Diabetes and menopause: A twin challenge

Diabetes and menopause: A twin challenge

Diabetes and menopause may team up for varied effects on your body. Here's what to expect — and how to stay in control.
By Mayo Clinic Staff

Menopause — and the years before it — may provide some challenges for women who have diabetes. If you have diabetes and you're going through menopause — or soon will be — learn what to expect. Then consider what to do about it.

Diabetes and menopause: What to expect

Menopause is the phase of life after your periods have stopped and your estrogen levels decline. Menopause can also occur as a result of surgery, when the ovaries are removed for other medical reasons.
Diabetes and menopause may team up for varied effects on your body, including:
•Changes in blood sugar level. The hormones estrogen and progesterone affect how your cells respond to insulin. After menopause, changes in your hormone levels can trigger fluctuations in your blood sugar level. You may notice that your blood sugar level changes more than before, and goes up and down. If your blood sugar gets out of control, you have a higher risk of diabetes complications.
•Weight gain. You might gain weight during the menopausal transition and after menopause. Weight gain may require an adjustment in your diabetes medication.
•Infections. Even before menopause, high blood sugar levels can contribute to urinary tract and vaginal infections. After menopause — when a drop in estrogen makes it easier for bacteria and yeast to thrive in the urinary tract and vagina — the risk is even higher.
•Sleep problems. After menopause, hot flashes and night sweats may keep you up at night. In turn, the sleep deprivation can make it tougher to manage your blood sugar level.
•Sexual problems. Diabetes can damage the nerves of the cells that line the vagina. This can interfere with arousal and orgasm. Vaginal dryness, a common symptom of menopause, may worsen the issue by causing pain during sex.

Diabetes and menopause: What you can do

Menopause can wreak havoc on your diabetes control. But there's plenty you can do to better manage diabetes and menopause.
•Make healthy lifestyle choices. Healthy lifestyle choices are important aspects of your diabetes treatment plan. Eat a variety of fruits and vegetables, whole grains, lean poultry and low-fat dairy products. Aim for about 30 minutes of physical activity — such as brisk walking — a day. Healthy foods and regular physical activity can help you feel your best after menopause, too. Also quit smoking if you smoke.
•Measure your blood pressure often. Make sure your blood pressure levels are within a healthy range. Ask your doctor if you have questions or concerns about your blood pressure. If you take medications for high blood pressure, be sure to take them as prescribed.
•Measure your blood sugar frequently. You may need to check your blood sugar level more often than usual during the day, and occasionally during the night. Keep a log of your blood sugar readings and symptoms. Your doctor may use the details to adjust your diabetes treatment plan as needed.
•Ask your doctor about adjusting your diabetes medications. If your average blood sugar level increases, you may need to increase the dosage of your diabetes medications or begin taking a new medication — especially if you gain weight or reduce your level of physical activity. Likewise, if your average blood sugar level decreases, you may need to reduce the dosage of your diabetes medications.
•Ask your doctor about cholesterol-lowering medications. If you have diabetes, you're at increased risk of cardiovascular disease. The risk increases even more when you reach menopause. To reduce the risk, eat healthy foods and exercise regularly. Your doctor may recommend cholesterol-lowering medication if you're not already taking it.
•Seek help for menopausal symptoms. If you're struggling with hot flashes, vaginal dryness, decreased sexual response or other menopausal symptoms, remember that treatment is available.

For example, your doctor may recommend a vaginal lubricant to restore vaginal moisture or vaginal estrogen therapy to correct thinning and inflammation of the vaginal walls. Your doctor may also recommend hormone replacement therapy to relieve the symptoms if you don't have conditions that could cause a higher risk of complications.
If weight gain is a problem, a registered dietitian can help you revise your meal plans. Hormone replacement therapy might be a good option, too.

Having diabetes while going through menopause can be a twin challenge. Work closely with your doctor to ease the transition.

The Riddle of the Sphincter

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Everything You Need to Know About Male Orgasms

1. Is this a certain type of orgasm?
No, it’s an all-encompassing term for any kind of orgasm related to male genitalia.
It could be ejaculatory or non-ejaculatory, or even a mix of both! That’s right, you may be able to have multiple orgasms in one session.
All that said, your genitalia isn’t your only option when it comes to achieving the big O.
Read on for tips on where to touch, how to move, why it works, and more.

2. It can be an ejaculatory orgasm
Orgasm and ejaculation often happen simultaneously, but they’re actually two separate events that don’t necessarily have to happen at the same time.
If your pleasure mounts and you shoot — or dribble — semen from your penis, then you’ve had an ejaculatory orgasm.
Try this
Here’s a doozy from our Masturbation Guide called “The Stranger.”
To give it go: Sit on your dominant hand until it falls asleep, then use it to masturbate with. It’ll feel like someone else is doing the job.

3. Or a non-ejaculatory orgasm
Again, you don’t need to expel semen to have an orgasm.
Not everyone ejaculates with orgasm, and even those that do may not ejaculate every time.
This is also referred to as a dry orgasm.
Unless you and your partner are trying to conceive — in which case you should see a doctor — dry orgasms are usually harmless and just as enjoyable as an ejaculatory orgasm.
Try this
Make some noise. We know that masturbation is often quick and quiet. There’s nothing wrong with a discreet quickie, but letting loose and making all the noise that comes naturally can be freeing.
Get into it and let out every moan and groan your body wants to — just be sure to save this one for an empty house or company that’ll enjoy the sound show.

4. Or even multiple orgasms
Though not as common for someone with a penis, multiple orgasms are possible. And who doesn’t like a challenge?
Try this
The key to multiple orgasms may be in learning to extend the period of high arousal before you come.
Masturbate almost to the point of orgasm and change the stimulation by switching hands or rhythm, or breathing slower.
When the urge to come subsides, bring yourself to the edge again, and then back down again using the techniques we just described.


5. Or a mix of all of the above
Chances are that if you have multiple orgasms, you’ll experience a mix of ejaculatory and non-ejaculatory orgasms.
Try this
Try sex toys to change things up and practice prolonging your level of high arousal as described above. You can find all kinds of sex toys online, each offering up different sensations.
Some common options are:
Fleshlights
pocket strokers
vibrating cock rings


6. But you can orgasm from other stimulation, too
Your penis doesn’t have all the power when it comes to orgasm — your body’s loaded with pleasure points that are just waiting to get you off.
Prostate
Your prostate is the way to an intense, full-body orgasm. This walnut-sized gland is located between your penis and bladder, just behind your rectum.
You can access it by inserting a finger or sex toy in your anus.
Try this: Start by slowly rubbing the outside and inside of your anal opening with your finger. Insert your finger and massage your prostate, slowing increasing your speed as your pleasure builds.
If you’d rather not use your finger, there are plenty of toys you — or a partner — can try. Shop now for anal sex toys.
Nipple
Nipples are full of nerve endings. They’re also connected to the brain’s genital sensory cortex, so almost anyone can get pleasure from their nipples.
Nipple orgasms are said to sneak up on you and then send pleasure shooting through your whole body.
Try this: If you’re flying solo, get comfortable and let your mind wander to whatever gets your juices flowing. Use your hands to rub your chest and nipples to find what feels good and then keep at it.
For partner play, have them use their hands, lips, and tongue to caress, flick, pinch, and lick the area.
Erogenous
Your body is full of erogenous zones that go beyond the obvious ones we’ve just covered. These are sensitive spots on your body that lead to some serious arousal and possibly a full-body orgasm when touched just right.
Try this: Get comfortable and begin touching yourself starting at your scalp and working your way down, lingering on any parts that feel especially amazing.
Increase your speed and pressure as your pleasure intensifies. If you can’t take yourself over the edge like that, let one hand head south for a hand job while the other keeps pleasuring the rest of your body.

7. Where does the G-spot come in?
Stumped about the male G-spot? That’s because what’s often referred to as the male G-spot is actually the prostate.
We’ve already covered how to find it via your anus, but you can actually stimulate it indirectly by massaging your perineum.
Also known as the taint, the perineum is the landing strip of skin between your balls and your anus.
A finger, a tongue, or a vibrating toy over the perineum can all work magic on the prostate.

8. Isn’t ejaculation the same thing as orgasm?
Most people refer to ejaculation and orgasm as one in the same, but they are actually two separate physiological events.
Orgasm includes the pelvic contractions and intense pleasure and release you feel when you come. Ejaculation is the expulsion of semen from the penis.

9. What happens in the body when you orgasm?
An orgasm is just part of the sexual response cycle, which happens in stages. Every body is different, so the duration, intensity, and even order of the stages can vary from one person to another.
Excitement
The excitement phase is the kick-off to the sexual response cycle. It can be triggered by thoughts, touch, images, or other stimuli depending on what turns you on.
During this phase your heart rate and breathing speed up, your blood pressure increases, and increased blood flow to the genitals causes an erection.
Plateau
This is an intensified version of the excitement phase, during which your penis and testicles continue to increase in size.
Orgasm
This is when your pleasure peaks and releases. It can last from a few seconds to a few minutes. If you’re going to ejaculate, this is when it usually happens.
Resolution and refraction
During the resolution phase, your body begins to return to an unaroused state. Your erection gradually subsides, your muscles relax, and you feel drowsy and relaxed.
Some people go through refractory period after orgasm, during which you may not be able to get an erection or have an orgasm. Further stimulation may feel too sensitive or even painful.


10. What makes a male orgasm different from a female orgasm?
Turns out there isn’t much difference. Both experience increased heart rate and blood flow to the genitals. Ejaculation is also possible for some.
Where they differ is in duration and recovery. For example, “female” orgasm can last up to around 20 seconds longer.
Individuals who have a vagina are less likely to experience a refractory period, so they may be more likely to have more orgasms if stimulated again.

11. Is there anything I can do to have a more intense orgasm?
Absolutely! Here are some things you can try.
Edging
Also called orgasm control, edging involves maintaining a high level of arousal for a longer period by holding off your orgasm.
To do this, stimulate yourself until you feel like you want to come and then change the stimulation until the urge to come subsides.
Pelvic floor exercises
Pelvic floor exercises, such as Kegels, help strengthen your pelvic floor muscles, which may improve orgasm control.
To do this, tense the same muscles you would to stop from passing urine. Hold for three seconds, then release for three seconds, and repeat 10 times.
Do this every day, building up to holding for 10 seconds.
Breathing exercises
Learning to slow and focus on your breathing plays an important role in the practice of tantric sex, which is all about maximizing pleasure.
Zeroing in on your breathing while masturbating or having sex can intensify sensation.
Take slow deep breaths as you become aroused to help keep you in that state of high arousal longer for a more powerful orgasm.

12. What can affect my ability to orgasm?
Lifestyle factors, your mental health, and other medical conditions are just some of the things that can affect your ability to orgasm.
These include:
Premature ejaculation. Ejaculation that occurs sooner than you want is premature ejaculation. The main symptom is a regular inability to control ejaculation for more than a minute after penetration. Psychological factors, certain medications, and hormonal imbalances can cause it.
Retrograde ejaculation. Retrograde ejaculation occurs when the muscles that help expel ejaculate from the penis fail, causing the ejaculate to end up in the bladder. The most common symptom is very little or no semen when you orgasm. It can be caused by nerve damage due to diabetes and other conditions. Certain medications and surgical procedures can also cause it.
Anorgasmia. Also called orgasmic dysfunction, this occurs when a person has difficulty having an orgasm or has unsatisfying orgasms. Psychological, emotional, and physical factors can cause it.
Alcohol or substance use. Drinking too much alcohol can make it difficult to orgasm. Smoking marijuana and using other drugs can also cause it.
Depression, stress, and anxiety. It can be hard to get aroused enough to have an orgasm if you’re dealing with stress, anxiety, or depression. Fatigue, trouble concentrating, and feeling sad or overwhelmed are common symptoms.

13. Should I see a doctor?
Orgasms aren’t the same for everyone, and what makes one person climax won’t necessarily work for another.
If you have concerns or feel like you’re having trouble climaxing, talk to a doctor or sexual health specialist.
They can answer any questions you may have and may be able to make some recommendations.

What Can Orgasms Do for Your Skin?

Orgasms have benefits
It might be time to start saying “an orgasm a day keeps the doctor away” because besides feeling amazing, the Big O also has plenty of important benefits for the body, especially on your skin.
That elusive glow you’ve been chasing after? You just might see it in your reflection the next time you finish a spin in the sack!


 Beat down flare-ups from stress
Ever find that having an orgasm calms you down? You’re not alone. In fact, getting it on can actually help skin maintain itself. Planned Parenthood reports that in a 2000 survey, 39 percent of 2,632 U.S. women reported masturbating to relax.
Other studies have found that low levels of oxytocin in the bloodstream are correlated with high levels of stress, tension, and anxiety disorders. And when you’re stressed out, a big organ like your skin might take the hardest hit. Not only can stress trigger inflammation in conditions like rosacea and psoriasis, it can also trigger those oh-so-annoying breakouts we all experience.
Get your beauty sleep in too
There’s a strong correlationTrusted Source between lack of sleep and acne, so doctors recommend sleeping for a full eight hours in order to allow skin to perform the maintenance necessary for glowing skin. The immune system and inflammation heals itself during deep, long sleep stretches, too. So take advantage of that urge to roll over and fall asleep right after you climax.

All hail estrogen
A 2009 study at the University of MichiganTrusted Source found out that having an orgasm raises the levels of estrogen in your body. And that’s good… why? Because estrogen actually appears to aid in the prevention of aging skin in a number of ways.
First, it prevents the decrease of collagenTrusted Source, an important protein for maintaining the appearance of youthful skin. It also helps with skin thickness, keeping skin resistant to wrinkles. Mentioning wrinkles — estrogen’s effects on the elastic fibers of the skin prevent them as well! And finally, estrogen may also lock in the skin’s moisture, keeping skin plump.


 Glow on
If you’re wondering where exactly that post-sex glow comes from, we’ve got the goods. During sex, there’s an increase in the rate of blood flowing through your body, meaning more of those blood cells carrying oxygen can reach your face.
When your blood vessels start to dilate, you get that rosy flushed look, and an increased amount of oxygen stimulates collagen production. So it’s hello collagen, goodbye wrinkles!

 Say cheese
Science supports the idea that frequent sex and affection make people happy. You’re no longer sleepy, completely stress-free, and glowing — so we wouldn’t blame you if you’re grinning ear to ear in the morning as well. And that smile does wonders, like making people think you’re younger. A 2016 studyTrusted Source confirms this correlation, noting that when people smiled they were actually perceived as looking younger.
The fabulous thing about the benefits of orgasm on your skin is that it doesn’t involve any fancy and expensive creams or lotions. But the best part is that you can reap all the good benefits orgasming alone, just as much as you can with a partner!
So go forth, get your glow on, and thank us when you take your next selfie

The case of the female orgasm

At the risk of being yet another male offering an opinion on a female issue, and on top of that a scientist outside the field, I nevertheless respond to Jessica Hamzelou's description of men arguing about the size of their pet theories on the female orgasm (12 March, p 27). I suggest females experience orgasm for the same reason men do: humans like intensely pleasurable things and seek to repeat them.
Unless females are enslaved, it seems to me that a woman who enjoys and seeks out intercourse with her mate would be more likely to reproduce than one who does not. The lesser frequency of female orgasm may be due to pervasive sexist cultural conditioning, which is rampant in the mass media even in the most liberal of countries.
I think the wrong question is being asked. It isn't a matter of whether the orgasm serves any purpose in women: it is what compelling argument exists for evolution to exclude one gender from getting any enjoyment out of intercourse. I cannot think of how that could possibly promote greater reproduction.
San Antonio, Texas, US

Women don’t need to ‘switch off’ to climax, orgasm study shows

Not switching off

Oleksiy Maksymenko /age fotostock/Superstock

The most detailed study yet of orgasm brain activity has discovered why climaxing makes women feel less pain and shown that ‘switching off’ isn’t necessary.
It’s not easy to study the brain during orgasm. “A brain scanner like fMRI is the least sexy place in the world,” says Nan Wise at Rutgers University in Newark, New Jersey. “It’s noisy, claustrophobic and cold.” There is also the problem of keeping your head still – movement of little more than the width of a pound coin can render data useless.
Despite these hurdles, Wise and her colleagues recruited 10 heterosexual women to lay in a fMRI scanner and stimulate themselves to orgasm. They then repeated the experiment but had their partners stimulate them.

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Wise’s custom-fitted head stabiliser allowed the team to follow brain activity in 20 second intervals to see what happens just before, during, and after an orgasm.

Pain relief

Back in 1985, Wise’s colleagues Beverly Whipple and Barry Komisaruk, both at Rutgers, discovered that, during self-stimulation and orgasm, women are less likely to notice painful squeezing of a finger, and can tolerate more of this pain. They found that women’s ability to withstand pain increased by 75 per cent during stimulation, while the level of squeezing at which women noticed the pain more than doubled.
Now Wise’s team has explained why. At the point of orgasm, the dorsal raphe nucleus area of the brain becomes more active. This region plays a role in controlling the release of the brain chemical serotonin, which can act as an analgesic, dampening the sensation of pain.
Her team also saw a burst of activity in the nucleus cuneiformis, which is a part of brainstem systems that are thought to help us control pain through thought alone.
“Together, this activity – at least in part – seems to account for the pain attenuating effect of the female orgasm,” says Wise.

Turn on, not off

Wise’s team also found evidence that overturns the assumption that the female brain “switches off” during orgasm.
In 2005, Gert Holstege at the University of Groningen in the Netherlands used a PET scanner to analyse brain activity in 13 women while they were resting, faking an orgasm and being stimulated by their partner to orgasm. While activity in sensory regions of the brain increased during orgasm, activity fell in large number of regions – including those involved in emotion – compared with their brain at rest.
Based on this finding, it was suggested that women have to be free from worries and distractions in order to climax. From an evolutionary point of view, the brain might switch off its emotional areas because the chance to produce offspring is more important than the immediate survival to the individual.
But the new study saw the opposite: brain activity in regions responsible for movement, senses, memory and emotions all gradually increased during the lead-up to orgasm, when activity then peaked and lowered again. “We found no evidence of deactivation of brain regions during orgasm,” says Wise.
The difference between the two studies may be because PET can only get a small snapshot of brain activity over a short period of time, unlike fMRI scanners.

Better understanding

It’s not yet clear why pain sensation decreases during orgasm, or if men experience the same phenomenon. It may be that, in order to feel pleasure in the brain, the neural circuits that process pain have to be dampened down.
Whipple suggests that the pain-dampening effects of the female orgasm could be related to child birth. Her research suggests that pain sensitivity is reduced when the baby’s head emerges through the birth canal. Vaginal stimulation may therefore reduce pain in order to help mothers cope with the final stages of birth, and promote initial bonding with the baby.
The ability to study what happens during stimulation and orgasm could be used to better understand and treat those who have mood disorders like anhedonia – the inability to experience pleasure, says Wise. “We know so little about pleasure in the brain, we are just now learning the basics.”
You might wonder what it’s like to participate in such experiments. Wise says people often think her participants must be exhibitionists, but it’s not the case, she says. “Some women do like that aspect, but most are doing it because it’s empowering to them. Some find it difficult to orgasm, others don’t. One of our participants in this experiment was a 74-year-old lady who had two fabulous orgasms in the machine. I said to her, ‘You go girl!’ ”


Read more: https://www.newscientist.com/article/2150180-women-dont-need-to-switch-off-to-climax-orgasm-study-shows/#ixzz6OjgEZmXU

Oh, oh, oh! The clitoris certainly gives pleasure. But does it also help women conceive?

New research reported in the media says the clitoris plays an important role in fertility and reproduction, making it more than an organ that exists purely for sexual pleasure.
But some media headlines were misleading, including:

The truth about the clitoris: why it’s not just built for pleasure
and

New clue reveals how a woman can conceive, and it all comes down to the clitoris
The reports were based on a controversial review by retired UK scientist Dr Roy Levin published this week in the journal Clinical Anatomy.
He brings together evidence to support a new theory that the clitoris is equally important for reproduction as it is for sexual pleasure, which he first proposed in 2018.
This is controversial as the clitoris has not previously been given a direct role in reproduction. Levin says this is because other researchers have been so fixated on its role in sexual pleasure they have completely overlooked its other role.
How the clitoris has courted controversy
Levin’s review is the latest development in a long history of controversy about the clitoris. Over the centuries, anatomists have debated its function, a discussion often dominated by men.
As early as 1559, Matteo Realdo Colombo, an anatomist at the University of Padua in Italy, termed the clitoris:
However, his contemporary Andreas Vesalius, known as the “father of modern anatomy”, dismissed the proposition. He said the clitoris was an anomaly and simply does not exist in normal healthy women.

Others saw the clitoris as a liability.
In the 1820s, English surgeon and president of the Society of British Medicine Isaac Baker Brown thought the clitoris was a source of “hysteria” and epilepsy. And he said it should be removed to cure hysteria and other forms of “female madness”.
And as late as 1905, Sigmund Freud considered clitoral orgasm to be a sign of a woman’s psychological immaturity.
Where are we today?
Today, most scientists agree the main function of the clitoris is for sexual pleasure. But how did we come to have such an organ and why would we need one?
Researchers just last month proposed the clitoral orgasm is a remnant of our evolutionary past that once served to induce ovulation during intercourse.
Another view of the clitoris argues it allows women to discriminate between sexual partners based on who can help them reach orgasm with the right type of stimulation.
A third common view is clitoral orgasms lead to stronger bonding between sexual partners preparing them for childbearing and parenting.
So how does this fit with the latest claim?
This latest paper argues stimulation of the clitoris activates parts of the brain, leading to multiple physiological changes in the vaginal tract.
These changes lead to vaginal lubrication, an increase in vaginal oxygen, an increase in temperature and decrease in acidity, so facilitating reproduction by creating the right environment for the sperm.
While it’s not unusual for organs to have two functions, Levin’s view needs further investigation.
Some of the physiological changes he describes occur when a woman is sexually aroused, before her clitoris is stimulated.
For example, women can experience vaginal lubrication and engorgement of erectile tissues while watching erotic movies, without clitoris stimulation.
He also discusses how female genital mutilation reduces a woman’s fertility, implying this is a result of circumcision of the clitoris. However, he does not cite any evidence for this.
While there is some evidence for a decline in fertility after female genital mutilation it varies between studies. The link seems to be strongest where not only the clitoris, but parts of the labia are also removed and stitched together during the procedure, narrowing the opening into the vagina.
In these cases, infertility may also be caused by the difficulty in sexual intercourse due to the narrowing of the vaginal opening, infections or other complications of the procedure.
With this equivocal evidence, Levin’s conclusion that “the reappraisal of the functions of the clitoris as both reproductive as well as recreative are of equal importance is clearly now unavoidable”, could be disputed.
The conclusion is not quite that definite.
However, this does not mean Levin’s theory is incorrect; it just requires further investigation and discussion.
His review highlights that often the science around the clitoris has been heavily influenced by the cultural context — from feminism, through to religion and simply the morals of the time. While cultural context is important, this has diverted attention away from objectively examining scientific evidence.
Perhaps the most important aspect of this review is it may trigger a discussion on the functions of the clitoris and bring that discussion back to science.
As Levin highlights, the two proposed functions of the clitoris as an organ of both “procreation” and “recreation” are not mutually exclusive and can be of equal importance, a proposition worth examining.

Don’t fear the patriarchy, girls. Just keep your knickers on

There’s a video out there on the intertubes that’s got conservatives cheering and lefties in a lather. Actually such videos are legion, but I’m talking here about a particular one with the rather broad and even-handed title of The Economics of Sex.
You can watch it, but I must offer a trigger warning that people who have ever had sex before marriage, or know someone who has, might find its pure, unadulterated truth-bombiness a little too much for their besmirched souls to withstand.
If you can’t bear to watch, here is a very brief precis of the argument:
•marriage rates in the US are down. Like, worse than the Dow!
•to understand this calamity we need to know more about the economics of sex
•men have higher sex drives than women. That’s just the way it is
•which makes sex a resource controlled by women. Always has been
•sex is cheap these days - because the pill largely freed women the cost of becoming unexpectedly pregnant. Lower costs = more supply = lower prices
•this created a “split mating market” - on one side, people “only interested in sex”, and on the other, people “largely pursuing marriage”
•there are too many men in the sex market, so women can call the shots
•but women outnumber men in the marriage market, putting blokes in the drivers’ seat
•it’s always been up to women to set a high market value for sex by restricting supply
•this unspoken female pact to set a high market value for sex has all but vanished: women compete for men by hopping in the sack with them, thus lowering the ‘price’
•which is why Americans are less likely to marry, and do so later in life than ever before
•if women just resume colluding to set a high price for sex, then men will be nicer, take women on more expensive dates, buy bigger diamonds and get busy marryin’
•and then balance will be restored to the force.
Qualified admiration

This is a slick piece of strategy. It combines the electronic reach of the internet with a funky old-skool brown-paper and texta visual device sure to appeal to all those youngsters stumbling haplessly onto the sex-marriage market. Not so sure about the Sinatra backing tracks, but love and marriage certainly do go together like a horse and carriage. At least they did, back in Ol’ Blue Eyes’ day. Except when they didn’t.
Strategy? What strategy?
The video is a product of the Austin Institute for the Study of Family and Culture a Texas-based think-tank whose mission is “to be a leading resource for tested, rigorous academic research on questions of family, sexuality, social structures and human relationships”. By which they appear to mean research in favour of families with one father married to one mother (preferably stay-at-home).
The brains behind the Institute, according to the Austin Chronicle happens to be one Mark Regnerus, a darling of the pro-marriage (as long as its not gay marriage) right. Regnerus achieved fame/notoriety in 2012 for his New Families Structures Study of young adults who were raised by parents in gay relationships, compared with ‘still-married’ parents. And he’s not so keen on upwardly-trending masturbation tendencies, either.
Who ever said there’s no such thing as a conservative Christian sociologist?
The bulk of the video relies on Timothy Reichert’s economic argument that the contraceptive pill, in reducing the ‘price’ of pre-marital sex, has favoured mens’ interests at the expense of womens’. Reichert’s article, published in the religious organ First Things, even finishes with some helpful suggestions about the future of feminism:

What is needed is a movement of “new feminism” based on a deep understanding of the nature of woman and her role at the center of society.
Riechert and Regenerus’ ideas about a mating market cleft - by the pill - into those seeking sex and those seeking marriage, has long been popular with conservatives. Our very own Cardinal George Pell built an op-ed in The Australian around his work, lamenting the transformation 50 years of the pill had rent upon a formerly chaste and god-fearing society.
Suppression of female sexuality
The bit that interests me most about this video, however, is the way Regnerus uses an important 2002 paper by the psychologists Roy Baumeister and Jean Twenge with the title of The Cultural Suppression of Female Sexuality. It doesn’t take much perspicacity to see that where sexual activity - from masturbation to extra-marital activity - is suppressed, women and girls bear much more of the cost than men and boys.
It might seem logical, then, to assume that sexual suppression is something men do to women; that it embodies patriarchal control of female sexuality. Yet Baumeister and Twenge present an impressive body of circumstantial evidence that women enthusiastically engage in policing one another’s sexual activity. From slut-shaming to female genital mutilation, the chief antagonists are often women.
The rationale? That if a majority of women restrict the supply of sex, then all women can drive a harder bargain on the marriage market. When women who engage sexually with a speed or abandon that exceeds the cultural norm get branded ‘cheap’, it isn’t a metaphor.
This idea that women control the price of sex like an unscrupulous cartel is an important one with many implications for our understanding of sexual behaviour and relationships. My reading of the evidence suggests that it is probably true. But that is not to say it is the only dynamic feeding the suppression of female sexuality. Many old ideas about the involvement of men, particularly husbands and religious leaders also appear to have strong support.
This is a very exciting and hotly contrested area of research right now. So I was struck by the sheer audacity when (6:35) the peppy female narrator confidently piped:

Here’s the thing: In the past it really wasn’t the patriarchy that policed women’s relational interests. It was women.
Yep. If women just collectively kept their knees together, they’d all find it easier to ensnare a guy who’d willingly fork up two months’ salary to another cartel - the deBeers diamond company - for a great big diamond ring. And then, as if in a Disney movie, all the bad magic wrought by the pill, including declining marriage rates and …. men playing video games …. would be magically erased.
It’s the end of the world as we know it (and I feel fine)
Sneer as I might, there are interesting research questions embedded in this piece of conservative propaganda and in Regnerus’ research in general. I’m actually happy to entertain the idea that a loosening of cultural suppression of female sexuality may be driving the reduction in marriage rates. And possibly even the drift away from religion. But I’m interested, too, in the broader implications of what it all means.
Regnerus quite astutely summarises the conservative fears that underpin their deep hang-ups with female sexual freedom and the effect it has on supply, when he writes, in Slate:

Don’t forget your Freud: Civilization is built on blocked, redirected, and channeled sexual impulse, because men will work for sex. Today’s young men, however, seldom have to. As the authors of last year’s book Sex at Dawn: The Prehistoric Origins of Modern Sexuality put it, “Societies in which women have lots of autonomy and authority tend to be decidedly male-friendly, relaxed, tolerant, and plenty sexy.” They’re right. But then try getting men to do anything.
You don’t have to be a marrow-deep sexist to embrace this position. The psychoanalyst Mary Jane Sherfey, who bore the wrath of her male colleagues in emphasising the power of the human female sex drive and in questioning Freud’s insistance of the primacy of vaginal (over clitoral) orgasms, argued that suppressing women’s powerful, innate, sex drives was an essential stepping-stone to the success of agrarian societies and thus the rise of civilization.
And yet this idea that sex must be suppressed or all will be chaos hasn’t a whole lot of objective support. It seems to me to be a re-stating of an ancient bias - one that favoured older, wealthier men.
Since at least the dawn of the Roman republic, and probably well before that, conservative leaders have insisted that sexual liberty was the first step toward the end of civilization. The chastity of the Vestal Virgins was considered Rome’s primary safeguard against its enemies. How different is that from Reverends Jerry Falwell, Pat Robertson and Rabbi Noson Leiter blaming calamities like Hurricane Katrina and 9/11 on “abortionists, […] feminists, […] gays and the lesbians”?
It doesn’t seem like it should be controversial that all people - not just women - are better off in post-enlightenment wealthy societies where effective medical interventions limit deaths in childbirth, where women can make their own decisions about how many children to bear and when to have them, and in which people have greater choice about when to leave a dysfuntional marriage or whether to enter one in the first place. As Michelle Goldberg puts it, in her exceptional book, The Means of Reproduction, “there is no force for good as powerful as the liberation of women”.
And yet it is controversial. Regnerus and the Austin Institute want the suppression of female sexuality back, and they want it back badly. Women, they argue, should be doing it for their sisters. Now how far they want to wind the clock back they haven’t stated. Apart from the pill, which other forms of female suppression would they like to revoke? Voting rights? Laws against witch-burning?

Marijuana and sex

Dear Alice,
Does the use of marijuana affect a person's sexual performance?

Dear Reader,
Will marijuana put a hex on sex? Ought smoking pot make it heavy and hot? No matter how you frame it, the answer to these questions is simply: maybe. Research shows both positive and negative effects of cannabis (also called marijuana, weed, and pot) use on sexual performance, meaning one’s marijuana-infused sexual experience likely depends on the people involved. Stick around for more information on the relationship between weed and sexual performance.
Marijuana’s effect on the performance of any activity (whether it be socializing, skydiving, or sex) can vary person-to-person. While some may feel more calm or mellow after using it, others may feel more anxious or paranoid. Although these factors contribute to a variety of possible reactions to pot use, certain effects remain fairly consistent across the board. For example, using marijuana can impair both coordination and judgment, much like alcohol. So, making safer decisions and communicating clearly about sexual behavior might be difficult while high, and some may notice that their sexual interactions are fumble-filled. After all, sex can take a lot of coordination, even while completely sober!
Most studies conducted about the relationship between marijuana use and sexual performance have historically indicated strong correlations. However, more recent studies offer a different perspective: they note that cannabis use doesn't have a direct impact on sexual performance. Rather, smoking weed can lead to side effects that are experienced regardless of whether you're engaging in sexual activity, and those side effects are, in fact, what seem to impact a person’s sexual experience and performance. For example, many report an increase in sexual arousal and tactile sensitivity during sexual activities after marijuana use. This may actually be explained by marijuana’s tendency to slow temporal perception. The slowing of temporal perception can also make periods of time seem longer than they really are, so a person may perceive that the sexual experience lasted longer than it really did and that their endurance has increased. There may be another weed-related explanation for the perceived sensitivity cannabis users often report during sexual encounters — many experience anxiolytic (anti-anxiety) effects after use. The more relaxed a person is, the more they may be able to pay attention to their senses. Finally, they may have perceived that their experience was more positive as opposed to the same type of experience where marijuana wasn't used. This may not have been due to the drug itself, but the belief that it was, which is commonly described as the placebo effect. Cannabis has long been rumored to be an aphrodisiac, so those who believe this to be true may be more inclined to confirmation bias (confirming evidence as true based on prior beliefs) when experiencing these effects themselves.

Despite the recent rise in theories about the indirect relationship between marijuana use and sexual experience, there’s still little to no conclusive evidence available about the direct relationship between marijuana and sex. Large-scale studies on this topic are limited, as most research about marijuana and sex focuses on effects that cannabis use has on fertility (and on animals, at that). Unfortunately, research related to your question predominantly relies on surveys and anecdotal experience. That's not to say these reports are worthless, however; they actually shed light on some of the negative effects that marijuana use has on sexual encounters, such as higher rates of erectile dysfunction, diminished sexual desire, and difficulty reaching orgasm. Further, there’s reportedly less condom use in sexual encounters involving cannabis, regardless of the amount consumed, which increases the likelihood of pregnancy as well as contracting or passing sexually transmitted infections.
Above all, there's no way to predict how pot might influence people's sexual experiences, or those of anyone else. However, if you're considering having sex while using marijuana, you may be able to figure out its effect by exploring your response to marijuana in nonsexual situations, or by discussing marijuana's role in your sex life with your partner. In the end, you may find that relaxing during sexual encounters and getting turned on may be possible without the use of drugs. Fortunately, you have the power to choose their role in your life and in the bedroom!

Non-surgical contraception options for men: New methods coming?

Alice,
I have been doing some research on the web about Male Contraceptives. My girlfriend can't use hormonal methods, and we don't want to use surgery or inserts. Can you give me any info on non-surgical/non-drug male methods, such as MSR, MPU, Shug, etc...? I can't find anything on the availability of these methods. Thank you.

Dear Reader,
Unfortunately, research on new forms of male contraception has yet to produce any non-surgical, non-drug methods (besides condoms) that are approved and on the market. However, there is hope on the horizon with some methods that are currently being researched. The methods you mention in your question — medical-grade silicone rubber (MSR), medical-grade polyurethane (MPU), and the Shug (a silicone plug) — are all still experimental methods that focus on blocking sperm from leaving the penis (similar to a vasectomy), and it’s unclear as to whether these methods are continuing to be researched. Some methods that are currently being researched with the intention of bringing them to a larger population are the reversible inhibition of sperm under guidance (RISUG) and Vasalgel (more on these in a bit). Additionally, although you noted interest in non-drug methods, some hormonal methods are currently being explored as well, such as the transdermal gel and dimethandrolone undecanoate (DMAU).

The MPU, MSR, and Shug are all various forms of plugs that are inserted into the vas deferens (which is the tube in the body that carries sperm cells from the epididymis to the urethra). While not a surgical procedure, the plugs were inserted through the skin using a needle. The MPU used medical-grade polyurethane, but after concerns about the safety of the material, researchers looked for other materials and started to try silicone. The MSR and Shug are both made of medical-grade silicone rubber. Similar to the MPU, the MSR would require an injection in which the silicone would form a plug in the vas deferens that would prevent sperm from ending up in the ejaculate. The Shug, while made of silicone, differs in that it injected pre-formed silicone plugs into the vas deferens. For any of these plugs to be reversible, the removal process may require surgery. Additionally, these methods were only available in clinical trials, and some of the most recent research on these methods is decades old, suggesting that research hasn’t continued.
Other non-hormonal products currently in clinical trials are RISUG and Vasalgel. For RISUG, a polymer is injected into the vas deferens and solidifies on the tube wall within 72 hours. Instead of blocking sperm, the RISUG actually ruptures the cell membranes of sperm passing by, leaving them unable to fertilize an egg. It appears that a single injection can provide up to ten years of contraceptive use. Vasalgel is based on the same idea as RISUG, except that this polymer gel blocks the flow of sperm altogether as opposed to rupturing the sperm itself. Both the RISUG and Vasalgel compounds are removed by flushing the vas deferens with a solvent, restoring fertility. There seem to be few complications and side effects yet observed.
Though you mention an interest in non-drug options, some of the more widely researched methods include hormones, which could be taken in pill form, absorbed through a skin patch, or injected through a needle. The current goal is to identify a hormonal male contraceptive that’s efficient, reversible, safe, with few or tolerable side effects, inexpensive, and accessible. Two promising options are transdermal gel and DMAU. Transdermal gel contains two synthetic hormones that are rubbed into the skin and has already been shown effective in a six month study. DMAU is a hormone combination pill that is taken once a day; however, users have complained of slight weight gain and a decrease in HDL ("good") cholesterol. Research is continuing to monitor side effects and look at these in the longer term.
For those not interested in hormonal contraceptives and non-surgical procedures, condoms and the withdrawal method (also known as pulling out) are the other two options available, although the withdrawal method has a 28 percent failure rate. Your girlfriend could also look into non-hormonal methods, such as the copper IUD, the diaphragm, internal (female) condoms, or the symptothermal method. You may consider speaking with your health care provider about your options or checking out the Go Ask Alice! Sexual and Reproductive Health for an array of Q&As on contraceptive options, including barrier methods. Remember, of all the existing and new methods for men, only condoms will provide protection against sexually transmitted infections (STIs).
More people are expressing interest in male-directed contraceptives; hopefully there will be new methods on the market in the next few years. Until then, safer sex through barrier methods may be your best bet!

Tell me more about the contraceptive implant

Dear Reader,
Kudos to you for seeking out more information about birth control methods; there are a great many options from which to choose. There’s a good amount to know about the contraceptive implant — and the first item to address is that the version called Implanon is no longer available! Implanon’s manufacturer, Merck, has made a few improvements on this device with a newer version called Nexplanon. It’s virtually the same as the older version, but has a few additional benefits (more on that in a bit). Generally speaking though, this method is injected underneath the skin of the upper arm by a health care provider. The small, rod-shaped implant slowly releases a hormone called etonogestrel (a type of progestin) over the course of three years in order to provide long-lasting pregnancy prevention for the duration of use. The etonogestrel works in three ways: First, it prevents ovulation so that there isn’t an egg released to be fertilized. It also thickens cervical mucus, making it difficult for sperm to enter the uterus. Lastly, it changes the lining of the uterus, preventing any egg that does happen to get fertilized from implanting itself in the uterine wall. This device is considered highly effective for most users, but may not be appropriate for everyone.
A few more specifics about this method: The plastic rod (for both the old and new versions of the device) is 40 millimeters (mm) in length and two mm in diameter (about the size of a matchstick). It’s inserted relatively painlessly (for many) into the underside of the upper arm after local anesthetic is used to numb the area and the procedure takes about one minute. The implant is designed so that the rod isn’t easily visible, but can be felt just underneath the skin. Some users may experience slight swelling or bruising after insertion, but it tends to go away within a short period of time. The rod contains 68 milligrams of etonogestrel that is released over a three-year period (though there is some evidence to indicate that the hormones from the device may remain at levels that would be enough to protect against pregnancy for up to the fifth year of use). The removal of the rod takes slightly longer than the insertion, but with the use of local anesthetic, pain from removal can be minimized. A health care provider will make a very small incision in the skin near the tip of the rod and then pull the rod out from underneath the skin. A new one can be inserted immediately after the old one has been removed. If it isn't replaced or use is discontinued, users usually quickly return to fertility (i.e., have the ability to conceive).

The newer version, Nexplanon, differs in a few ways to the benefit of both the user and the provider. First, the updated device has an applicator that allows for one-handed insertion by the health care provider, increasing ease with and decreasing time needed for the insertion. The other improvement with the newer version is encountered when the device is ready to be removed. It can be located using an x-ray machine when necessary, making removal a bit easier even if not inserted properly.
The implant seems to be highly effective for many individuals. Due to the reduction of risk associated with user error (because it's inserted by a medical professional and no daily maintenance is required), the method is upwards of 99 percent effective at preventing pregnancy. If inserted within five days after the start of a user’s menstrual period, the method becomes effective immediately. Despite this high effectiveness rate, the method doesn't provide protection against sexually transmitted infections (STIs). So, it's wise to consider complementary methods of prevention, such as condoms. That said, the device can be used safely by those who are breastfeeding, which isn’t the case with all birth control methods. Like other forms of hormonal contraception, however, it’s key to know that there are some side effects associated with the use of the implant. Of note is the potential to experience irregular bleeding, changes in how long users have their periods (either shorter or longer than is typical for them), or not having a menstrual period at all. Other commonly reported side effects include weight gain, acne, headaches, breast tenderness, changes in mood, and abdominal pain. Mayo Clinic mentions that if a user develops breast lumps, heavy vaginal bleeding, symptoms of a blood clot, jaundice, infection, possible pregnancy, changes in blood pressure, migraine with aura, or significant depression, that it be brought up with a medical professional. Experiencing these issues may indicate that it would be best that the device be removed.
With that in mind, the implant may not be the contraceptive choice for everyone. The device isn’t recommended for folks who are or may be pregnant, have allergies associated with any part of the device, genital bleeding that hasn’t been diagnosed, certain cancers, have had a history of blood clots or stroke, or liver tumors or disease. There are also some medications and supplements that may decrease the implant’s effectiveness when used at the same time, such as St. John’s wort, some medications to treat seizures, certain sedatives, and some medications used to treat human immunodeficiency virus (HIV). Further, for those with a with a body mass index (BMI) above 30, there is some concern that the method may be less effective — though there is some evidence to suggest it may provide sufficient protection against pregnancy at any BMI. Because more evidence on this topic is needed and every individual is different, talking with a health care provider about whether or not the implant would be appropriate to use, given a potential user’s health history, is especially crucial.
For even more information about birth control options, check out the Go Ask Alice! Contraception category in the Sexual & Reproductive Health archives.

Nervous about nipple-play’s effects on nursing

Dear Concerned Future Mom,
To “nip” your concern in the bud — nipple play using pressure and stimulation during sex is unlikely to cause breastfeeding issues in the future. Folks experience pleasure from nipple stimulation, both as receivers and givers. Some like soft sensations, while others prefer more intensity, including gentle biting, pinching the nipples, or even using piercings, clamps, or other items for additional pleasure. After a particularly long or (consensually) rough period of nipple play, it's possible to experience some soreness or uncomfortable levels of sensitivity. This generally isn’t a cause for concern, as long as the exchange was pleasurable and consensual. However, any experience that may cause injury to the breast tissue may cause some complications with breastfeeding (more on this in a bit). Maintaining communication with a partner during the experience can help ensure that all parties are enjoying the sensations throughout.
Pressure and stimulation are unlikely to cause lasting injury to the internal structure of the breast, but any type of trauma that causes scarring of the nipple and its surrounding tissue have the potential to cause complications with breastfeeding. In particular, scarring in or around the milk ducts can cause blockages. However, the milk ducts and lobules, which are essential to breast feeding, are covered by layers of fat, so unless you and your husband are participating in extremely rough nipple-play (i.e., play that results in cuts, tears, or crushing of nipple and breast tissue, causing scarring to occur), it's unlikely that damage would result that would prevent breastfeeding.

Direct injury to the milk ducts is rare, and usually only occurs in extreme cases. The most common form of breast harm is fat necrosis, which is when breast tissue is damaged. As the body works to heal the damaged tissue, it may create firm scar tissue in place of the damaged cells, or the cells die and the waste products create fluid-filled sacs called oil cysts. Oil cysts and fat necrosis may form a painless but noticeable lump in the breast that might have a bruised or red appearance. They tend to disappear on their own with time, but in some cases, a medical provider may need to help release fluid from the cyst through needle aspiration or surgery.
Any time the nipple or breasts have scars or cuts, there’s a heightened possibility of infection. In some cases, individuals may develop infected lumps known as mastitis, which may lead to breastfeeding complications. For folks who are currently breastfeeding, mastitis can sometimes be confused with a plugged milk duct, which presents as a painful lump in the breast and can be cleared through massage and regular feedings. Some signs of infection to look out for are fever, nausea, non-milk discharge from the nipple, or the breasts becoming hot to the touch. While it’s possible for mastitis to pass on its own, some people might need a prescription to treat it.
Even those who are actively breastfeeding can still enjoy nipple stimulation without hindering their ability to breastfeed. Some people who breastfeed experience heightened nipple sensitivity and discomfort at first, as parent and child both learn to nurse effectively. Gradually, nipples toughen and the sensation changes, as the two get used to each other during this process. Many parents successfully breastfeed their children for up to several years, without harmful effects or complications. Similarly, they can still enjoy sexual stimulation and pleasure with their partner(s).
Although serious breast damage may affect breastfeeding, nipples are tougher than some might expect. Now that you know, feel free to enjoy their many incredible functions!