Kait Scalisi

Internet Porn, ’50 Shades,’ Women, Desire, Violence, Consent … Let’s Talk

by Kait Scalisi | Mar 13, 2015 | News, Sex Stories

By Kait Scalisi, MPH

The release of 50 Shades of Grey last month came with an explosion of media attention on BDSM practices. But are people really interested the kinds of sexual activities depicted in 50 Shades? Just ask Pornhub. (Pornhub on Wikipedia) Personal views about pornography aside, it must be acknowledged that Internet porn viewing data can provide unprecedentedly candid insights about the sexual interests of vast numbers of people—not hundreds or thousands, or even millions, but tens of millions of individuals. These data could be boon to scientific inquiry on human sexuality, and could have practical applications in sexual health promotion and education.

Pornhub, the largest pornography site on the Web, maintains a robust dataset that includes segmenting user data by gender, geography, and more. Pornhub’s data analysts reported a spike in BDSM-related searches (SFW) in the days leading up to and following the movie’s debut: an increase of 20% in the U.S. overall, and a 40% increase among women.

When it comes down to the specific terms users searched for, Pornhub reports:

Searches for “BDSM,” “submission,” and “domination” rose more than 40% each.
Searches for specific BDSM-related activities or objects, such as “chains,” “spanking,” “leather,” and “whip” increased between 5-33%.
Search behavior varied by gender. Searches for BDSM-related terms increased 30-219% among women, but only 3-46% among men.

The gender difference observed is particularly surprising given that 50 Shades was marketed mainly to women. It is also important to note that Pornhub does not report whether any of these changes are statistically significant, so the statistics must be interpreted with caution.

Nevertheless, this information suggests that Americans, women specifically, may be more interested in pushing their boundaries by checking out different sexual activities, whether or not they ever try these things. It also suggests that women might be the primary audience for messages promoting safe and healthy BDSM play. While the depiction of BDSM practices in 50 Shades was arguably faulty, especially on the matter of consent, this enormously popular media franchise continues to provide openings for mainstream discussion about various aspects of sexuality, and in a way that addresses its light and dark sides. 50 Shades can help add nuance to the public discourse around sexual violence. The time is ripe to talk about consent, not only in the context of dating, but also between partners in long-term relationships.

Finally, this conversation should not avoid the question of whether interest in sexual practices that include elements of violence relates to a wider social consciousness and acceptance of sexual violence. While this is one way to look at the issue, it would be fascinating to segment that data into the pre- and post-50 Shades era. To me this explanation always feels lacking.

I understand that porn is not a good educator (and for that matter neither are fairy tales or romantic comedies, which I would argue can be just as damaging to individuals’ ideas about relationships, and contain many of the same themes, such as male dominance). Yet the notion that the explicit portrayal of BDSM-related fantasy reflects or reinforces violence against women ignores the fact that women do seem to be stepping into their sexual desires more fully.

Does everyone with a male-bodied partner want him to ejaculate on their face? Probably not. But that doesn’t mean no one does. By assuming a direct link between porn preferences and actual violence against women, one breaks the cardinal “correlation does not equal causation” rule, and misses opportunities to talk about and understand why anyone would want to ejaculate on a partner’s face, and why some like it and others do not. Taking a broader look at pop culture trends, can provide the unique chance to really meet folks, especially youth, where they are at, and more effectively promote safe, sane, and consensual sex—vanilla, kinky, and everything in between.

Other Sexual Health News This Week

New Bill Would Increase Access to Plan B, Contraception (US News)

NIH-Led Study to Assess Community-Based Hepatitis C Treatment in Washington, DC (NIH)

Unplanned Pregnancies Cost Taxpayers $21 Billion Each Year (Washington Post)

1 in 5 U.S. Teen Girls Physically or Sexually Abused While Dating (US News)

Twitter Changes Sexual Health Ad Policy, Reinstates Condom Retailer’s Account (RH Reality Check)

Washington Senate Votes to Ban Aversion Therapy for Sexual Orientation, Drug Use (The News Tribune)

Opt-In Sex Education Bill Passes House (The Salt Lake Tribune)

Supreme Court Reopens Notre Dame Bid to Bypass Birth Control Coverage (Insurance Journal)

Conference Proposals Due

The following conference proposals are due in March and April. Click on each name for more information.

The Society for the Scientific Study of Sexuality, March 15.

California Family Health Council’s Women’s Health Update, March 23.

Ohio Alliance to End Sexual Violence Annual Conference, March 23

National HIV Prevention Conference, April 19.

Upcoming Conferences

The following conferences take place in March and April. Click on each name fore more information and to registers.

Association of Schools & Programs of Public Health, March 22-25.

Central College Health Association Annual Meeting, March 23-25.

Nuestras Voces (our voices) National Bilingual Sexual Assault Conference, March 26-27.

Catalyst Con East, March 27-29.

Art and Science of Health Promotion, March 30-April 3.

Building Healthy Futures Advanced Training – Re-imagining Men’s Role in the Movement to End Sexual and Intimate Partner Violence, April 22-23.

Sexual Assault Summit, April 29-May 1

Pulling Back the Curtain on Sexual Violence

by Kait Scalisi | Mar 6, 2015 | News, Sex Stories

By Kait Scalisi, MPH

Results from the 2011 National Intimate Partner & Sexual Violence Survey (NISVS) are in and reveal a mix of surprising and not-so-surprising patterns. More often than not, such violence starts at an early age, one’s race and gender affect their likelihood of being victims or perpetrators, and the long-term health impacts are substantial.

The 2011 results are only the second set of data since the survey was revived in 2010. Prior to that, it had not been done since the mid-90s. This revival is undoubtedly linked to increased public interest in and awareness of the true impact of such violence.

The goal of the NISVS is to describe the prevalence and demographics of different forms of intimate partner and sexual violence. In 2011, the results include nearly 13,000 responses from English- and Spanish-speaking adults throughout the US. They looks at rape, stalking, intimate partner violence (IPV), and other forms of sexual violence. The study uses the following definitions:

Rape: completed or attempted forced penetration or alcohol-or-drug-facilitated penetration.
Stalking: experiencing multiple stalking tactics or a single stalking tactic multiple times by the same perpetrator AND feeling very fearful or believing that they or someone close to them would be harmed or killed as a result of a perpetrator’s stalking behaviors.
IPV: sexual violence, physical violence (e.g. being slapped, pushed, shoved, hit, kicked, slammed, choked or suffocated, beaten, burned, or using a weapon), stalking, and psychological aggression (e.g. name calling, insults, humiliation, and any behaviors that are intended to monitor, control, or threaten the victim) by current or former partners.
Other forms of sexual violence: being made to penetrate a perpetrator, sexual coercion (nonphysically pressured unwanted penetration), unwanted sexual contact (e.g., kissing or fondling), and noncontact unwanted sexual experiences (e.g., being flashed or forced to view sexually explicit media).

Data was broken down by sex, race/ethnicity, age at first victimization, type of violence committed, and time when the victimization occurred (previous 12 months versus lifetime). The results were consistent with those from the 2010 survey.These include the following:

1 in 5 women and 1 in 59 men have been raped in their lifetime.
1 in 3 women and 1 in 8 men have experienced noncontact unwanted sexual violence.
1 in 7 women and 1 in 18 men have been stalked.
1 in 5 women and 1 in 7 men have experienced severe physical violence by an intimate partner.
1 in 4 women and 1 in 10 men who experience IPV reported neg impact incl fear, PTSD, injury, or needing services (legal, housing, medical, advocacy, etc).

Beyond these basic statistics, the survey reveals a variety of patterns about both victims and perpetrators. These include:

At least 80% of female victims have a male perpetrator, regardless of the type of violence. For male victims, the gender of their perpetrator varied by the type of violence committed.
With the exception of non-contact sexual violence, the majority of violence was committed by someone the victim knew.
Drugs or alcohol use was greater than 75% for female victims.
Half or more of victims experienced violence for the first time before age 25. 20-40% of these victimizations happened before the victim was 18. Numbers vary based on specific type of violence.
Multiracial and American Indian/Alaska Native women are at the highest risk of most forms violence. The exception was IPV where mutliracial and white women had the highest risk. For men, it varied greatly by type of violence.

The NISVS carries the usual limitations seen in survey-based studies: low response rates, missing important high-risk populations who may not have either a land line or cell phone, and recall bias. In addition, individuals currently in violent relationships may have avoided responding. Lastly, the researchers did not complete additional statistics to determine whether differences by race, gender, etc are significant.

Despite these somewhat unavoidable limitations, the survey’s implications are broad. The researchers note that primary prevention—including bystander intervention training, reducing the risk of perpetration, and healthy relationship education—must start earlier while secondary prevention efforts must be expanded. As California Coalition Against Sexual Assault summarizes:

Findings from this report can be used to help demonstrate that sexual violence, intimate partner violence, and stalking create a considerable public health burden, and can help identify priority target populations for prevention. Specifically, the data confirms the importance of efforts that focus on preventing these types of violence against young people. (Source)

The true potential implications run much deeper though.With the addition of a few questions, researchers can begin to establish how this type of violence impacts sexual health. For example, do victims delay seeking sexual or other healthcare? Are rates of sexual dysfunction higher among this group? Is someone who’s victimized as a child more likely to experience repeat victimizations? While intimate partner and sexual violence ultimately are about power, not sex, they involve the body’s sex organs and sexual response system. Harenessing the power and reach of this particular survey to explore these additional impacts is important for individuals working in sexual violence prevention and response, sex education and health promotion, and healthcare. How can those of us working in these fields encourage things like STI testing, pleasure, etc if this victimization impacts trust in authority, being touched or examined in the genital region, etc? It is time to begin making the connection between power-based personal violence and sexual health and pleasure.

Lastly, while consistency between the 2010 and 2011 results demonstrates the survey’s reliability, it also shows that not much changed. I do not say this to undermine the amazing work of violence prevention and response organizations but rather to support the idea that better and more resources need to be committed to this cause. While this topic is front-of-mind for the public, its important to harness and channel its popularity as best we can. Hopefully the 2012 data will show the beginnings of society-level shifts.

Other Sexual Health News

Ravages of Revenge Porn Spur Federal Crime Push (Women’s ENews)

Clinician Support Critical to HPV Vaccination (MedPage Today)

CDC Panel Gives Thumbs Up to Vaccine Against Nine HPV Types (Science News)

CDC News: First-of-its-Kind Model Estimates HIV Transmission at Each Stage of Care (AIDS.gov)

In contraception news, women embrace more effective birth control options (USA Today), over-the-counter birth control could reduce unintended pregnancies by 25% (Huffington Post), and the future of male birth control looks promising if not distant. (US News Health)

San Francisco Issues Alert Over Ocular Syphilis (Outbreak News Today)

Low Libido in Women: What’s Killing Your Sex Drive? (Shape)

Conference Proposals Due

The following conference proposals are due in March. Click on each name for more information.

2015 National Summit on HCV and HIV Diagnosis, Prevention and Access to Care, March 9.

NYSCHA/NECHA 2015 Combined Annual Meeting, March 10.

The Society for the Scientific Study of Sexuality, March 15.

California Family Health Council’s Women’s Health Update, March 23.

Ohio Alliance to End Sexual Violence Annual Conference, March 23

Upcoming Conferences

The following conferences take place in March. Click on each name fore more information and to registers.

Association of Schools & Programs of Public Health, March 22-25.

Central College Health Association Annual Meeting, March 23-25.

Nuestras Voces (our voices) National Bilingual Sexual Assault Conference, March 26-27.

Catalyst Con East, March 27-29.

Art and Science of Health Promotion, March 30-April 3.

Review: Gender Identity Based in Biology, Not the Mind

by Kait Scalisi | Feb 27, 2015 | News, Sex Stories

By Kait Scalisi, MPH

For decades, transgender individuals have been referred to psychiatric treatment, told it’s all in their heads or it is something they can change. Behind the scenes, however, researchers have been looking for biological underpinnings of gender identity. Now a new study from Boston University has reviewed the existing data and reached one conclusion: there is a strong support for the biological nature of gender identity.

Before discussing the review itself, it is important to make a few notes. First, the available data on the biologic basis of gender identity is neither broad nor deep. It is limited in rigor, sample size, etc. Nevertheless, it is what we have right now and this review provides an important starting point and call to action to further examine the mechanisms of gender identity. It is the first step in educating healthcare providers to not simply refer transgender patients to psychiatry but rather to treat them medically (e.g. hormones, gender affirming surgery, etc).

Secondly, you may be wondering why it matters if we know why someone is transgender and why we can’t just accept people for who they are. This is a valid point, and certainly the hopes of transgender individuals and their allies, but it is also the ideal. Healthcare providers and public health professionals rely on data to inform their work. In addition, transphobic arguments often center around non-binary gender identities as being a choice. Having such data is the first step in ensuring transgender individuals have access to appropriate, informed, and compassionate healthcare.

Now that those potentially contentious points are out of the way, let’s look at the research.

The study looked at studies and examined different potential biologic bases for gender identity issues. These included:

Disorders of sexual development, such as penile agenesis
Neuroanatomical differences, such as in the amount of grey and white matter
Steroid hormone genetics, such as genes associated with sex hormone receptors.

From these three areas the researchers reached three major conclusions:

Abnormal hormone exposure may result in someone being transgender. This is not expected to be the norm as the bulk of transgender individuals have normal sexual differentiation.
There are transgender-specific neuroanatomical differences. Specifically, the sexual differentiation of the brain in transgender individuals differs from that of their physical body. So transmasculine individuals have brain structures that look similar to those of cis-gender men.
Genetic factors including abnormalities associated with steroid hormones, twin case studies, neuroproteins, and prenatal exposures may also lead to a transgender identity.

How does this review help? Physicians continue to be wary of treating transgender patients with surgery and hormones. This is likely due to a combination of personal biases, misunderstanding about trans identities, and a lack of research showing the need for such approaches. The researchers are transparent in sharing that the goal of the subject was to better establish this biological basis so they could then/with the hopes that physicians will then treat patients medically instead of just referring them to therapy. The study also hopes to solves step one—determining whether gender identity is biologic—so researchers can shift their focus to the underlying mechanisms of this biology while healthcare providers focus on how to best address the needs of transgender individuals.

The evidence presented in the article also fights against the idea that gender identity can be changed via psychotherapy/psych treatment. This places the burden of treatment on the medical/healthcare providers. As the study’s PI says:

“If you realize that gender identity, to a large extent, is a biologic phenomenon, then you aren’t going to say, ‘Oh you should just deal with it’ […] You’re going to want to know what is the most logical intervention based on success.”

The authors note that future research should focus on the best interventions and treatment approaches for transgender patients as well s more overall research on the exact biological mechanism by which gender identity and gender identity issues are determined.

Other Sexual Health News This Week

San Francisco cannot reverse STD rate increase (The Bay Area Reporter); meanwhile, a free condom-by-mail program is set to start in San Bernardino County. (The San Bernardino Sun)

NIH-Supported Trials to Evaluate Long-Acting Injectable Anti-Retrovirals to Prevent HIV (Science News Wire)

Proposed Bill: Couples Must Prove They Don’t Have STD’s Before Marriage In OK (News on 6)

Effect of Body Weight and BMI on the Efficacy of Levonorgestrel Emergency Contraception (Contraception)

Why You’re Still Paying for Birth Control Even Though It’s “Free” Now (Money.com)

Week-On, Weekend-Off Treatment Controls Viral Load in Young People (AIDS Map)

Drug Maker Resubmits Application for Women’s Sex Drive Pill to FDA (United Press International)

About 50 Clergy in Nebraska Pledge to Perform Same-Sex Marriages if Ban Overturned (Omaha.com)

Conference Proposals Due

The following conference proposals are due in March. Click on each name for more information.

2015 National Summit on HCV and HIV Diagnosis, Prevention and Access to Care, March 9.

NYSCHA/NECHA 2015 Combined Annual Meeting, March 10.

The Society for the Scientific Study of Sexuality, March 15.

California Family Health Council’s Women’s Health Update, March 23.

Upcoming Conferences

The following conferences take place in March. Click on each name fore more information and to registers.

Southern College Health Association Conference, March 4-7.

Association of Schools & Programs of Public Health, March 22-25.

Central College Health Association Annual Meeting, March 23-25.

Nuestras Voces (our voices) National Bilingual Sexual Assault Conference, March 26-27.

Catalyst Con East, March 27-29/

In Pap We (Still) Trust

by Kait Scalisi | Feb 14, 2015 | News, Sex Stories

By Kait Scalisi, MPH

A recent national survey shows distrust of new cervical cancer screening recommendations as well as a lack of knowledge and understanding among women about HPV, cervical cancer, and more.

Cervical Cancer Today: A National Survey of Attitudes and Behaviors, a collaboration between the National Association of Nurse Practitioners in Women’s Health (NPWH) and HealthyWomen (HW) surveyed over 2,000 women and nearly 1,000 healthcare providers to gain a better understanding of women and HCPS’s attitudes and decisions in the exam room. The major finding: we’re all resistant to change.

For example, the Pap test, long viewed as the gold standard of cervical cancer detection, although recently replaced/addenedumed by the HPV test, is highly trusted by both healthcare providers and women/patients. The newer HPV test, only recently approved as a first-line screening/primary screening tool, however, is not a preferred method.

Other major themes included:

Both women and healthcare providers like routine and time-tested screening. More likely this finding represents fear of the unknown rather than a love for the Pap test itself.
Women lack basic knowledge about their sexual and reproductive health, including how HPV actually works.
Race matters.

It is well established that many racial minorities have a distrust of the health care system due to systematic oppression and being taken advantage of (Henrietta Lacks may be the most well-known example, but certainly isn’t the exception or the only one). When it comes to their cancer screenings, African American and Hispanic women were even more concerned with cutting back on the number of tests or lengthening the time between tests, regardless of the type of test.

The survey also speaks to larger issues: policy changes being made without appropriate health promotion campaigns. Women reported being distrustful of lengthening the time between tests, a sentiment that the healthcare providers reported expecting. Public health professionals know that switching from annual Paps to once every three years is cost-effective and does not have much of an impact on incidence. However, when this is not communicated to the public clearly in places where they can ask questions or get more information (e.g. social media, doctor’s offices), it leads to the distrust reported in this survey. The question then is, how can medicine and public health work together to craft policies that are known to be effective, and then share them with the public in an accessible way?

Secondly, the survey’s results speak to the need for more factual and comprehensive sex education at all ages. A considerable percentage of the women surveyed did not know that HPV causes cancer, or that there are treatments for it. A representative from one of the sponsoring organizations notes:

“Healthcare providers need to help women understand the significance – or lack thereof – of an HPV infection[…]Women need comprehensive information about the meaning of both HPV and Pap tests when deciding how to protect themselves from cervical cancer.”

While this sentiment is true, it is also on public health professionals to push for programs and campaigns that meet women where they are, and help get them this information. This includes getting them the information as early as possible.

The issues with our health care system run deep—high burdens on providers, short appointment times, competing interests, etc.—and aren’t likely to change soon. Plus healthcare providers express hesitation in talking about sex and sex-related topics like STIs, HPV, and cervical cancer. The only solution is for public health and medicine to work together to further each other’s interests so that patients have reliable sources of health infomration from sources other than their providers, who simply cannot cover everything in one visit.

Other Sexual Health News

A Setback for HIV Prevention Trial: Getting People To Take the Medicine (Smithsonian)

Study: HPV Vaccines Do Not Lead Teen Girls to Risky Sex

Study Counters Stereotypes of Black Men Most at Risk for HIV/AIDS (Medical Express)

Doctors’ Assumptions On Sex Heighten Lesbians’ Cervical Cancer Risk: Study (Medical Daily)

Waters Reintroduces the Stop AIDS in Prison Act (Hudson Valley Press Online)

Conference Proposals Due

The following conference proposals are due in February and March. Click on each name for more information.

National Sexual Assault Conference, February 24.

2015 National Summit on HCV and HIV Diagnosis, Prevention and Access to Care, March 9.

NYSCHA/NECHA 2015 Combined Annual Meeting, March 10.

The Society for the Scientific Study of Sexuality, March 15.

Upcoming Conferences

The following conferences take place in February and March. Click on each name fore more information and to registers.

Southern California LGBT Health Conference, February 21.

ISSWSH 2015 Annual Meeting, February 19-22.

Conference on Retroviruses and Opportunistic Infections (CROI), February 23-26.

National Conference on Campus Sexual Assault and Violence, February 24-25

Southern College Health Association Conference, March 4-7.

Association of Schools & Programs of Public Health, March 22-25.

Central College Health Association Annual Meeting, March 23-25.

Nuestras Voces (our voices) National Bilingual Sexual Assault Conference, March 26-27.

Catalyst Con East, March 27-29/

Sex-Positive SOTU

by Kait Scalisi | Jan 21, 2015 | News, Sex Stories

By Kait Scalisi, MPH

Let’s take a look at some of the highlights from President Obama’s State of the Union address related to sexual and reproductive health. These include:

Noting the importance of the United States having its lowest unplanned and teen pregnancy rates ever.
Calling on Congress to end the wage gap, raise minimum wage, and institute paid sick leave.
Stressing the need for paid maternity (and paternity!) leave
Underscoring the need for women to have access to comprehensive healthcare including contraception.
Comparing the US’ current policies on these issues to an episode of Mad Men.

All of these highlights, save the pop culture reference, focus on increasing women’s autonomy over their bodies and their SRH. For example, most minimum wage workers are women. Therefore, increasing minimum wage empowers more women to care for themselves and their families and access the healthcare and education they desire, two factors which positively impact SRH.

Though many accurately call the speech feminist, it also was decidedly if not explicitly sex-positive. Sex-positivity takes a non-judgmental view of human sexuality and acknowledges the many broad and diverse expressions of it. Though rarely stated and often ignored, families start with sex. Therefore policies that promote family planning and ease around caring for one’s family—for example, by allowing a parent to take a day off from work to care for a sick child—also create space for people to make the sexual decisions that feel right to them. These policies also make sense from an economic standpoint. STIs and unplanned pregnancies can be costly, particularly if the STIs go untreated and lead to later fertility issues. This power over their sexual lives, in turn has a noted and positive impact on the economy: healthcare costs decrease and the the economic burden on the average taxpayer decreases.

The inclusion of LGBT individuals is another manifestation of this sex-positive view and one that has been written about extensively. As Janet Mock told Time, “The President’s acknowledgment helps shatter the cloak of invisibility that has plagued trans people and forced many to suffer in silence” (source). Given the disproportionately high rates of mental health issues, homelessness, and suicidality among transgender individuals, the impact of this recognition may run deeper than can be easily quantified. As the Time piece points out, every word of the speech is vetted and these words were included, making them among the most important.

Something that has gotten remarkably less press, is that Obama also noted that these rights need to extend to fathers too. It is about equal rights and true quality treatment of everyone, caring for those who need our help the most, and standing together.

This is the last SOTU where the President will be the center of attention. By this time next year, the 2016 primaries will be well underway and though it will still be important, as a nation we will have begun looking forward to what’s coming next. It is also the most tense SOTU yet with POTUS facing an opposing Congress. Therefore it is particularly powerful that Obama took the time to highlight not only his successes but also took the time to highlight and honor the essential role that women play to this nation’s success. As he put it: