by Kait Scalisi | Apr 24, 2015 | News, Sex Stories
By Kait Scalisi, MPH
From the start, the Obamacare contraceptive coverage provision has been controversial. Now, a new report shows that the promise of free birth control may, in fact, be too good to be true.
The provision itself requires most private insurance plans to cover all FDA-approved contraceptive devices without any cost-sharing (e.g., co-pays). Federal guidelines, however, state that individual plans may apply limitations in an effort keep costs down and care efficient. Additionally, carriers should have a process for waiving coverage limitations for patients who need a form of contraception that the plan either limits or does not cover.
The Kaiser Family Foundation recently released a report exploring these limitations. They looked at the insurance coverage policies of 20 insurance carriers for twelve forms of contraception, not including oral contraceptive. Information was gathered by interviewing plan officials and reviewing publicly available coverage documents. The short version of their findings? Most insurers do not cover all forms of birth control. More specifically:
- There is a lot of variation in how carriers are interpreting and implementing the contraceptive provision. In many cases, the limit coverage of certain methods by either denying coverage completely or requiring policy holders to cover a portion of the method’s costs.
- NuvaRing is the method that is the least likely to be covered by carriers. They report they do not want to cover multiple forms of birth control with the same chemical formulation, such as the ring and at least one birth control pill, despite the fact that the ring is defined as a distinct form of contraception.
- There is a lot of variability in whether and how IUDs, the implant, and the patch is covered. Some plans cover all of the methods without any limitations while others cover some with limitations and some without.
- Plan B is widely covered but ella, which has a longer window to work and is recommended for women with BMIs above 25 is not.
- Half of the plans cover sterilizations completely, including associated services such as anesthesia and follow-up visits.
- None of the carriers have an established process for policy holders to appeal limitations based on medical need.
The goal of the Affordable Care Act is to provide coverage to anyone who needs it, and especially those who need it the most. However, these limitations in contraceptive coverage mean that many women still do not have full access to contraception, including the method that might be best for them.
The lack of a formal appeals process specific to contraception is particularly alarming. Susie Poppick wrote about her experience with these limitations and though she eventually got her birth control, she had to make several calls to her carrier. More importantly, she knew how to and had the time to do so. This is a privilege not everyone has, whether its the wherewithal to ask for a manager, the cell minutes and time to spend making multiple phone calls and waiting on hold at least once, or even that contraception is supposed to be covered.
All of this is not to diminish the fact that the ACA did increase birth control access for many women. Confusion, bumps, and negative outcomes are bound to happen, making reports such both vital and valuable. Now that we know the state of contraceptive coverage limitations, it is up to the government to clarify the guidelines related to different forms of contraception and for insurance companies to take the next steps in making their policies clear and accessible.
Other Sexual Health News This Week
Gonorrhea and chlamydia are on the rise in one CA county (Times Standard). An increase has also been reported in Montana. (KRTV)
Research Informs HIV Treatment Policy for Inmates (Medical Xpress)
Poll: Gay-Marriage Support at Record High (Washington Post)
Sex and Orgasm Makes You More Likely to Reveal Deep Secrets (The Daily Mail)
Bill to Allow More Sexual Abuse Suits in NY, Cites Syracuse University Scandal (Syracuse.com)
Culture’s Transgender ‘Moment’ (CNN)
Upcoming Conferences
The following conferences take place in April. Click on each name fore more information and to registers.
YTH Live 2015, April 26-29
Sexual Assault Summit, April 29-May 1
American Conference for the Treatment of HIV, April 29-May 2
by Kait Scalisi | Apr 10, 2015 | News, Sex Stories
By Kait Scalisi, MPH
Nearly 4,000 women divulged their sexual health habits in a new survey given by Planned Parenthood and Women’s Health magazine. The results will either totally surprise you or confirm what you already knew: women aren’t using condoms, getting tested for STIs or talking to their sexual partners about safe sex.
More specifically, the survey found the following results.
Condom Use
- 58% of women rarely or never use condoms.
- 16% say they always do.
- 95% rarely or never use condoms during oral sex.
STI Testing
- One-third of women have never been tested for any STD.
- 3% of women are not sure if they have.
- 38% of women have never been tested for HIV.
- 6% are unsure if they have.
Talking to Partners About Safer Sex
- 37% report they’ve never talked to a partner about STD prevention
The magazine does not provide information on the survey’s methodology or the respondents’ demographics. This information is extremely important as age is known to influence condom use with rates of it decreasing over time. It is somewhat safe to assume that respondents have similar characteristics to the magazine’s readership. This would place most of the respondents in their 20s and 30s, the ages when condom use begins to decline from adolescence.
The results of this are alarming if not totally surprising to those of us in the field. They support past findings from the National Survey of Sexual Health and Behavior as well as anecdotal evidence from our colleagues, peers, and family members. As Planned Parenthood’s Vice President for External medical affairs said:
Unfortunately, it’s not uncommon for smart, educated, otherwise safe-playing women to forgo all caution when it comes to STD prevention. (Source)
The Women’s Health piece does a decent job of outlining why condom use, regular STD testing, and talking to partners is important. Instead I’ll focus on what else the results offer: an opportunity to make change. Condom rates seem to be static, if not declining. This implies that public health’s efforts to promote safer sex practices need some reworking. Scare tactics, shame, and “come on you should no better” clearly aren’t working. Our questions then should shift from simply describing what’s happening to exploring, in-depth, the motivations behind these behaviors. For example, why aren’t women talking to their partners about safer sex? What practical strategies can we teach them to normalize this conversation and make it easier and less awkward? Can we eroticize safer sex in some way so that it becomes, in fact, sexy? How can we better market safe sex? How can healthcare providers be better trained to talk about sex with patients? These questions are where the true value of this survey lies.
In my opinion, the whole point of research is to influence policy and programming. It is fairly useless to simply state the facts and move on. Will Women’s Health use this data to influence the content that will appear in their magazine and website? Will Planned Parenthood and other sexual health organizations, which already do fabulous and extensive outreach during STD Awareness Month, focus a bit more on sex education for adults? I recognize this all is much easier said than done but looking into new ways to approach this issue is vital if we want to make long-lasting, macro-level changes.
Lastly, I hope the organizations conduct follow-up surveys that not only ask these questions again but also delve into the why behind this data. As the condom landscape changes and becomes more female-friendly (brands like Sustain and Loveability focus almost exclusively on millenial women), it will be interesting to see if and how the data changes.
Other Sexual Health News This Week
The US Healthcare System Isn’t Doing Enough for Vulnerable LGBT Communities (Quartz)
Domestic Violence Deters Contraception (ScienceDaily)
Gay Hookup Apps: Survey Reveals Some Things That Might Surprise You (WEHOville)
For Gay and Bi Blood Donors, New Rules but Same Ban (Huffington Post)
For Millenials Making Sexual Health Decisions, There is No Black and White (News OK)
Democrats in North Dakota Ask Governor for Executive Order Prohibiting Sexual Orientation Discrimination (Valley News) while San Diego Adds Gender Identity, Expression to Nondiscrimination Policy (San Diego Gay & Lesbian News).
CDC: Teens Unfamiliar With Most Effective Form of Birth Control (US News)
Conference Proposals Due
The following conference proposals are due in April. Click on each name for more information.
National HIV Prevention Conference, April 19.
Upcoming Conferences
The following conferences take place in April. Click on each name fore more information and to registers.
From Abortion Rights to Social Justice: Building the Movement for Reproductive Freedom, April 10-12
Gender Matters Conference, April 17-18
National Transgender Health Summit, April 17-19
Building Healthy Futures Advanced Training – Re-imagining Men’s Role in the Movement to End Sexual and Intimate Partner Violence, April 22-23.
SOPHE 66th Annual Meeting, April 23-25
YTH Live 2015, April 26-29
Sexual Assault Summit, April 29-May 1
American Conference for the Treatment of HIV, April 29-May 2
by Kait Scalisi | Apr 3, 2015 | News, Sex Stories
By Kait Scalisi, MPH
These results come from a new study by the Brookings Institute (PDF). Using data from the National Survey of Family Growth (NSFG) 2011-2013, researchers sought to answer one question:
How much do gaps in contraception and abortion matter in terms of explaining variation in unintended birth rates by income?
From the more than 10,000 men and women who responded to the NSFG, researchers focused on 3,885 single women who were not trying to get pregnant. Women fell into this category if they fell into one of the following three categories:
- Using contraception
- Not using contraception for a reason other that trying to get pregnant (e.g. cost)
- Classifying a pregnancy as unintended
The sample was then placed into one of five income categories.
- At or below FPL
- 100-200% FPL
- 200-300% FPL
- 300-400% FPL
- 400%+ FPL
The researchers used these categories to make comparisons on four measures: sexual activity, contraception, abortion, and birth.
- Sexual Activity was defined as having at least one opposite sex partner in the last year. There were no differences in rates by income level. Researchers also looked at sexual activity in the last month and total number of sexual partners in the last year and found no relationship. Sexual frequency is not captured in any of these measures and could account for some of the differences in rates of unintended pregnancy. However, past research supports the idea highlighted here that there is no connection between SES and how much sex people are having.
- Contraception was defined as any contraception use in the last year. Women with the lowest income were twice as likely to have sex without contraception compared to those with the highest income. No analyses were done by type of contraception used which can also be related to the differences in unintended pregnancies.
- Abortion rate was calculated by dividing the the women who reported their last pregnancy ended in abortion by the women who reported a pregnancy in the last year. Women with the lowest income were more than three times less likely to have an abortion than those with the highest income. Access to abortion services was not explicitly examined although it is implied that those with higher incomes would have the means to travel even if they lived in an area without one.
- The birth rate was almost five times higher for women with the lowest income compared to those with the highest.
The authors went on to determine how the gap would be different if lower income women adopted the same rates as the highest income women. Their findings are twofold:
- If all single women adopted the high SES rates of contraception use, the gap in unintended births would be cut in half.
- If all single women adopted the high SES rates of abortion, the gap in unintended birth would be reduced by a third.
These are tabulations, however, and may not tell the whole story.
Other Factors Influencing the Contraception and Abortion Gaps
Several other factors may come into play when discussing the differences in pregnancy rates by SES.
- Access to better methods of contraception. Currently 24 states do not cover long acting reversible contraceptives (LARCs), the most effective form of birth control. These states tend to be in the public health hotspots of the US including the Bible Belt where there are corresponding higher rates of poverty.
- Distrust of healthcare. Due to abuses throughout history, people of color and low income individuals tend to feel distrustful of the healthcare field. This has been shown to delay seeking medical attention. From my own experience working in medicare/medicaid clinics, there also are racial and generational differences in what forms of birth control are accepted.
- Limited access to sex education. Only about half of the states (PDF) require information on contraception be taught during sex or HIV education. Many of the states that do not cover LARCs also do not have comprehensive sex education. How can we expect people to use protection if they don’t even know about it?
- Less access to a safe abortion. Women with lower SES are less likely to have the means to get to an abortion clinic and pay for an abortion. The Washington Post reports that primary deterrent to safe procedures is financial with women in the highest income brackets being three times as likely to have had an abortion in the past year that poor women.
- Desire to have children. Some sociological research hows that having children, intended or otherwise, provides great fulfillment to women of lower income resources. As said in the study: “[it may be that] women with limited economic prospects will control their fertility less carefully because they have less to lose.” Data from the study does not show clear differences by income level in preferences for children; however it does show that a third of single women not trying to get pregnant would not be bothered by an unintended pregnancy.
Policy Implications
Since sexual frequency does not seem to contribute to differences in birth rates, policy should focus on increasing access to contraception and abortion, especially long-acting reversible contraceptives (LARC) such as the IUD or implant. Past research shows that when money is no issue, most women choose this option; however, for many the cost is prohibitive. This alone
From a practical standpoint, contraceptive access is a slightly easier product for public health to “sell.” It lacks some, if not all, of the moral controversy of abortion. Additionally, increased contraceptive use, particularly of LARCs, leads to a decrease in abortion rates as well. Lastly, expanding access to birth control makes economic sense. Unintended pregnancies cost taxpayers $21 billion each year according to a recent analysis (PDF) by the Guttmacher Institute.
This quote from the study’s co-author Richard Reeves, policy director of the Center on Children and Families. sums things up nicely:
“In a sense, inequality starts before birth,. An important part of the policy story is helping parents have children when they’re ready. The life chances of those children will be better as a result.” Source
Other Sexual Health News This Week
Adequate Sleep Tied to Women’s Sexual Function (Reuters)
Black Market Breast Milk Could Spread HIV (Vocativ)
This Experimental Vaccine Could Mean The End Of Herpes (Refinery 29)
Dating Research from OkCupid: Race and Attraction, 2009 – 2014 (OK Cupid)
Do I Have an STD? Spring Break Edition (GQ)
Millennial Attitudes on Reproductive and Sexual Health Show Promise for Advocates (RH Reality Check)
Conference Proposals Due
The following conference proposals are due in April. Click on each name for more information.
National HIV Prevention Conference, April 19.
Upcoming Conferences
The following conferences take place in April. Click on each name fore more information and to registers.
Preventing Sexual Violence Through Assessment,Treatment and Safe Management, April 8
ISSWSH Spring Course, April 10-12
From Abortion Rights to Social Justice: Building the Movement for Reproductive Freedom, April 10-12
Gender Matters Conference, April 17-18
National Transgender Health Summit, April 17-19
Building Healthy Futures Advanced Training – Re-imagining Men’s Role in the Movement to End Sexual and Intimate Partner Violence, April 22-23.
SOPHE 66th Annual Meeting, April 23-25
YTH Live 2015, April 26-29
Sexual Assault Summit, April 29-May 1
American Conference for the Treatment of HIV, April 29-May 2
by Kait Scalisi | Mar 13, 2015 | News, Sex Stories
By Kait Scalisi, MPH
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
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.
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/
