It’s relatively well-established that veterans are likely to face mental health problems upon returning from service. And while anecdotal evidence suggests this also includes sexual health issues, a new study shows that’s indeed the case.
Young and Not So Sexually Healthy
Participants were mostly male, white or black, and had a mean age of 31. Just under half had a primary romantic partner. About one-fifth screened positive for sexual health concerns. Participants were more likely to report sexual health concerns if they also reported any of the following:
- higher service connection rating
- problem alcohcol use
- a history of military sexual trauma (MST)
Gender also played a role with females being more likely to report issues with arousal and lubrication.
Together, these results tell us 1) that there’s a relatively high rate of sexual dysfunction among veterans returning from deployment and 2) there are specific characteristics associated with both overall sexual dysfunction and specific aspects of sexual dysfunction.
Just What is Sexual Health, Really?
One issue with studies like these, and with measures of sexual functioning generally, is the limited view they take on sexual health. This study uses the Arizona Sexual Experience Scale (ASEX) which measures five items:
- Libido (“How strong is your sex drive?”)
- Psychological arousal (“How easily are you sexually aroused (turned on)?”)
- Vaginal lubrication/penile erection (“How easily does your vagina become moist or wet during sex?” or “Can you easily get and keep an erection?”)
- Ability to reach orgasm (“How easily can you reach an orgasm?”)
- Orgasm satisfaction (“Are your orgasms satisfying?”)
While at first glimpse this list looks fairly inclusive, it’s based on a number of assumptions. First, that sex equals intercourse, or at the least involves penises and vaginas. While this is obviously common, it misses other forms of sex the patient enjoys. Secondly, that being wet is a sign of arousal. In many people with vaginas, getting wet is impacted by everything from stress to certain medications and diagnoses, making this a faulty measure of female physical arousal.
The answers are also extremely subjective. For example, “easily,” to one person may include twenty minutes of foreplay because that’s their norm whereas to someone else that same exact amount of time and effort may be perceived oppositely. And then there’s the obvious question of how much sex they’ve been having while deployed. These questions are always important since sexual health is part of quality of life; however, they might be better asked at later points after a veteran returns home.
That being said, the orgasm satisfaction piece provides a surprising and necessary nuance to the measure. After all, someone could be satisfied with their sex life despite not perceiving their sex drive as high or their ability reach orgasm as easy. We see this in studies showing that people with penises are just as satisfied with sex whether they use condoms or not, even though many men report a disinterest in using condoms because they decrease sensation and pleasure. The downside to the satisfaction question is that many healthcare providers lack the training and expertise to address this range of questions. I’m also curious to know if sex therapy is covered by veterans’ benefits since many insurance programs exclude it.
Small but Important
At 250 participants, the study is relatively small but provides necessary data to inspire future research. While mental health and sexual health remain stigmatized, recent media coverage and societal attention given to these issues in the military, especially MST, have created the perfect time to delve into them more.
In addition to a larger sample size, future studies would benefit from measuring sexual function at multiple times post-deployment. This study only looked at the initial primary care visit upon returning to the states so it misses any problems that arise later.
Despite these limitations, this study adds to our understanding of the issues faced by veterans upon returning home. Hopefully, wider spread acknowledgment and more research will continue to de-stigmatize sexual dysfunction and help our vets have the more pleasurable sex we can all agree that they deserve.
Other Sexual Health News This Week
The War on Campus Sexual Assault Goes Digital (The New York Times)
Obama Supports Bill to Amend Civil Rights Act To Ban Sexual Orientation, Gender Identity Discrimination (CNS News)
These Are The Best Colleges For Sexual Health Resources Across The Country (Bustle)
The Sex Talk Works, Even if it Makes You Cringe (NBC News)
Supreme Court to Hear New Case on Contraception and Religion (The New York Times)
Did Shoddy Birth Control Cause 113 Pregnancies? (The Daily Beast)
How Science is Uncovering the Truth About Sex Addiction (Mic)
For people with a uterus who want permanent contraception, Essure seemed to offer many benefits. The device, which is put into the Fallopian tubes to create scar tissue and prevent pregnancy, can be placed at a doctor’s office without anesthesia or a hospital stay. Unfortunately, the device’s popularity was held back by horror stories about side effects. Now, a new study confirms that patients with Essure are more likely to need an reoperation compared to those who chose to have their tubes tied with surgery.
A few good benefits and some major risks.
The study used data from over 50,000 patients treated in New York state between 2005 and 2013. Of these, only 8,000 had Essure placed. In addition to avoiding anesthesia and the hospital, those with Essure also had a lower risk of major medical complications 30 days after it was placed. The risk of unintended pregnancy is the same for both permanent options.
Unfortunately that’s where the good news ends. Essure is an average of $2000 more expensive. And patients with it were 10 times more likely to need a reoperation later on compared to those who had surgery. This difference held steady even after adjusting for age and other health problems.
An outcome patients care about.
The study is the first to look at Essure’s safety as it relates to the need to undergo surgery. Though the study did not examine reasons behind patients’ choices, we can speculate that many wanted to avoid surgery for either personal reasons or medical one such as obesity or scarring from previous abdominal operations.
Like all research, this one has its flaws.
The overall rates for reoperation are still pretty low at 2% compared to surgical sterilization’s 0.2%. Additionally, because the study used medical record data, we don’t know the purpose of the reoperations. Were they for a serious problem or second attempts to place the device? Lastly, Essure patients are supposed to come in for a three-month follow-up, unlike those who get their tubes tied. This means that it’s easier to discover problems since a surgical patient may not see their doctor again until their next annual visit or if a problem arises.
Nevertheless, for patients who want to avoid surgery, this data provides one more variable to consider when choosing the right type of sterilization for them. This is especially true since surgery after Essure failure can be riskier than the minimally invasive surgical sterilization would have been.
Adding to the controversy
The study comes at a particularly heated time as the FDA met at the end of September to reexamine Essure’s safety and effectiveness. Meanwhile Congress submitted a bill to have the device’s pre-market approval pulled. If passed, Essure would be unavailable within 60 days.
The increased risk of reoperation is not the only thing concerning the governmental bodies. Other unusual side effects, including pain, heavy or irregular periods, and fetal death in people who became pregnant after Essure was placed, were reported by over 5000 individuals since the device launched in 2002. Lastly, new data from Bayer, the device’s maker, came out earlier this year showing strong concerns about Essure’s safety.
What’s ironic about this whole situation is that if the device had been researched more thoroughly and improved as necessary, it could have been more popular, helpful, and profitable. Everyone would have benefited. Unfortunately, we know that both the FDA’s regularly processes and research paid for by a medical device or drug’s manufactur is problematic. Both of these come into play with Essure but only time will tell if they, along with some relatively small numbers of people with complications, are enough to pull it from the market.
Other Sexual Health News This Week
HHS to Include Sexual Orientation & Gender Identity in Meaningful Use of Electronic Health Program (Human Rights Campaign)
Sobering Results from Real World HIV Treatment Analysis (Medpage Today)
ATIXA: Schools Must Protect LGBT, Gender Non-Conforming Students from Harassment (Campus Safety Magazine)
Closure of Women’s Health Clinics Due to Government Cuts Affects Preventative Health (News Medical)
TSA Dropping the Term ‘Anomaly’ For Transgender Passengers (The Hill)
Affordable Care Act Coverage Improves Chances of Viral Suppression for Americans with HIV (AIDSMap)
Are public health efforts to beat HIV in the U.S. coming to fruition? Not quite, but the HIV rate among US adults is stable. National survey data show that between 2007 and 2012, the rate dipped slightly but not significantly. This is despite the fact that just over half of respondents were in one or more high-risk behavior groups.
This information comes from the most recent National Health Statistics Report and uses data from over 10,000 Americans ages 18-59 who completed the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2012. The slight decrease in overall HIV prevalence is likely the result of multiple factors including but not limited to:
- Approval of PrEP and the subsequent health promotion campaigns surrounding it
- Improved ability via technology and other tools to reach the individuals most at-risk for HIV
Age, race, and gender matter.
Besides the overall HIV rate, the report also looks at key risk factors and prevalence of antiretroviral drug (ART) use among adults with HIV. They found that age, gender, race, STI status, and sexual risk-taking all impact who gets HIV. Specifically, someone is more likely to be HIV-positive if they are older, male, or non-Hispanic black. These correlations aren’t particularly surprising given the lack of condom use among older Americans and the distrust of the healthcare system reported by many blacks.
Other factors associated with HIV infection included being in one of the following high-risk groups:
- having herpes simplex virus type 2 or a history of another STI
- sleeping with 10 or more people in their lifetime
- same sex sexual contact among men
Here again, the report doesn’t offer any new information but rather supports the idea that so-called risky sexual behavior puts individuals more at risk for all STIs, including HIV.
The researchers also found a few things that did not affect the HIV rate. These include education, poverty index ratio, or current health insurance status. This provides an interesting counterpoint to the social-political narrative of the poor, uneducated, uninsured, and “living off the system” person who has HIV. Even more interesting is the lack of news coverage about this result.
ART use remains low.
While the steady rate of HIV is promising, the news around treatment is less so. Only about half of adults with HIV report using ART in the past month. And the exact numbers were extremely small, making this data highly unreliable. ART use was higher among non-Hispanic whites, men, and those with health insurance. ART use also increased with age and was more common among those in one or more high risk groups.
2007-2012 was the first year adults over age 49 were included in the NHANES.
Some people are getting tested, though.
Most of those with HIV have a history of being tested for it outside of blood donations but less than half of adults without HIV can say the same. Testing rates were higher in men, MSM, those with a history of an STI, and those with five or more lifetime sexual partners.
This last correlation is particularly exciting because it shows improvement in sexual health care by providers and/or patients. It’s impossible to know whether these individuals are self-selecting for more routine testing or if their healthcare providers are encouraging testing based on taking a full sexual history. Either way, this is good news because it shows that health care providers and patients are taking more responsibility for sexual health.
Though this is likely outside the abilities of the NHANES it would be fascinating to perform some qualitative studies looking at the conversations the different subgroups have with their sexual partners. Are the risk takers who get tested having the talk more? Who’s initiating the conversation? Is this more or less than individuals who report less sexual risk taking? Answers to these questions could help public health professionals better address concerns people express about having such conversations.
Education, not shame
As public discourse around STIs becomes more nuanced, the question is how can we as a field make a significant dent in the HIV rate without shaming those already diagnosed and/or who are sexual risk takers. It’s a tricky balance. Those who didn’t grow up during the AIDS crisis, and who don’t study it as most of us do, lack a certain fear of HIV that can push them to make less risky sexual decisions. On the other hand, fear-based campaigns don’t work and ultimately add to the sexual shame that prevents people from being honest about their sexual histories (check out the story below) and getting the testing and treatment they need.
Obviously getting rid of HIV isn’t so simple as answering this question There are clear connections to socioeconomic status, race, and other forms of oppression that make it more difficult for certain people to access the information, tools, and treatment that could help them more fully assess what risks they’re willing to take and then live with the potential outcomes of those risks. And of course, there’s a lack of funding for comprehensive sex education and a lack of states that require even medically accurate HIV education.
Figuring out how to navigate this more nuanced, balanced approach to HIV education and messaging is just one piece of the larger puzzle. However, it’s something we should begin studying sooner rather than later, along with novel ways of getting our messages to the highest risk groups, so that in the next Report (or maybe the one after that), the news will be significantly more positive.
Other Sexual Health News This Week
Millions More Need H.I.V. Treatment, W.H.O Says (New York Times)
Billboards Linking Tinder to STDs are Latest Battleground in Online Dating Wars (Washington Post)
Men May Underreport Male Sex Partners at Time of HIV Testing (Medscape)
Beauty or Beast? Why Perceptions of Attractiveness Vary (Live Science)
California Mandates New High School Lessons to Prevent Sexual Assaults (LA Times) This is part of their new mandated sex education for grades 7-12 (EdSource).
Lawmaker Works to Add Gender Identity to [Wisconsin] State Law (Channel 3000)
What the Updated National HIV/AIDS Strategy Means for Black America (Indianapolis Recorder)
Generally speaking, sex is a good thing. It helps people de-stress, feel closer to their partners, and more. But those with heart disease or a history of heart attack often worry that sex might trigger another cardiac event. A new study says that’s not the case and that, for most, even those who’ve had a heart attack in the past, sex is part of a heart-healthy lifestyle.
For the most part, sex won’t trigger a heart attack.
The study aimed to shatter the myth that sex can trigger a heart attack. To do this, researchers reviewed the health histories of over 500 heart disease patients aged 30-70. Most participants were 50+ and male at baseline. The researchers sought to answer three main questions:
- How long before their heart attack did participants have sex?
- How often did they have sex in the 12 months before their heart attack?
- Did they have another heart attack in the 10 years since the original one?
What they found is that less than 1% of the participants had sex within an hour of their heart attack. For a very large majority, there were more than 24 hours between sex and the heart attack. Additionally, most participants were having sex on a regular basis in the year before their heart attack without problem. More than half did it at least once a week while 74% reported having sex somewhere between once a week and once a month. Lastly, when researchers followed up with patients after 10 years, 100 cardiac events were reported. This was less likely if patients were younger, male, generally active, and in good health.
This data is heartening; however it is also lacking some important information. For example, how often did participants have sex during those 10 years? A lot can change in a decade, including participants’ ability to have vigorous sex. Other common life changes that could impact their sex lives during this time include loss of a spouse to death or divorce, having children, menopause, opening or closing a relationship, getting injured, and being diagnosed with other conditions.
It also did not measure participants’ knowledge about the relationship between sex and heart attack or their intent to change their sex lives in any way as a result of the heart attack. Given the pervasiveness of this myth, these additional questions would make the results both more generalization and more weighty.
Rather than triggering a heart attack, sex may actually be heart-healthy.
The study’s researchers classified it as a safe moderate activity, similar to brisk walking. Cardiologists often recommend this type of activity to heart disease patients alongside a heart-healthy diet and medicines. While the researchers don’t go so far as to recommend sex as part of the patient’s physical activity plan, they note that doing it is better than not:
…our data still indicate that the benefits of [sexual activity] outbalance the relatively small risk, especially because very few patients at risk could be easily identified by physical examination and stress testing.
Healthcare providers aren’t talking to their patients about sex.
The study also found that most patients–less than half of men and less than a third of women–don’t get information about sex after a heart attack from their healthcare provider. This mirrors the narrative in the US where healthcare providers don’t talk to patients about sex, regardless of the diagnoses. Undoubtedly, the lack of conversation about sex contributed to the misunderstandings about sex and heart attacks.This makes it especially important for cardiologist to reassure patients when they can resume sex and/or make the appropriate referrals to providers who specialize in sexual issues if needed.
The question behind the question.
According to one cardiologist interviewed by Newsweek, when patients ask about sex, they really want to know how much they can exert themselves. She also discusses the routine follow-up that heart patients often have after a heart attack, including regular stress tests. She says,
This can help a physician determine if certain levels of physical exertion could be life-threatening, whether it’s jogging, snow shoveling, chasing after grandkids or having sex. Source
What this perspective doesn’t take into account is the socioeconomic factors that may prevent someone from getting these regular checkups. While the researchers controlled for age, sex, education, rehabilitation program, smoking status, diabetes, HDL level, self-reported physical activity, and other health factors, they do not go into detail about how these factors impacted the outcomes.
We need a more nuanced look at the connection between sex and heart health.
The study adds to the body of research that currently exists around the connection between sex and heart attack risk. It tells us that, in general, sex won’t lead to heart attack. This supports past research showing that coital angina, or angina d’amour, represents less than half of all anginal attacks. Though angina doesn’t always lead to a heart attack, it’s one indicator.
Other factors could increase the risk of having a heart attack during or immediately after sex. These include:
- Being mostly sedentary outside of sexual activity.
- Other underlying health conditions including diabetes.
- Having sex with a new or forbidden (e.g. mistress) partner.
Any of these could increase blood pressure and/or exertion level, making sudden cardiac death more likely. So while this study gives generally good news, it should absolutely be interpreted based on the individual patient’s health and lifestyle.
The final piece of info that could add a lot to the conversation is whether the length, intensity, and type(s) of sex matter. For example, are there additional risks for those who have more vigorous sex? How about folks who take part in certain BDSM sex acts? Answering these questions will let healthcare providers give more accurate and personalized information about sex and heart attack risk.
Other Sexual Health News This Week
Meta-analysis Supports Ovarian Suppression in Breast Cancer (Medscape)
High Standards of Care Associated with Reduced Mortality Risk of Patients with HIV (AidsMap)
Still Far to Go on Gender Equality Blueprint Set Out in 1995, Say Activists (The Guardian)
Women DO Want Sex as Much as Men and Most Orgasm Every Time (Daily Mail)
Sex Education Overhaul at Elite US Private Schools to Prevent Sexual Assault (ABC News)
To say Planned Parenthood has had a rough month is an understatement. Between heavily edited videos questioning the integrity of their services to renewed calls to defund the organization, it’s easy to undertand why the Congressional Budget Office commissioned a report to quantify the value of their services. The report sought to answer one question: where is Planned Parenthood the only option for low-cost family planning services?
The short answer: a lot of places.
The study used data from 2010, the most recent year it was available, and looked at a variety of factors including:
- distribution of low-cost family planning centers
- patient load
- quality of services such as number of birth control options offered
The results of the study highlight the vital role that Planned Parenthood plays in providing low-income, medically-underseved communities with contraceptive services.
In many places, Planned Parenthood is the only option.
Nearly half of the organization’s health centers are in medically underserved areas. To break this down more:
- Almost two-thirds of the 19 million women in need of publicly supported contraceptive services live in counties with a Planned Parenthood health center.
- In 21% of the 491 counties with a Planned Parenthood center, they are the only safety-net family planning center.
- In two-thirds of these counties, Planned Parenthood centers serve at least half of the patients who get birth control from such a health center.
To borrow a rather geeky phrase, Planned Parenthood boldly goes where no health center has gone (or perhaps stayed open) before.
Planned Parenthood serves a disproportionately high number of low-income patients.
Despite the fact Planned Parenthood centers only make up 10% of all safety-net family planning centers health centers, they serve over one-third of the patients who visit such clinics for contraceptive services. As Emily Crockett from RH Reality Check notes:
There may be more locations of other safety net family planning clinics than there are Planned Parenthood sites, but those clinics don’t serve nearly as many patients as Planned Parenthood does, and would likely be overwhelmed if their patient load suddenly surged. Source
Then of course there are the counties where there are no other clinics to serve this population. Defunding Planned Parenthood would leave nearly 100 counties access to any saftey-net family planning clinics. One can’t help but wonder what that would do to the current super low unexpected pregnancy rate.
The quality of service is practically unmatched.
Beyond the locations of Planned Parenthood health centers and the number of contraceptive patients the centers serve, the report also compared the quality of contraceptive services received at the different type of safety-net health centers. For this, researchers looked at number of birth control options available, the wait time, and the ability to get a same-day appointment.
Over 90% of the Planned Parenthood health centers offered at least 10 of 13 reversible contraceptive methods. Only about half of other sites could say the same. Additionally, wait times were three times shorter and patients were almost twice as likely to get a same-day appointment.
This means that patients are geting the services they need more quickly and able to choose the birth cntrol option that’s best for them. For low-income patients, especially hourly workers, these benefits are invaluble. s someone who’s both been on Medicaid and worked in a Meicaid contracpetive clinic, I can personally attest to the day-long waits, lost hours of work, and extra costs of childcare.
In many places, Planned Parenthood is critical to women’s reproductive health.
The data unequivoacally show that Planned Parenthood plays a major part in delivering contraceptive services to women in some of our nation’s most critically underserved areas. In some places it is the only option and in many others the centers serve many more contraceptive patients than other safety net providers.
At this point, we can only speculate what will happen to Planned Parenthood’s funding and how, if and when other center’s could fill the gaps left if they were to be defnded. What we do know though is this:
[…] women nationwide rely on Planned Parenthood health centers for the contraceptive services and supplies they need — and for women in many areas of the country, losing Planned Parenthood would mean losing their chosen provider and the only safety-net provider around. Source
Other Sexual Health News This Week
Vaginal Estrogen Linked to Improved Sexual Health For Some Women (Fox News)
Funding Increase Means More Housing for Atlantans with HIV/AIDS (Atlanta Intown)
Sex Education Study Ignite Passionate Opposition to Statewide Standards (JournalStar.com)
With Federal Grant, NYU Researchers Focus on Father/Son Communication to Reduce Teen Pregnancies and Sexually Transmitted Diseases in Disadvantaged Communities (NYU)
Syphilis cases are on the rise in a number of states including Colorado, California, and Ohio.
HIV Testing Staggeringly Low Among Gay/Bisexual Male Teens (NewNextNow)