parts of the United States prior to the 1950s, the gay/straight binary distinguished between effeminate men (or “fairies”) and masculine men (“normal” men) – not whether or not a man engaged in homosexual sex. Historian George Chauncey’s study of gay life in New York City from 1890-1940 revealed that through much of the first half of the 20th century, normal (i.e., “straight”) working class men mixed with fairies in the saloons and tenements that were central to the lives of working men.

With sex-segregation the general rule for single men and women in the early 1900s, the private back rooms of saloons were often sites of sexual activity between normal men and fairies, with the latter perceived as a kind of intermediate sex – a reasonable alternative to female prostitutes. Public parks and restrooms were also common sites for sexual interaction between straight men and fairies. In such encounters, the fairy acted as the sole embodiment of queerness, the figures with whom normal (straight) men could have sex – just as they might with female sex workers. Fairies affirmed, rather than threatened, the heteromasculinity of straight men by embodying its opposite.

Deep kissing was an expression of brotherhood among Hells Angels gang members. thisisthewhat
Deep kissing was an expression of brotherhood among Hells Angels gang members. thisisthewhat

The notion that homosexual activity was not “gay” when undertaken by “real” (i.e. straight) men continued into the 1950s and 60s. During this period, the homosexual contact of straight men began to be undergo a transformation from relatively mundane behavior to the bold behavior of male rebels. The American biker gang The Hells Angels, which formed in 1948, serves as a rich example. There are few figures more “macho” than a heavily tattooed, leather-clad biker, whose heterosexuality was as much on display as his masculinity. Brawling over women, exhibiting women on the back of bikes, and brandishing tattoos and patches of women were all central to the subculture of the gang.

Yet as the journalist Hunter S. Thompson documented in his 1966 book Hell’s Angels: A Strange and Terrible Saga, gang members also had sexual encounters with one another. One of their favorite “stunts” was to deeply French kiss one another – with tongues extended out of their mouths in a type of tongue-licking kiss often reserved for girl-on-girl porn. Members of the Hells Angels explained that the kissing was a defiant stunt that produced among onlookers the desired degree of shock. To them, it was also an expression of “brotherhood.”

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Fraternities often engage in hazing rituals that involve same sex contact. Wikimedia Commons

Today, sexual encounters between straight-identified men take new but similarly “manly” forms. For instance, when men undergo hazing in college fraternities and in the military, there’s often a degree of sexual contact. It’s often dismissed as a joke, game, or ritual that has no bearing on the heterosexual constitution of the participants.  As I document in my forthcoming book, fraternity hazing has included practices such as the “elephant walk,” in which pledges are required to strip naked and stand in a circle, with one thumb in their mouth and the other in the anus of the pledge in front of them.

Similarly, according to anthropological accounts of the Navy’s longstanding “Crossing the Line” initiation ceremony, new sailors crossing the equator for the first time have garbage and rotten food shoved into their anuses by older sailors. They’re also required to retrieve objects from one another’s anuses.

One relatively recent example of the pervasiveness of these kinds of encounters between straight men was revealed in a report by the US-based watchdog organization Project on Government Oversight. In 2009, the group released photos of American security guards at the U.S. Embassy in Kabul engaging in “deviant” after-hours pool parties. The photos show the men drunkenly urinating on each other, licking each other’s nipples, and taking vodka shots and eating potato chips out of each other’s butts.

Individuals often react to these examples in one of two ways. Either they jump to the conclusion that any straight-identified man who engages in sexual contact with another man must actually be gay or bisexual, or they dismiss the behavior as not actually sexual. Rather, they interpret it as an expression of dominance, a desire to humiliate, or some other ostensibly “non sexual” male impulse.

But these responses merely reveal our culture’s preconceived notions about men’s sexuality. Look at it from the other side of the coin: if straight young women, such as sorority pledges, were touching each other’s vaginas during an initiation ritual or taking shots from each other’s butts, commentators would almost certainly imagine these acts as sexual in some way (and not exclusively about women’s need to dominate, for instance). Straight women are also given considerable leeway to have occasional sexual contact with women without the presumption that they are actually lesbians. In other words, same-sex contact among straight men and women is interpreted through the lens of some well-worn gender stereotypes. But these stereotypes don’t hold up when we examine the range of straight men’s sexual encounters with other men.

It’s clear that straight men and women come into intimate contact with one another in a range of different ways. But this is less about hard-wired gender differences and more about broader cultural norms dictating how men and women are allowed to behave with people of the same sex. Instead of clinging to the notion that men’s sexuality is fundamentally inflexible, we should view male heterosexuality for what it is – a fluid set of desires that are constrained less by biology than by prevailing gender norms.

____________________

Jane-Ward71i3LOTI0nLJane Ward is an Associate Professor of Gender and Sexuality Studies at The University of California, Riverside, where she teaches courses in feminist, queer, and heterosexuality studies. She has published on a broad range of topics including: feminist pornography; queer parenting; gay pride festivals; gay marriage campaigns; transgender relationships; the social construction of heterosexuality; the failure of diversity programs; and the evolution of HIV/AIDS organizations.  This post is based on research for a forthcoming book with NYU Press–Not Gay: Sex between Straight White Men.

Nice Work

What’s all the fuss? Pissed off people on consumerism, sex, and sexism

Virginia Rutter on July 28, 2014

It is weird. The evidence from psychology, sociology, economics, neuroscience and history point in the same direction: there’s just not much to the claims of a war between love and lust or that equality in relationships—or even housework—damages sexual desire. Such clarity begs the question, why all the hype and misinformation about sexual disappointments in marriage or committed relationships?

Anxiety about how we are doing sexually is not new! But still creepy after all these years. (1926 Ad from WikiCommons)
Anxiety about how we are doing sexually is not new! But still creepy after all these years. (1926 Ad from WikiCommons)

There’s a quick, cynical answer, and I heard it from most people I spoke to when writing my recent article in Psychology Today on Love and Lust. The sex hype is instrumental in fueling anxiety with “How I’m doing?” “What’s wrong with me?” “Am I keeping up with the Jones’s?”

Why do we keep seeing these claims that long-term relationships mean you aren’t having the “best possible sex”? I discussed this with Vanderbilt University sex researcher Laura Carpenter: She speculated, “Is it some version of late modern capitalism gone crazy? Think about it: We are not good capitalists or good consumers anymore if we are committed to our car, house, brand of yogurt, clothes, shoes—and in a culture all about consumerism and desire—why would you not extend that idea—have that expectation about relationships and sex?” Carpenter continued, “We don’t know what normal is. We really don’t–even if merely in statistical sense, much less in the sense of what is good for you or what people desire.”

Who cares what normal is? People hate the imposition of “normal”—but it definitely absorbs attention. When it is in the air they notice it and respond to it. It is irritating to the mind, the heart, the ego.

One (non-sociologist) friend I talked to—a straight married guy with three kids–rolled his eyes about the recent series of sex-can’t-last-in-marriage articles. “Part of the premise is that ‘happiness’ is a never-ending quest for peak experiences–sexually and romantically. Our society conditions us to believe we can achieve and maintain a state of bliss, to have a peak marriage and a peak sexual relationship for decades. That isn’t the way it is, and if that’s how you set your expectations for a relationship then you’re guaranteed to be disappointed. There are valleys and plateaus, and they are based on other things in your life—career, children.”

A D.C. colleague I met during her busy work day—it started early because it was her day to drive her kids to school—was just pissed off by the claim that career couples don’t have sex. That’s not her normal. “You might be fighting or upset or low, for us it has nothing to do with what’s happening in our sex life. I find that is much safer, there’s no keeping score. Some people would say that’s so unemotional—but I think that is what makes it fun!”

The even more cynical answer—given that stories about disappointments with married sex focus on women’s sexual desire or on women’s careers—is that it fuels anxiety about “what’s wrong with women?” It works like a dog whistle: an argument using code that, in this case, signals that women just can’t get have it all—but they are on the hook for it.

One economist pondered, “Are articles like this a way of telling women ‘don’t expect too much from your husband; settle for what you can get; if you’re accommodating and don’t push on the chores you’ll get rewarded’?” She was making reference in particular to coverage of the ASR study on egalitarianism and housework–you know, the study where sexual frequency was associated with whether the housework you did was gender normative. My PT article takes a few steps to putting the ASR study into perspective–including useful comments from study co-author Julie Brines. But here’s how the dog whistle works: the study doesn’t say that couples have lower sexual satisfaction depending on housework, just a tiny bit of difference on sexual frequency. There is no disappointment. Well, that is sort of not true. I’ve been disappointed that we are still talking about this.

Mediating Beauty

Miley’s Embrace of the F-Word

Dara Persis Murray on November 18, 2013

Terms like “empowerment” have flooded popular culture for quite some time, often in relation to promoting consumerism as well as hypersexual self-presentation. Of late, though, a rather unlikely source employed the word “feminist” to describe herself. Last week, media sensation Miley Cyrus stated: “I’m one of the biggest feminists in the world because I tell women not to be scared of anything.”

Central to Miley’s values of “not being scared of anything” is her embrace of shock value, especially as related to seemingly self-assured hypersexual posturing. As consumers of popular culture are likely familiar, she exhibited her self-confidence at the August 2013 VMAS, in which she performed a raunchy rendition of “Blurred Lines” with Robin Thicke. She continued her domination of the headlines by appearing nude (save for some boots) in the music video for her song “Wrecking Ball.” This sort of “empowerment” has underscored Miley’s rebranding effort from Hannah Montana to…something else more…well, “adult.”

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Given that Miley’s brand of feminism feels more like Girls Gone Wild than a feminist figurehead, it’s quite interesting that she uses “feminist” as a self-descriptor. It’s notable, too, since many female celebrities, especially her contemporaries, have distanced themselves from identifying as a feminist. For example:

Katy Perry: “I am not a feminist, but I do believe in the strength of women.”

Carrie Underwood: “I wouldn’t go so far as to say I am a feminist, that can come off as a negative connotation. But I am a strong female.”

Beyoncé: “That word [feminist] can be very extreme … I guess I am a modern-day feminist. I do believe in equality … Why do you have to choose what type of woman you are? Why do you have to label yourself anything? I’m just a woman, and I love being a woman.”

The qualifications in Katy, Carrie, and Beyoncé’s communication about employing the word “feminist” reflects a longstanding conversation in feminist scholarship about why feminist has become a label that is fraught with contention. Part of the reason seems to be the history of generational conflict associated with women’s efforts to fulfill feminist aims. Along these lines, women seem to want to assert that their view of feminism is not that of their mothers or grandmothers. They want to own their feminism.

In addition, female celebrities’ ambivalence towards the term “feminist” is perhaps based on the ways in which notions of feminism have been communicated through mass media outlets over almost fifty years. As many scholars of consumer culture have identified, feminist discourse has been employed in advertisements and other media products to create a positive association between goods and the values we associate with them. This, in turn, has led to a devaluing of the language of feminism in popular culture, particularly in relation to feeling good through self-beautification. So, for instance, even though most people are aware that it’s simplistic to equate an experience of empowerment with nail polish, the constant presence of manufactured visual/verbal associations reinforces the desired meaning of the message, as in this advertisement:

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While it is unlikely that wearing a nail polish called “Empowerment” will actually lead a woman to feel empowered when she wears it, it is possible that her act of carving out a space in her busy day to take care of herself and exercise an aesthetic pleasure will constitute a meaningful assertion of her power. The trouble here is that it’s not just one nail polish advertisement that links meanings of empowerment with a beauty product. The messages in this advert connect to those in other types of media texts (films, tv shows, ads/branding campaigns, celebrity images) as well as to cultural values that equate women’s work on their beauty/bodies with self-improvement. This sort of messaging about “empowerment” reinforces the idea that beauty routines are a necessity for presenting ourselves as socially acceptable and transform the pursuit of beauty into an oppressive journey of conformity.

Although feminism and feminist may currently be nebulous terms, there exists nonetheless an understanding among the public about what feminism, in essence, means. A poll conducted on People Magazine‘s website found that 92% of those who responded did not think that “Miley is, as she claims, one of the world’s biggest feminists.”

People poll

In early twenty-first century Western culture, it’s not a leap to argue that meanings and practices of feminism have become distorted and distant from their origins or that they have come to be associated with beauty-related goods and issues in consumer culture. Feminism is not a catch all for anything that involves a woman feeling good about herself, nor is it an excuse for a woman’s bad behavior. There is much feminist work to be done (see, for instance, recent studies on gender pay gaps here and here). As a culture and as individuals, we need to start thinking more about what we want feminism to be and do for women and society. Miley’s brand of feminism opened up a conversation. Let’s continue it.

Bedside Manners

BEDSIDE MANNERS: Can Catholic Colleges Block Free Condom Distribution?

Adina Nack on April 25, 2013

New controversy about free condoms inspires this month’s column, a critique about student health and public health by Chloe E. Bird, Ph.D., senior sociologist at the nonprofit, nonpartisan RAND Corporation and co-author of Gender and Health: The Effects of Constrained Choices and Social Policies (Cambridge University Press).

File:Condoms 08293403.jpgThe Affordable Care Act requires that birth control be made available through health plans, in some cases without co-pays or deductibles. That’s prompted religious institutions to object to paying for care that’s not consistent with their values. But Boston College’s recent steps to stop free condom distribution doesn’t involve sponsoring birth control—it involves location. Boston College Students for Sexual Health, an unofficial campus group formed in 2009, gives away condoms on a sidewalk next to campus and from about 15 dorm rooms, which the group calls “safe sites.”

Until recently, Boston College, a private Jesuit institution, appeared to have taken an approach common among Catholic colleges: tolerating condom distribution by its students as long as it was done offsite, but officially banning the activity on its property. There is some dispute about whether the college previously asked the student groups to stop the on-campus distribution program; however, it recently informed students that any reports that they were distributing condoms on campus would be referred to the student conduct office for disciplinary action. At issue is whether public health policy should protect such actions by students, or whether Boston College and other private universities can ban condom distribution on their property on religious grounds.

If this issue were to be decided on the basis of public health benefits, the outcome would be clear: Condoms indisputably prevent both unintended pregnancies and the spread of sexually transmitted infections (STIs). Although abstinence is the only way to completely prevent pregnancy and STIs, it works only when practiced without exception. Students who have chosen sexual activity over abstinence could benefit from accessible distribution sites—and the numbers indicate that most do choose sex over abstinence. On the spring 2012 American College Association National College Health Assessment, 69.6 percent of college students reported having one or more sexual partners in the previous 12 months, and 27 percent reported having two or more.

Decades of research demonstrate that condoms do not cause individuals to have sex but do reduce rates of STIs, unwanted pregnancies and abortions. Moreover, a lack of available birth control has not been shown to be effective in either causing abstinence or preventing pregnancy and STIs. While a lack of access to condoms might lead students to employ other approaches to reduce the risk of pregnancy, condoms remain the best available option to prevent STIs outside of abstinence. Free distribution is particularly effective because cost has been shown to be a barrier to condom use, particularly among younger males. Consequently, publicly supported condom distribution programs have been both cost-effective and cost-saving.

A recent Guttmacher Institute report noted that unplanned pregnancies interfere with the ability of young women to graduate from college. They also increase the odds that a relationship will fail. And,

People are relatively less likely to be prepared for parenthood and develop positive parent-child relationships if they become parents as teenagers or have an unplanned birth.

Condom distribution programs have been shown to be highly effective not only in increasing condom use among sexually active populations, but also in promoting delayed sexual initiation and abstinence among youth. So both students and their future sexual partners stand to benefit from the free distribution of condoms. Clearly, condoms are critical to student health—especially women’s health.

To be sure, Boston College’s administration does not approach the issue wholly on the basis of public health considerations. The Catholic Church sets narrow limits on the use of condoms—to protect human life and reduce the transmission of HIV. But given the clear public health benefits of condoms, it does make sense to seek a path that honors the right of religious institutions to set limits consistent with their moral principles while also providing access to free condoms for those students who choose to use them.

Massachusetts public health officials, legislators and the general public will have to weigh the merits of allowing religious institutions to ban the free distribution of condoms. If they decide to respect and allow such bans, then perhaps they should consider joining Washington, D.C., and New York State in establishing condom distribution programs for all residents.

– Crossposted with permission from the Ms. Blog –

The Next Generation

NEXT GENERATION: To Shave Or Not To Shave

Kyla Bender-Baird on February 2, 2013

By Dairanys Grullon-Virgil*

While reading Paulo Coelho’s novel Aleph over the semester break, a passage jumped out to me.  Coelho, the main character, sees Hilda, his love interest, naked and notices her shaved genitals: “When I met her in her past life, when I first saw her naked she had pubic hair. Today the woman in front of me has shaved all of it, something that I think is abominable, like if all man are looking for a infant to have sex with. I ask her to never do that again.”

What? He is actually fine with her having pubic hair and begging her not to shave it all ever again?! That is certainly not the message I’ve gotten as a young woman. Then thinking about it he makes a very important point. Pubic hair on a woman or a man is the symbol of becoming, growing, age. However, thanks to the media and social norms, we often feel repulsed or embarrassed by having pubic hair. Especially for women, we are constantly targeted with messages on how our vagina should look when we wearing a bikini or before having sex. I am not saying that all women feel this way, but many of us have felt that that way including myself. more...

Bedside Manners

BEDSIDE MANNERS: Medical Care or Moral Surveillance?

Adina Nack on August 25, 2011

Is the legality of abortion in the U.S. a moot point if too few ob-gyns are willing to perform the medical procedures?  A recent post on FREAKONOMICS inspired me to find out more about a new article in the journal Obstetrics & Gynecology titled “Abortion Provision Among Practicing Obstetrician-Gynecologists.”

This group of researchers mailed surveys to practicing ob-gyns and reported on the data from 1,800 who responded. The article’s main findings are as follows: “Among practicing ob-gyns, 97% encountered patients seeking abortions, whereas 14% performed them.” Their analysis of the data revealed that male physicians were less likely to provide abortions than female physicians. Age was also a factor, with younger physicians being more likely to provide abortions.

The new article’s abstract states, “…physicians with high religious motivation were less likely to provide abortions.” I wonder if the large numbers of ob-gyns who do not provide abortions speaks to moral judgments that this medical procedure is a sin. So, the legality of abortion may be rendered pointless by physicians who may be making decisions based on religious doctrine? Access to abortion remains limited by the willingness of physicians to provide abortion services, particularly in rural communities and in the South and Midwest.” Does a woman’s geographic location doom her to restrictions on her ability to obtain a medical procedure that is protected by law?

During my study of women and men living with genital herpes and HPV/genital warts infections, I coined the term moral surveillance practitioner to describe the doctor-patient interaction style of health care providers who conveyed a sense of disapproval, judgment, condemnation, and even disgust to their patients who had sought their sexual health services.  In the case of STDs, these practitioners tended to blame their patients for having contracted a medically incurable infection because of their own “bad” and sinful sexual behaviors.

It would be interesting to see if a companion study to the newly published one, perhaps a qualitative interview study, would reveal a more nuanced understanding of the attitudes and values that ob-gyns hold about their female patients who seek abortion services.  With women’s physical and/or mental health often hanging in the balance of the ability to receive a legal abortion, we deserve to know more about the large number of ob-gyns whose moral opinion may be taking precedence over their ethical obligation to, in the words of the Hippocratic Oath, “First, do no harm”…in this case, to do no harm to their female patients who may be harmed by not having a medically safe, legal abortion.

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Note: If you’re curious about physicians’ insights and experiences in providing (or not providing) abortion care, then check out two recent books: Carole Joffe’s Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us and Lori Freedman’s Willing and Unable: Doctors Constraints in Abortion Care. And, for more of the latest research on reproductive health care and policy, explore the work of UC San Francisco’s reproductive health think tank ANSIRH.

Bedside Manners

BEDSIDE MANNERS: Respect and Protect the Pelvic Floor

Adina Nack on July 28, 2011

Okay, I’ll admit it – ever the STD researcher, I was tempted to focus on the recent NYT article, “A Vaccine May Shield Boys Too.”* Instead, I dedicate this month’s column to a recent news item that has not attracted a lot of attention: the FDA issued an advisory warning against the use of mesh implants that are routinely used for surgical repairs of pelvic floor damage.  Warning: This post contains medically accurate language which some readers might find disturbing. (It also contains new medical findings that all readers should find disturbing!)

 

First, it’s important to know what the pelvic floor is and what functions it serves: in addition to this image from 1918’s Gray’s Anatomy, check out a newer medical illustration included in a recent LA Times article.  This muscular structure has the demanding job of supporting the uterus, bladder, urethra, the walls of the vaginal canal and rectum. In other words, it’s pretty darn important.  Without functional pelvic floor muscles, women can experience urinary incontinence, fecal incontinence, and uncomfortable/painful sexual intercourse.  (Not to mention, it’s more than a little disconcerting to have to manually push your prolapsed organs back into place.)

Surgical repairs of this type of damage are often done to correct prolapses of the uterus and surrounding organs which, to put it bluntly, can feel “as if something is falling out of your vagina.”  The problem is that the mesh devices used in many of these surgeries may be harming the sexual and reproductive health of many of the tens of thousands of women who have surgery each year for prolapse.

You might be wondering, how many women are at risk for pelvic organ prolapse?  Cigna say the top risk factors are full-term pregnancies (which stretch the pelvic floor), the strain of childbirth, and having a hysterectomy (surgical removal of the uterus).  On a recent episode of his TV show, Dr. Oz shared the estimate “almost 50% of women will experience some form or prolapse in their lifetime.”

Thousands of women opt for prolapse surgery every year, and many of these surgeries have involved the use of mesh implant devices to support torn/damaged pelvic floor tissue.  As noted in a July 14th LA Times article, “The advisory was issued after an increase in reported complications involving the device.”  This article also describes complications as including “pain and urinary problems,” as well as, “erosion, when the skin breaks and the device protrudes, and contraction of the mesh that leads to vaginal shrinkage.”  Back in 2008, the FDA’s Public Health Notification and Additional Patient Information documents cited 1,000+ reports of these kinds of serious complications but considered them to be rare.  Fast forward to 2011 when these serious complications “have jumped fivefold,” no longer rare.

So, how does this impact a woman’s sex life?  The FDA notes, “Both mesh erosion and mesh contraction may lead to severe pelvic pain, painful sexual intercourse or an inability to engage in sexual intercourse.”  And, male partners of these women are also at risk: “men may experience irritation and pain to the penis during sexual intercourse when the mesh is exposed in mesh erosion.” 

With the FDA deciding to not remove the mesh implants from the market, did they do enough to protect patients?  Some experts say, “No.”  Dr. Diana Zuckerman of the National Research Center for Women & Families points out that these mesh implants have been used, “despite no clinical trials, no testing on humans to see if they’re actually safe and effective.”  It is time to advocate strongly for research and development of pelvic floor surgical repair techniques which do not involve the use of synthetic mesh implants.

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*This article sheds very little new light on a topic I wrote about over a year ago forMs. Magazine and blogged about back in 2009 – Gardasil is not simply the ‘cervical cancer’ vaccine its initial branding advertised; it also offers several potential health benefits for boys and men.