Sex Spoken Here: Secrets of a Sexuality Educator

Multiple Sclerosis (MS) and Sexuality

While I do not have MS, I have become one of the few sexuality educators who presents workshops specifically around MS and sexuality. In the past, the majority of my sex and disability workshops have been focused around the HIV/AIDS community.

I am someone who is constantly trying to expand my knowledge when it comes to sex and sexuality. I decided to throw myself into finding out as much info on how MS affects sexuality. I quickly found out that there is not a whole heck of a lot of information available. Curiously enough, the best resources on MS and sexuality come from the MS Society in Canada. I'm also gonna brag here and say I've presented this workshop for 2 of the finest medical hospitals around, Stanford and UCSF. 

What I have learned is that MS is one of the most common diseases that affects the central nervous system. Our nervous system is made up of a complex system of nerve fibers that are surrounded by a protective sheath called myelin. MS occurs when the protective sheath (myelin) becomes damaged and communication between the brain and the rest of your body become obstructed. Lesions can form on the spinal cord which can result in non-reversible deterioration of the nerves. 

Studies show that between 40% and 80% of people with MS experience significant sexuality issues, and it is higher than other chronic illnesses. Sometimes this means that people have to redefine what sex means to them. It can also make people with MS incredibly creative when it comes to how they have sex. Make no mistake, people with MS can experience fantastic and satisfying sex lives. 

There are 3 distinct categories when it comes to MS and sexual dysfunction. 

Primary sexual dysfunction:

• When lesions on the spinal cord impair and interfere the nerves between the brain and genitalia. Common side effects are altered genital sensations, decrease in intensity of orgasms, erectile dysfunction, decreased vaginal lubrication and engorgement, and decrease in pelvic muscle tone.

Secondary sexual dysfunction:

• This is when sexual dysfunction occurs as a result of MS symptoms or the medications that are used to treat MS. Common side effects are fatigue, spasticity, bladder/bowel disturbances, sensory changes of genitals that can cause numbness or severe pain, decreased levels of sexual excitement, and tremors.

Tertiary sexual dysfunction:

• This is when the psycho-social and cultural feelings and beliefs of having MS affects sexuality. Common side effects are lowered body image, grief, anxiety, depression, feeling like your body has betrayed you or feeling disconnected from your body, and feeling like you rarely have control of your body since MS can be so unpredictable. 

It can be pretty freaking hard to feel sexual with all this stuff going on. Hell, I'm able bodied and can tend to feel non sexual and have had lots of experience with low desire. Having MS can be extremely frustrating because of the fact that it is so unpredictable. This is hugely challenging when it comes to sexual activity. 

Here are a few of my personal tips for enhancing your sexual life with MS. 

• Redefine what sex means to you. Yeah, I can see how you might be scratching your head at this. Most people believe that the only way to have sex is to have penetration and end with ejaculation and orgasm. But boy oh boy, sex can be so much more than the act of penetration. 
  

1. Give yourself permission to find pleasure in your body
2. Allow yourself to feel sexy and have erotic thoughts
3. Experiment with lots of oral sex and digital (finger) penetration
4. Figure out through exploration what parts of your body are more sensitive than others
5. Challenge the thought that sex always boils down to penetration with ejaculation and orgasm
6. Allow yourself to experience pleasure without feeling like you have to achieve ejaculation/orgasm
7. Communicate with your partner what you need to feel safe in order to engage in sexual activity
8. Remember that sex is fun, sometimes awkward and messy, and often funny. Being accepting of these facts can help strengthen the intimacy you already have with your partner

 

• Talk to your doctor. Here's the deal--doctors get maybe 20 hours of training in sexuality during medical school. You may need to bring up sexuality with your doctor in stead of hoping they will do it. Medications to treat MS can absolutely effect your sexuality, so ask about what you can take (or add) so you can regain sexual feelings. Also, ask for testosterone testing. Low testosterone affects both men and women. If you use a catheter, know that sexual activity is totally possible. Make your doctor aware of your sexual activity so you can determine which type of catheter is best for your needs. 

 

• Try to schedule sexual activity for when you typically have the most energy.

 

• Avoid coffee, tea, other caffeinated drinks, and alcohol if you are scheduled to engage in sexual activity. Also, empty your bladder before sexual activity. Put some towels down before you engage in sexual activity. A little (or a lot) of urine isn't really a big deal when you think about the bigger picture. 

 

• Incorporate sex in the bathtub. We know that bathing in warm water prior to sexual activity can help reduce spasticity as well as relax your muscles and joints. You will need to have silicone lubrication for your sexy bath time play. However, it is very slippery so try experimenting with a little before using a lot.

 

• Try out different sex positions. Using pillows (both regular and ones made specifically for sexual activity) can decrease joint pressure. Rear vaginal penetration can be helpful for people who wish to keep their legs together. Having sex sideways doesn't put as much pressure on your bladder so many people find it enjoyable. If your male partner has MS and is unable to full extend his legs, try experimenting being on top.

I hope you have found this blog post to be useful.

If you did, I would love it if you left me a comment. Also, you might want to consider printing out this blog post and bringing it with you to your next doctors appointment. I'm going to follow up this post with my top sex toy picks for those who are differently abled, so please stay tuned. 

 

    

Catherine's Big Book Review "Free Love" by Thomas Kelleher

I admit that I am horrible at product reviews most of the time. I wish I could guarantee a 6 week turn-around, but that would just be setting me up for failure. This book review has been a long time coming. 

"Free Love--True Stories of Love and Lust on the Internet" by local author Thomas Kelleher is a very fun, quick, and interesting read. Although many of the people talk about using other dating/sex forums besides CL, it seems to be the main source of peoples stories. One part of me, however, is jealous that he put this information into a book because I have sooooo much experience with Craigslist (CL). 

I'm jealous because I pioneered online outreach to the young LGBT community in San Francisco in 2002. I presented all over the country about how engaging in risky sexual encounters was responsible, in part, for a growing number of HIV and STI cases. I also did what is now called "online outreach" where an educator takes to the internet to provide accurate information on sex as well as local HIV/STI testing sites. It seriously never occurred to me that it was a potential book idea.

But enough about me. 

What I really like about this book is the way it is formatted. Just like in CL, the chapters are designated into men for men, men for women, women for men, women for women, missed encounters, and casual encounters. The left side of the page shows the original ad or posting the person was using in order to find someone, and the right side (and, in some cases, pages) tells the anecdotal story of what happened in response to that particular posting. 

It's entertaining, compelling and voyeuristic. As someone who majored in sociology, this book is treasure trove of data on what it's like to have relationships, date, and have sex in the internet era. 

Because I have so much personal experience with CL, many of the original ads were a tad too familiar. Some of the anecdotal stories were also a bit commonplace, but I found them to be really interesting and kept me entertained.

The people in the book basically fall into a few different categories: people who were placing ads as a joke or a bet (in other words for shits & giggles), people who were looking for long term relationships, and people who were looking for sex. Lots and lots of sex.

I found it intriguing that a number of people never admitted or wanted it to "get out" that they used online forums like CL to find a partner. In all fairness though, it seemed to me that the people who were embarrassed about using the internet to find dates were in an older demographic and fondly re-called the good old days of having to place personal ads in the paper. 

More than a few people found real love online and are either engaged or married. A few posters met potential dates whose mental health was questionable to say the least. There were also a few red flags going off in my head when I read certain anecdotal stories. I'm not a therapist or mental health worker, but it seems like a few of the people who placed the ads could benefit from a couple therapy sessions. 

People have long loved the internet because of the feeling of anonymity. Yes they do! Engaging in cyber sex, sexy phone calls, steamy texts, and naked picture exchanges can be really intoxicating. It can also be a fabulous way to safely explore the depths of your personal sexual fantasies.

Talking about sex or what you want to do with someone online gives you much more courage than if you were standing next to that person. The internet can give you the confidence and assurance to vocalize thoughts that you might never say if you were in a traditional dating setting. Incidentally, I also think that online dating is a great way to negotiate what you are looking for, what you are willing to do sexually, and it is one of the easiest ways to broach the topic of sexual health. You can weed through people quickly to suit what you are looking for (especially if you ask the right questions), and it can also make the whole idea of rejection less personal. 

People also lie. A lot. The internet just makes it a hell of a lot easier to get away with lies for a longer amount of time. My personal experience is that, in general, women are always 20 pounds heavier and older than they report. Men, on the other hand, are always shorter, make less money, have less hair, and weigh more than they report.

People love sending the most flattering pictures of themselves, even if that picture is 2, 5, 10 or more years old. Not everyone does this, but many stories in the book "Free Love" talk about how a person was over 100 pounds more than what they stated or was bald or balding when they stated they had hair. 

On the internet, people love to pretend they aren't married or attached. Like I said before, the internet is intoxicating that way. Several stories address the horror of finding out the hard and unpleasant way that people who claim to be single are married or otherwise coupled. 

Of course, like any good gay, my personal favorite stories came from the men seeking men category. I always find it particularly interesting when a man claims he is "St8" (for those of you who don't know this term, it means straight) but wants to find a jack off buddy, someone who will suck him off, or someone who will let him top (after all, some people don't believe they are engaging in homosexual activity if they are not the person being penetrated). 

Internet dating has forever changed the way in which people meet, date, and have sex. The book "Free Love" gives you a raw and voyeuristic view into what internet dating and "hooking up" is all about. The bottom line is that no one wants to be rejected, are longing for a connection (even if it is purely sexual), and maybe, just maybe, fall in love. 

Is That a STI in Your Eye? (Viral Edition)

I know that STI's aren't something that makes most people pop out of bed and think to themselves "Hey, I wonder what kind of new info I can find today on STIs", but, then again, they aren't me. 

Last summer I wrote this companion piece to this post about bacterial infections. STI's aren't pretty, and they certainly make a lot of people super uncomfortable talking about them, but this is stuff you need to know if you are sexually active. Viral STIs are different from bacterial STIs because there is no cure. They can be managed, and managed well. The kicker is.....you have to know you have it. 

I'm someone who thinks that STIs would be less prolific if people were exposed to photos of STI symptoms with some frequency. I'm not kidding. Google a STI and then go to the pictures tab. Like I said, it ain't pretty. There are some pictures where it takes you a minute to figure out just what you are looking at. 

Ok, on to viral STIs (I'm leaving out HIV because that is really a whole other blog post)

HSV 2 (Herpes Simplex Virus Type 2):

HSV 2 is the more common form of genital herpes (remember HSV 1 can also cause genital herpes), HSV 2 can also present on the mouth although it is rare. HSV 2 can also affect the eyes. 

HSV 2 is a STI which means it is transmitted through sexual activity. Penetration need not take place for transmission to occur. HSV 2 is passed through skin on skin transmission while engaging in sexual activities like kissing, oral sex, vaginal penetration, anal penetration, and naked skin on skin rubbing. 

Symptoms vary from person to person so there really is no "typical" type of symptom pattern. However, many who have genital HSV 2 report the following: blisters, sores, skin cracks and fissures, itchy and irritated areas, pain during urination (blisters can form inside the urethra--ouch!). Non-genital symptoms are: headache, swollen lymph nodes, low grade fever, and sensitivity to light. 

There are lots of studies out there, but most report that 1 in 5 people in the United States who are over the age of 14 has HSV 2. But, and are you ready for this, 90% of people who have HSV 2 do NOT know they are positive. 

HPV (Human Papilloma Virus):

HPV is the most frequently acquired viral STI in the United States and there are over 40 types that specifically affect the genitals. Studies show that 50% to 80% of sexually active people will acquire HPV at some point in their life. HPV is transmitted through skin to skin contact and can appear on the penis, vulva, anus, rectum, and cervix. 

HPV has 2 basic risk categories: low risk and high risk. 

Low risk HPV are warts that appear mostly externally. 

High risk HPV can cause cancer. 

Also, HPV that causes external warts are not the same that cause cancer. 

HPV is interesting in that 90 % of infections clear on their own within 2 years. 

Genital warts present as small clusters that look a lot like cauliflower in the genital region. Warts can appear on the vulva, in or around the vagina or anus, on the cervix, penis, scrotum, groin, and thigh. You can have them removed by having a doctor freeze, cut, or laser them off. You can also use a topical cream that is prescribed by your doctor. 

Whether you treat them or not, these warts will never turn into high risk HPV or cancer.

Cervical cancer is a STI that is caused by HPV. Most people don't exhibit symptoms until it has already advanced. Getting regular Pap smears is a persons best bet for catching cervical cancer because it looks for abnormal cell structure or cell changes. There is a secondary test that can identify if the HPV is low risk or high risk in women. 

HPV also causes something called OPC or Orapharygeal Cancer. Many researchers are calling OPC the "new" STI. HPV causes about 40% of OPC. Many believe it is on the rise because many people don't consider oral sex to be sex, and therefore they don't think about using a barrier. Even though women are affected, researchers are seeing a trend that young white men are of greatest risk for OPC. 

HPV is also responsible for a growing number of Anal cancer patients. Because a lot of warts tend to appear inside the anal cavity, it is more difficult to diagnose. Anyone who engages in unprotected anal activity (including rimming) should request a yearly anal Pap smear. Yes, there really is such a thing. Yes, I have been a "guest" at many a anal Pap smear. 

General cancer treatments like radiation, surgery, and chemotherapy are used for Cervical cancer, OPC, and Anal cancers. 

There is a vaccine called Gardasil that helps protect uninfected people from 4 of the most common HPV types. There is also a new vaccine called Cervarix that is now available.  

One of the most important facts to remember is that all sexual activity carries some personal risk. Condoms can help decrease transmission, but they don't cover or protect the entire genital area. Condoms cover the head of the penis and not all of the penis shaft. Female condoms are popular because they cover a larger surface area of the vulva. 

I believe that it is up to each and every person to help safe guard their sexual health. You can begin by requesting from your doctor a complete HIV/STI panel. Most tests only look for a few STIs. In order for you to be fully aware of your health status you need to specifically request a full panel and then ask what it tests for. Bottom line is the more compete the testing, the better. It's also something I get done ever year during my annual Pap smear.

How Talking About Sex Made Me Doubt Myself

This post is a long time coming as I haven't been able to properly articulate why I've felt so uncharacteristically doubtful about my work in the sexuality community. A 5 day juice cleanse apparently cleared out more than just the toxins in my body. The juice cleanse gave me the clarity to finally resolve my inner conflict.

Hopefully, I can get this stuff out in a somewhat coherent way. 

Being a sex educator comes with a lot of baggage for me. I absolutely LOVE my work, but I can't shake the feeling that people expect me to have more of a platform or cause. I feel like every time I open my politically incorrect mouth, people are going to be there telling me I'm wrong, need to change the way I speak, am not a good sex educator, will never be accepted, etc.

I've put together a list of the biggest challenges I face when working in the sexuality community. 

Point # 1 Sex & Politics: You will never see me give a workshop, talk about, or write about sex and politics. This makes me hugely different from many educators. It's not that the 2 things are mutually exclusive to each other because they are not. It's more of me thinking that they don't always have to be the same thing...kinda like orgasm isn't always the same thing as ejaculation--they are often talked about at the same time, but it's not uncommon for them to be separate.

Even though I graduated from a women's college, I have never considered myself to be a feminist and hope like hell no one ever calls me one. I like to think of myself as a "sex-positive-female-empowered-woman." I guess my general feeling is that calling myself a feminist requires me to be political or more importantly, politically correct.

When I was growing up, I was basically raised with the belief that talking about politics was bad etiquette. This is not unlike being brought up to not ask people about how much money they made--you just didn't do it (sorry about the double negative).

Which brings me to my next point. 

Point # 2 Sex & Religion: You will never see me lead a workshop or talk about sex and religion. I'm not religious and never grew up with a religious belief. Again, I was also raised in a way that asking someone about their religion or getting into conversations about it was bad etiquette. In college I was required to take a few classes in religion in order to graduate, but that is the extend of my relationship with it. 

Point # 3 Sex & Political Correctness: This is probably the single biggest reason I have doubt. I'm not politically correct. At all. This is a huge deal breaker for many sex educators.

What I am is someone who spent 5 1/2 years working in the HIV positive community in San Francisco.

In case you haven't heard, that makes me pretty freaking gay. In fact, you probably already know that I am often  referred to as the "gayest gay man in the world" by my friends. By the by, my friends also happen to be some of the gayest people I know.

Here was a typical conversation at my job (I was technically their supervisor, but I don't always refer to me as such):

Me: Hey, I got a donation of 50 cupcakes from (insert cupcakery here) for our bake sale!

Co-worker: gaaaay.

Me: I also think it might be a good idea to get some table clothes so the folding tables don't look so ghetto.

Co-worker: super gaaaaaay.

Me: And I think I'm going to buy some of those cute cupcake displays since we do so many bake sales we can totally use them again-- oh yeah, I forgot I bought a bunch of glitter--I think it would be cute to have a glitter trail leading up to the bakesale.

Co-worker: gaaaayest thing ever. 

Me: Laughing...why the fuck does that make me soooo gay when you are the one who always wear pink, dresses your freaking chihuahua up in all pink outfits, and came into work singing the Scissor Sisters?

Co-worker: because you are hella freaking gaaaaay so just deal.

I'm not even kidding that this was a typical conversation at my office. Almost anything I did or said got a response of "gay" or that I was, in fact, gay. Therefore, it became a common response I used with other people who identified as being something other than heterosexual. It is really difficult to put into words, but it was as if the "that's so gay" campaign existed everywhere else except within the gay community. 

In case you haven't heard the news, it's also become extremely politically incorrect to say the term "tranny". It's not that I go around calling everyone a tranny Tourettes style, but I did use the term often. After all, this is the same community where a bar called "Trannyshack" exists.

First of all, it is difficult for me to not use the word when people who identify as transgender, use the word tranny.

Yes, I know the proper word is transgender.

Yes, I know it's not the same thing as transvestite or cross dressing.

Yes, I will absolutely use what ever pronoun you like. 

No, I don't go around using the term "she male" or "chick with a dick".

I have, however, used the term "girl/woman with something extra" or "girl/woman who has everything". 

In my mind, how can the term be so derogatory when a trans person suggested that we include a special "tranny spotting" section in the next work newsletter? 

Also, remember when Christian Siriano used the phrase "hot tranny mess"? Well, the Monday after Saturday Night Live aired a spoof of it, I found this in my work in-box

 

By the way, the person who sent it to me was my co-worker and a trans man. 

If you add all the points together, you get one very doubtful Catherine. 

It makes me different from others in the community, and, believe it or not, by some definitions make me not an ally. By the way, people who may think that can go fuck themselves. 

More importantly, it made me question my ability to be effective as a sex educator and if I should continue with my business.

What I now realize is that I am totally ok with all this. I don't need to be the most popular or respected sex educator. Just like in my personal life, I am not someone who always easily gets along well with everyone nor do I aspire to be liked by everyone. 

Shaming me (and at this point I'm not even sure if it is really happening to me or if I am just perceiving it to be happening to me) is not going to make me change the way in which I provide sex education. 

I am not political. 

I am not always politically correct. 

I am, however, freaking great at what I do.

And the people who don't support me for being the way I am can suck it. 

Are There Any Famous Women Who Look Like Me?

Growing up I lived in a really exclusive area called the North Shore of Chicago. Since I grew up in the 70's and 80's calling my neighborhood exclusive is really just a euphemism for "white". People were either (self identified) WASPY or Jewish. Seriously, it is not a surprise that all my sisters and I married Jewish men. As with many neighborhoods, it has become a lot more diversified, but that didn't help me much as I was growing up. 

Here's the deal: I guess I identify as mixed race. My dad is second generation Japanese American (born in America) and my mom is American born of German ancestry. Even though growing up a lot of adults repeatedly told me I looked just like my mom (who had blonde hair and blue eyes), the kids I grew up with told me I looked very Asian. I was reminded about this a lot and it was almost always done in a way that was intended to hurt me or make me feel bad about myself. 

When I was growing up models like Paulina Porizkova, Christie Brinkley, Farrah Fawcett, Cheryl Tiegs, Jerry Hall, and Kim Alexis were super popular.

So, what's a non white girl who grew up in the 70's and 80's to do when looking for a role model who is 1/2 Asian? I guess the short answer is not much.

It's not a huge surprise that there were few famous people or role models I could look to and say "hey, that person actually kind of looks like me..that's cool." 

I'm happy to report that a bit of progress has been made in Hollywood! 

Here are a few of my favorite female Hollywood actors/personalities who are 1/2 Asian:

(above: Meg Tily)

(above: Jennifer Tily...yes, they are sisters)

(above: Shannyn Sossamon)

(above: Alexa Chung)

(above: Olivia Munn)

(above: China Chow--we both graduated from Scripps College)

(above: Charlotte Lewis--technically not Asian, but she looks it, so I included her)

(above: Phoebe Cates)

I know who my favorites are--Shannyn Sossamon (she looks a lot like a young Lisa Bonet) and Phoebe Cates. For anyone under 30, Phoebe Cates was basically the star of Fast Times at Ridgemont High (she had an iconic bikini scene), Gremlins, and Drop Dead Fred. She left the Hollywood scene in the 90's to raise a family with her husband, Kevin Kline. 

It would be lovely to see more people of color entering the field of sexuality. Almost all the well known people in sexuality are Caucasian. This fact hadn't even occurred to me until it was brought up in a presentation, and now I can't get it out of my head. Don't get me wrong, I'm not complaining, it's merely an observation that many people make. It's also one of the reasons why I am so passionate about promoting the work of other people who don't fit into the status quo. This is a shout out to Becca Brewer and Sandra Daugherty!

 

Who Wants to Talk About Herpes? (HSV 1)

Judging from the number of people who end up at my blog after doing a "herpes" google search, I'm guessing a lot of you. Ok, maybe you don't want to talk about it as much as you want information on it. 

I'm not even kidding when I say reading the book "The Good News About the Bad News" by Terri Warren has blown my mind. I might even go as far as saying that this is probably the only book you need on herpes if you are a sex educator, are interested in sexual health, or have a herpes diagnosis. Not only is it funny (you can tell she has been on the front lines of sexual health because of her sense of humor), but it is filled with great and actionable advice. 

I've previously written about herpes and how the the two main players are Herpes Simplex Virus Type 1 (HSV 1) and Herpes Simplex Virus Type 2 (HSV 2). I've come to find out that there is so much more to herpes than I, most people (and even clinicians) know. 

Most people believe that cold sores (sores on the outside of your mouth, chin, and nose) are HSV 1 and genital herpes (herpes around your genital area) are HSV 2. In other words, sores about the waist are HSV 1 and sores below the waist are HSV 2. 

HSV 1 cause the majority of recurrent cold sores that appear on your chin, lips, nose, and other places on your face. Many people believe that in order to have HSV 1, there must be some noticeable blister that forms a crust, heals, and goes away. Like with many STI's, the majority of the HSV 1 oral infections are asymptomatic (or even go unrecognized). This means that there are A LOT of people who honestly don't know they have HSV 1. This wouldn't be so bad if HSV 1 weren't so infectious to others. 

A term you will hear time and time again when it comes to the herpes virus is "shedding". This basically means that a person is literally giving off the virus...kinda like our skin is always shedding but we don't really think about it or notice it unless our skin is really dry or we have a peeling sunburn. During the past 10 years (give or take) there has been a really interesting shift when it comes to herpes and STI transmission. The old school of thought is that you are only infectious to others when you are currently exhibiting visible or noticeable symptoms. What we now know is that the herpes virus is being shed even when there are no obvious symptoms. This is a pretty significant finding.

Besides HSV 1 causing cold sores, it is also responsible for the majority of herpes in the eye. This can happen when you touch your cold sore and then touch your eye without washing it first. It can also happen when the virus travels along the same nerves that provide sensation between the mouth and the eye. HSV 1 of the eye is treatable and something best left to an ophthalmologist and not an optometrist.

The big news about HSV 1 is that is can cause genital herpes. Studies show that about 40% of new genital herpes cases in the United States are caused by HSV 1. Also it is thought that the popularity of oral sex is why there are more HSV 1 cases than HSV 2 cases in teens and college students. 

HSV 1 is transmitted via mouth/genital contact and it can occur even in the absence of cold sores. The good news is that about 50% of people with genital HSV 1 have zero recurrences. 

An oral HSV 1 outbreak can be triggered by anything from too much sunlight to trauma, and I don't mean that in a "Fight Club" kind of way. Trauma can be anything from a new lip piercing, oral surgery, or even lip injections (now I know why my dermy asked me if I were prone to cold sores when I tried Restylane on my lips). Remember that shedding happens even with out obvious symptoms.

Another thing to remember when it comes to HSV 1 is "who is infected". Studies show that more than 50% of people in the United States who are over the age of 14 have HSV 1 infection. Unfortunately, there is no delineation between the number of oral and genital infections.  

HSV 1 can be diagnosed a number of different ways:

• Visual diagnosis only (error rate of 20%) **not advised & in 2002 the CDC began recommending a lab test for confirmation.

 

• Viral swab tests **they are ONLY effective when having visible symptoms and the testing culture must be done correctly with vigorous swabbing. Out of several choices, only the PCR (Polymerase Chain Reaction) swab testing gives a clinician the opportunity to tell if you have HSV 1 or HSV 2. It's important to know what type of swab test is being performed. 

 

• Blood tests. Just like with HIV tests, blood tests for HSV look for the antibody or the protein that your body makes in response to an infection. Blood tests are preferable when it comes to herpes because they can be type-specific to tell you if you have HSV 1 or HSV 2. When it comes to herpes blood testing, there are many options (and some are more effective than others) so it's important to figure out what type of testing is being offered. 

So what are the big take aways from the above information?

1. Knowing that HSV 1 can cause genital herpes is huge! This can even come as a surprise to clinicians and I know it did for me.
2. Knowing that people shed the virus and are infectious to others even when there are no visible symptoms is also a fairly recent finding. 
3. Testing is complex and some test for the virus, but they don't specify if you have HSV 1 or HSV 2.
4. "The Good News About the Bad News" by Terri Warren is a great book!
   
5. HSV 1 & HSV 2 can be managed quite well with a variety of treatment therapies! This is really, really good news. Because it is a virus, there is no cure, but the treatment options have much improved in the past 30 years. 
6. A huge percentage of people who have HSV 1 & HSV 2 are completely unaware and it can lay dormant for years and years before an outbreak ever happens. This is why I always advocate for COMPREHENSIVE HIV/STI testing for all sexually active people. 

Teens, Sex, and Communication

As a sexuality educator, I know too well that abstinence only sex education doesn't work. Study after study prove it. More recently, it has been shown that youth who take a "virginity pledge" are merely substituting other high risk sexual activities in lieu of vaginal penetration. 

Let me be clear that I believe abstinence has a place in sex education--when it is part of a comprehensive sex education program. Being part of a larger conversation about sex and sexuality makes a lot of sense to me. It is the abstinence "only" part that drives me a little nutso.

I'm not a professional wordsmith, but I have enough knowledge to know that the word "withholding" is synonymous with "abstinence", which makes almost no sense to me. Seriously, think about it for a minute.

Communication is truly one of the most important tools anyone uses in their life. However, most people are never taught how to effectively communicate with...really..anyone. Peers, bosses, kids, family, and the list goes on and on. 

Using an abstinence only model (with virginity pledges) is really only getting youth to agree to something they don't consent to (as well as depriving youth from learning how to communicate around the topics of sex and sexuality.) Consent is difficult to reach if you are purposely leaving important information out. Maybe I'm a bit dense, but what is the harm with giving youth accurate information about sex education?

Learning to make good decisions is part of getting older, isn't it? Giving youth comprehensive information on sex education allows them to know what the risks are for pregnancy or HIV/STI transmission and how they can prevent it. I, for one, would be incredibly happy to never hear about a new season of "16 and pregnant" or "Teen Moms".  

I've worked with a lot of youth in my undergraduate (interning at a juvenile prison & interning with a juvenile probation office) and professional life. My post college work with youth has been as a case manager at a half-way house (in other words, youth who were released directly from prison), as a probation office (and an active participant in a "teen court" program), and working with both HIV positive and HIV negative youth in the San Francisco Bay Area.

In short, I have had a lot of experience with youth--everyone from LGBTQIQ youth who are marginally housed and homeless to students who attend some of the finest (ie expensive & progressive) private college preparatory schools. When it comes to college age youth, I've provided sex education to people attending community colleges as well as premiere universities like Stanford. 

Even though I am a non-breeder, I truly love being around teens and young adults. I hear so many parents complain about how they can't relate to their children and that they have no idea what they might or might not be doing sexually. The thing is, with me, I have the exact opposite effect with youth. Basically they tell me in intimate details who, where, and when they have hooked up with sexually. Some have even drawn me flow-charts...I'm not even kidding about this.

Maybe it's because I don't have my own kids that I am able to relate so well (and in such a meaningful way) to youth. Maybe it's because I am super awesome sex educator, or maybe it's because I am perpetually curious and am genuinely interested in speaking with them. Also, I may look younger than I am, but many of the high school youth I had daily contact with were young enough to be my children. So why is it that, in general, youth are so open to talking about sex and sexuality with me?

Here are a few of my thoughts on why youth are so willing to talk openly about sex with me. 

I relate to them on their level. Ok, so maybe this makes me a bit un-sophisticated and immature, but I can talk to most youth about almost anything. It usually starts out with me asking something like:

    "Whats going on at school?"

    "Are you interested in anyone in particular?"

    "What's the newest update with you, give me the 411",

    "Hey, are you thinking about college yet?",

    "What do you do for fun?"

    or even

    "So, have you been getting any penetration lately?"

Being that I am a super curious person, all I have to do is open the door with a few open-ended questions and the proverbial flood gates open up. I also come from a place that I recognize youth are sexual beings, which is something really difficult for a parent to conceive of.

I've figured out that there is an art to asking the correct questions. For example, If they say they have, indeed, had penetration, I will ask what kind, did they enjoy it, how do they feel about it now, is it with someone serious, do they need condoms and lube, etc. 

It's been my experience that youth are way smarter and intuitive than they are given credit for. The youth I have known are really open to confiding intimate details about their life because they see me as a trusted adult and/or ally. 

I don't want to give the impression that I'm advocating parents to go out and become their children's best friend. I mean, look at how well that has turned out for Lindsay Lohan and her mom. There needs to be some sort of rules or parameters, and those should be set by the parent.

I guess what I'm getting at is that I don't want people to think youth gravitate towards me because they see me as their pal and, therefore, a push over because 1) If you know anything about me and my past work experience (see above), you know I am anything but a push over, and 2) I have never had a problem calling a youth out on their shit. My process looks something like this--we have a private conversation, we discuss whatever the issue is and I then communicate what type of behavior is expected from them moving forward, and then I drop it and move on. I've lost count the number of times youth were obviously squeamish to be around me after our little private conversation. They are usually blown away that I am still around for them after they have messed up. I think it is these type of instances where I have left the biggest mark on emerging youth. There have been many times when I (along with other youth service providers) have been the first healthy relationship a youth has had with an adult, and it is something I take very seriously. Being an active person in a teens life can have dramatic results, even if that time is limited to only a few months. 

I know that this might seem like a radical way of interacting with youth. Open and honest communication...how novel!  

I get that not everyone is going to have the capacity to do this. In that case, the best I can hope for is that those youth have some adult in their life who they feel comfortable discussing this stuff with.

Or, you can always send them my way. 

**Scarleteen, Sexetc.org, & Go Ask Alice are all wonderful sexuality resources!

How Ditching Pads and Tampons Can Save The World (Guest Blogger)

Believe it or not, tampons have been in the news a lot lately. 

In the past few months, I've seen headlines about tampons being recalled due to bacterial contamination, high schoolers soaking tampons in vodka to get drunk, and using tampons as flaming weapons. Seriously, I can not even make this shit up!

While I am not a fan of tampons, many vagina owners use them on a monthly basis. My personal reasons for not using them is twofold; they cause me to have wicked cramps and I know someone who almost DIED because of Toxic Shock Syndrome. I am much more partial to using Diva Cups and the Instead Soft Cup. 

Tampons, it seems, are a hot topic. 

FYI, I get the whole soaking tampons in alcohol thing. It is no different from when people take a nostril inhaler, dump out the contents, put in alcohol, and then squirt it into their rectum. Mucous membranes are an efficient way of getting substances into the blood stream. However, it generally is not something that is recommended. Vaginal and rectal tissue is really, really sensitive and introducing alcohol into either of them is dangerous. 

Becca Brewer, who I've written about before (remember she is the fabulous creator of the FREE download of the WWWcharts), posted a blog article about how a vagina owner (and fans of) can save the world by ditching pads and tampons. She has graciously allowed me to re-run her blog post that was originally posted on April 26, 2010. 

Connect with Becca via her website, on facebook (don't forget to "like" her), and on twitter.

~~

How Ditching Pads and Tampons Can Save The World

Those of you who are close to me know how much I love Menstrual Cups. When I began to hash this post out, I was simply going to rave about how amazing menstrual cups are.

And believe me, they are. They last for up to 10 years, can be worn for up to 12 hours, are hypoallergenic, have no TSS risks, don’t suck away the body’s natural fluids, are easy to carry, easy to transport, and are really cheap. Plus it’s my personal opinion that because they require manual removal by putting your fingers in your vag that they eventually make you less grossed out about periods, and help you to become more connected to what’s going on with your body.

But this post is not about all that stuff. This post is specifically going to speak to helping you all think more critically about how pads and tampons affect the environment.

DUDES. FELLAS. GUYS. PEOPLE WHO DON’T MENSTRUATE. This post is for you too. Even though I know that you don’t surf the crimson wave, I’m assuming that you may know one person who does. Maybe you have a wife or a girlfriend. Maybe you have a sister or a mom or an aunt or a daughter. Maybe you have a female friend. Maybe you know someone with a uterus. Even though you can’t use a menstrual cup, you can forward this post along or have a conversation with your uterus bearing acquaintance.

So let’s get on with it!

Pads and Tampons made by mainstream companies (Tampax, Kotex, OB, Playtex, Always, etc), are made in such a way that they do not biodegrade. This means that when you use these products, they will sit in a landfill far after you’ve stopped menstruating and even long after you’re no longer on this earth (either because of interplanetary travel or, you know, death).

And I’m not just talking the actual pads/tampons themselves. There are also the plastic tampon applicators, the plastic packaging that the pads/tampons come in, and any plastic packaging used to sell the products in multiples (assuming it’s a non-recyclable plastic).

All of it becomes waste that just sits in a landfill forever. 

How much waste? Let’s do some math!

• Tampons are about 5 cubic inches in size.
• Since I’m supposed to change my tampon every 4-6 hours, I’ll probably use about 6 per day.
• If my cycle is 5 days, that’s 30 tampons.
• Every cycle, I will create about 150 in3 (or .01 ft3) of waste that will sit in a landfill forever.
• If I menstruate from the age of 11 to the age of 51 every 28 days; that means that I will have 521 cycles over the course of my menstruating life.
• Over the course of my lifetime, I will leave behind 78,150 in3 (45 ft3) of non-biodegradable waste.
• To reiterate that, I will leave behind a box that measures 3’ x 3’ x 5’ of used tampons (plus all of the plastic waste that came with my tampons) as a gift the next generation has to deal with. (And that box will be larger if I use pads.)

Now a 3’ x 3’ x 5’ box doesn’t seem like all that much space. Except, I hate to break this to you all, I am not the only menstruating woman in the world.

There are about 3 billion women in the world, actually. At some point in their lives, if not currently, most of these women will experience menstruation. Which means that even though I only fill a small box personally, if even a quarter of the women in the world use mainstream tampons … we’re working together to create some serious long-lasting waste.

To counterpoint this with Menstrual Cups; here’s some more math:
• Menstrual Cups are about 1.6 in3 (.0009 ft3) in size.
• Over the course of my lifetime, I might go through 5 menstrual cups.
• Which means, if the cup doesn’t biodegrade (some do), I will leave 8 in3 (.005 ft3) of waste behind.
• To reiterate, that is a box that is 2” x 2” x 2” of waste over the course of a lifetime. (Note that this is a tiny 2 inch cube, and the last example was a box measured in feet).
• The cardboard box (if it came in one) and the paper instructions, along with the fabric bags I carried my cup in were all recycled or will biodegrade. 

In addition to landfill space, there’s also the manufacturing process to think about. Now, I’m not a tampon manufacturer and I surely don’t know the process involved, however I’m assuming that to manufacture tampons, one needs electricity, raw materials, chemicals, and water.

Which are things you also need in manufacturing menstrual cups.

But, because I’m all about math right now, let’s look at this in numbers again.

• If we go back to the 30 tampons per cycle and 521 cycles in a lifetime model, over the course of my lifetime, I will need 15,360 tampons.
• Let’s say I buy my tampons in 20 packs. This means I’ll need 782 packs of tampons over the course of my lifetime.

In thinking about my tampon use, I need to think about more than just the waste that results when I discard my tampons. I also need to think about all the resources required to make them AND the resources required to make the packaging my tampons come in. (Not to mention the shipping process that gets them into stores).

I need to think about this with menstrual cups too, but over the course of my lifetime, I may only need 5.

15,360 is way more than 5. 782 is way more than 5.

So even if it takes more resources to make 1 menstrual cup than it does to make 1 tampon, I’m using so many less menstrual cups that in the battle of both product and packaging manufacture, using tampons results in a much greater environmental strain.

Not to mention that tampons and pads are manufactured with chemicals (bleaching agents, adhesives, etc) that (while being bad for your body) also leach into the soil after you’ve thrown them away.

Now in terms of why they’re manufactured this way, I have no answers for you. But I can tell you that you’re not powerless in all this.

So what can you do?

Depends on your commitment. I’ll break it down for you:

Starting Small:
• Switch to tampons that don’t use applicators or that use cardboard applicators instead of plastic applicators, thereby getting rid of applicator waste.
• Use the smallest pads/tampons possible for your flow to cut down on the number of pads/tampons you’re using per cycle. (Don’t, however, leave them in/on longer as that could result in TSS or infection.)
• Switch from pads to tampons. 
• Forward this post to other people you think should know about this.

Getting Serious
• Switch to 100% cotton pads/tampons (Natracare, 7th Generation, etc) because they will biodegrade AND because their packaging is often paper-based and recyclable.
• Write to the mainstream pad and tampon companies asking why they’re not making environmentally conscious products.
• Ask your local drug stores, health food stores, and other retailers to have products like 100% cotton pads and tampons, cups, and reusable pads in stock.

Go Big or Go Home
• Switch to a menstrual cup (Moon Cup, Diva Cup, The Keeper, Miacup, Lunette).
• Switch to a washable, reusable pad (Glad Rags, Lunapads, etc.)
• Start a petition to major corporations demanding they change the way their products are made.
• Start a petition asking major tampon/pad companies to start manufacturing a line of ‘Green’ products.
• Petition large retailers (like Target, Walgreens, Rite-Aid, etc) to carry products like cups, reusable pads and 100% cotton products for purchase.

In Conclusion

Go Green! And although I didn’t mention this specifically, this is one of those instances that by going green, you’re also going to save some green. Do I hear more math? Hell yeah!

• So, we’ve already discovered that I’m going to use 15,360 tampons over the course of my life. 
• I randomly looked up tampons on Amazon and the cheapest deal I could find was $.15 per tampon.
• Which brings my lifetime grand total to: $2304 (pre tax and shipping).

• I’ve estimated 5 menstrual cups over a lifetime, but I’m going to up it to 10 for this example (people lose things, burn things, etc).
• On Amazon (although I’ve found them cheaper elsewhere) the cheapest cup price is $22.
• Which brings my lifetime grand total to: $220 (pre tax and shipping).

A total savings of: $2084

By switching to a cup, you’ll be saving your bank account AND the world. 

Keep Thinking

-Becca

What the Hell is Harm Reduction?

Harm reduction is probably one of my most favorite things about being a sex educator. Simply put, harm reduction means meeting people where they are at. 

Most people are familiar with the harm reduction concept because it is used in reference to alcohol and drug use. For example, needle exchange programs are, in essence, the perfect harm reduction model and here is why--people who work with needle exchange acknowledge that people are IV drug users (notice, there is no judgement here), and provide them with clean needles in order to decrease the transmission of HIV and Hepatitis C. Some needle exchange programs even distribute literature on how a person can shoot up in a way that is going to do the least harm. 

As someone who worked in the HIV positive community, I usually identify myself as someone who uses a harm reduction method when talking about sex education.

Ok, but what does that mean?

In a nutshell, it basically means that I acknowledge that most people engage in some type of sexual activity. Once I find out what type of sex they are having, I can talk about ways of minimizing personal risk or risk to others if that is something they are interested in.

In my case, the majority of the youth I worked with were either HIV positive or had an AIDS diagnosis, and sexual activity was the main mode of HIV transmission. The trend I noticed that at first surprised me was just how little HIV positive youth new about safer sex, much less about the HIV virus. This was one of those cases where people required basic sex education as well as specific sex education in relation to them being HIV positive (this is called "prevention with positives"). 

When working with HIV positive youth, harm reduction can be as simple as showing someone how to properly use a condom. It can also be incredibly complex and it can mean that you literally break down the level of risk involved in any sexual activity they participate in.

Many of the HIV positive people I worked with had their own harm reduction model--only they were not aware of it being a prevention strategy.

Hooking up online is really popular, and unless you met through a HIV poz website, you will most likely not know the HIV status of your newest partner. What I heard time and time again is because the HIV poz person didn't know their partners HIV status, they were more willing to "bottom" bareback. This works as a harm reduction method because 1) they already have HIV and 2) there is less risk of HIV transmission if you are "topping" bareback.

A lot of people take issue with this scenario because there is no HIV disclosure. However, believe it or not, this is harm reduction in action.

Engaging in barrier free receptive anal penetration is the most risky of all sexual activities when it comes to HIV infection. Offering up your ass constitutes harm reduction because it puts your partner at much less risk for HIV infection. 

There are A LOT of people who find harm reduction troubling. They may hold certain religious, medical, political, or personal beliefs that are incongruent with harm reduction. The best I could do was hope like hell that these people were not providing any type of HIV treatment, care, or advocacy for my clients. I would have never referred an HIV positive person to someone who doesn't subscribe to the harm reduction model. I'm also someone who tends to be super protective, so it was common for me to accompany my clients to their medical appointments. Because my dad is a practicing physician and my mom was a former nurse, I never had the weird or uncomfortable feelings many have towards medical treatment providers. In fact, I learned that growing up with parents in the medical field was a huge asset when it came to medical advocacy for others. 

I've mentioned this before, but it is my experience that disclosing that you are HIV positive is not always commonplace amongst some communities. Many people assume that if your partner doesn't say anything, then they are HIV negative. Also, many people never ASK about the STI/HIV/AIDS status of their partner.

For the record, I strongly believe that YOU need to be an active participant in your sexual health. This means getting tested regularly for all STIs. It also means talking with your partner (even if it is a one time hook up) about their sexual health history. Alternatively, you can use a barrier and stick to sexual activities that are less risky if you don't know your partners HIV/STI/AIDS status.

Let's face it, it is really difficult to make an empowered and informed decision about sexual risk if you don't know what parameters you are working with. Not talking about it doesn't mean that everyone involved is HIV/STI/AIDS negative.  

Most people who are not in the sexuality community find bringing up the topics of sex and sexuality to be really, really uncomfortable. I get it. It's not like anyone really teaches us this skill. However, I believe that the majority of your partners will be thankful for you broaching the subject. Incidentally, it is also one of those things that gets easier the more often you do it. 

Harm reduction, it's a really good thing!

Arrrghhh Writer's Block!

I admit that it tickles me that my last post on Sex Nerd Sandra was so well received....but, unfortunately, I've got a touch of writer's block.

I think it has to do with my newest project, CatherinesSexGlossary. Somehow I've managed to post **210 definitions in only a few weeks. Crazy stuff, right? If you check it out my new blog and like it, please do me a solid and 'Digg' it (if you happen to have an account).

I'll be back in a few days. 

If there is a particular topic you would like to see me tackle here, feel free to leave me a blog comment or shoot me an email (catherine@catherinecoaches.com).

Smooches

 

**If you see something inaccurate or a term that could be worded better, please let me know.**