Sex Education: Does the Conservative Approach Protect Children?

A CBC producer contacted me about the Ontario Progressive [sic] Conservative government’s decision to pull the revised 2015 Human Growth and Development curriculum.  In the face of ongoing public outrage, the government has been flip flopping ever since.  The producer asked me what they are proposing with this rollback; and asked about my biggest concerns.

As of this writing, the education minister has made no proposal at all regarding what teachers should offer as sex education in September 2018.  They have given no firm proposals besides a promise to consult widely before establishing a new curriculum.  The 2015 revision was, incidentally, the most consulted upon curriculum document in the province.

It is generally acknowledged that the government is rewarding their social conservative base which wants to “conserve” an ideal, ignoring fundamental changes in our society.

We’ve come a long way

Long before same gender marriage became a reality with the enactment of the Civil Marriage Act on July 20, 2005, Canadians had accepted and even celebrated same gender relationships.  Canadians are becoming used to the concept of transgender children, youth and adults.  They are beginning to understand gender fluidity.

We cannot “conserve” a mythical past where adolescents wait until marriage to have sexual relations, where gay people do not exist, where there is no sexual abuse of children; and where pornography and its related sexual scripts aren’t as common as dirt.

The World Health Organization’s definition of sexual health is the starting point:

 “Sexual health is a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.”

 Based on the above definition, if they revert to the 1998 curriculum, the spirit of the 2015 curriculum – providing agency to children and youth – will be lost.

 The spirit of the curriculum

The revised curriculum teaches children starting in grade two, that they can say no.  In this way, they begin to understand the basic concept of their personal rights, which eventually include their sexual rights.  As they develop agency, they also learn that if that line is crossed, they can tell someone and get help.  Because they learned the dictionary words for genitals in grade one, they have the tools to be explicit about their abuse and the permission to do so.

Kids who are beginning to come out to themselves as queer will have learned in grade three that there are invisible differences; and that these include diverse families.

When they learn about self-pleasuring in puberty classes, it deepens the concept that their bodies are their own; and that those bodies can afford them pleasure (notwithstanding the absence of the word “pleasure” from the new curriculum).

Building on these initial concepts, in middle and high school, they learn about online safety, including sharing and posting of sexual comments; and the skills of communication.  They learn that a relationship can be gradually sexualized – that there are higher and lower risk sexual activities.  They learn the value of waiting; and how to protect themselves if they engage in higher risk activities.

Agency means they can make informed decisions.  Parents and politicians opposed to the new curriculum want to keep this agency from them.

Prevention

Glen Canning sees the value of comprehensive sexual health education.  Had there been a good program in Nova Scotia for at least 10 years, he argues, he would still have his daughter.  Rehtaeh Parsons might not have been sexually assaulted, videos of the assault would not have been widely shared for other adolescents’ entertainment; and she would not have killed herself because of the ongoing harassment.

To be clear: we are talking about societal issues across our country.  For example, comprehensive sexual health education as described in the Canadian Guidelines for Sexual Health Education can make an impact on Indigenous communities suffering the ongoing effects of residential schools.  It is one tool which may help them become better equipped to end the cycle of abuse – physical and sexual – preventing more cases of missing and murdered women in their communities.

I am not reaching here.  Comprehensive sexual health education has a profound effect on society as a whole.  If we are going to eradicate rape culture, decrease rates of sexually transmitted infections, put an end to the sexual abuse of children, allow for children’s, youths’ and adults’ full expressions of their sexual selves, we need to start with this most basic concept of agency.

My biggest concern is that the Ontario government wants to roll back gains that have been made to protect our children.  The majority of parents want this education in the schools: the research is clear.  Our opponents would say they are the ones who care about children – and of course they do.  But their methodology is seriously flawed.

Primary prevention is children’s best protection.  Ignorance is not preferable to knowledge.  It’s time social conservatives took their collective heads out of the sand.

 

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Porn and sex ed

Listening to CBC’s The Current this morning I had a flashback to one of my earliest experiences teaching a puberty class, some time in the 1980s.

I was answering their written questions, when I came across one about a woman and a horse.  In those days, kids’ access to porn was through magazines and videotapes – you know, those things that were  supposed to be locked up in the cabinet?  If memory serves, I answered the best I could without being too graphic.  I let them know that sexual activities with a person and an animal is called bestiality, which is illegal, because it exploits the animal.  And although some adults like to watch those videos, they are not for children.

I am not sure how I made through the rest of the day.

The introductory lesson we used in puberty classes for 10 and 11 year olds included asking where they got their information about puberty and sexuality.  I began to ask classes whether they had computers at home and if they had access to the Internet.  Then I asked whether they had ever come across images that upset, frightened or grossed them out.  Inevitably, at least half of the hands would go up.

I wanted to know how they handled it.

Most of them said they would “exit” or shut off the computer.  I also suggested that they tell an adult that they had come across these images so that they could deal with their feelings and have their questions answered.  Hopefully the adult(s) at home could prevent any inadvertent re-appearance of porn sites.

Their admission gave me the opportunity to tell them this was adult entertainment, that it was not a typical representation of how people were intimate with each other; and that it was not helpful for them to continue looking at it at their age.

Back in the 1987, York University’s Dr. James Check said 12 – 17 year olds were the primary consumers of pornography (address at Humber College conference, “Sexuality ’87: Male Sexuality” April 23-24, 1987).  In the age of the Internet, it is safe to say that children and adolescents have free access to explicit sexual images (as well as some very useful information if they know where to find it).  Some kids will seek out pornographic images out of curiosity and/or because they want to masturbate to these images.

Is pornography harmful?

The adolescent/adult use and misuse of pornography has been a pretty hot topic these past few decades.  Feminists, academics (feminist or not) sex educators and religious critics have weighed in on the potential ill effects; e.g., the porn driven sexual scripts adopted by young people, the unrealistic expectations raised by perfect bodies, huge penises and never ending streams of ejaculate, the need for increased jolts upping the ante in visual violence; and the normalization of sexual activities which, although considered repugnant by some, may become an inevitable expectation.

While some adults choose the erotica or pornography with which they feel comfortable, others have become increasingly dependent on it, disturbed by their inability to relate intimately with real, live lovers.  However, while there is plenty of ink spilled on these issues, the academic literature is far from definitive.

We do not yet know for certain the effect of these images on children and adolescents.  “Not helpful” is a safe guess.

Consent and choice

Guiding principles for sexual health education include comprehensiveness.  Talking with children and adolescents about porn is part of sex education.  The cornerstone of teaching about sexual activity is, as always, consent.

When friends encourage them to watch porn, when they are asked to send sexual images of themselves or when their images are sent on for the entertainment of others there is a clear lack of consent.  Talking with older adolescents about pornographic scenarios and the portrayed lack of consent as well as the normalization of violence is critical to their understanding of how damaging some of these scenarios may be to their sexual development.

People who are raising children – and their allies in the classroom – need to face reality: children and adolescents are exposed to images which we do not feel are appropriate for their age.  Frank discussions about the reasons why they should wait until they are older to make these decisions are a critical component of comprehensive sexual health education.  We do not need to be judgmental or prescriptive; but we do need to try to dissuade them from using porn while they are children.

I look forward to the day when erotica and pornography for adults will be like fair trade coffee or chocolate: made by participants who have a stake in the game; enjoyed by people who savour what they have chosen.

In the meantime, this does not include our children.

 

Your Vagina does not Need Feminine High Jinx Products to Stay Healthy

Lolling in front of the TV one evening, I sat bolt upright when a commercial for a “vaginal wash” appeared on the screen.   The product contains “LactoPrebiotic” to “help maintain a healthy pH balance to fortify natural defenses”. They recommend women “use it every day as an important step towards good feminine health”.  Shades of perfumed, daily panty liners, here we go again.  A healthy vagina should have a “light and fresh scent”.

I assumed LactoPrebiotic was an invented term.  But no, there is such an animal.  WebMD explains,

“Probiotics are “good” bacteria that help keep your digestive system (my emphasis) healthy by controlling growth of harmful bacteria. Prebiotics are carbohydrates that cannot be digested by the human body….The primary benefit of probiotics and prebiotics appears to be helping you maintain a healthy digestive system (again, my emphasis).”

Their marketers have extrapolated benefits from one body system to another.

I found an article examining one of these “daily care for intimate skin” products, including a detailed examination of the ingredients.

I am horrified that these products continue to find a place on the market.

We know how to look after our vaginas; and countless articles have been written about maintaining good vaginal health.  Even this recent article mentions avoiding douching; but it neglects to warn women away from other vaginal cleansing products.  There is plenty of good advice, but also some missed opportunities.

Normal Vaginal Fluids

Vaginal fluids are normal.  Mucus produced in the cervix comes out through the vagina throughout the menstrual cycle indicating the most and the least fertile times in the cycle.  Vaginal lubrication is produced by the Bartholin glands.  Female ejaculate, a clear fluid that is projected from the urethra, is not strictly speaking vaginal but may be perceived as such.

Women who are aware of their normal vaginal fluids will likely be aware when these fluids look, smell or feel different.  Over the counter (OTC) products encourage women to self treat when there is a perceived problem.  I often see ads for OTC yeast treatments; and recently one for Bacterial Vaginosis (BV) came across my TV screen.  The latter surprised me, because the treatment for symptomatic BV is antibiotics.

The other issue I have with self treating is that there are several Sexually Transmitted Infections (STIs) that produce similar symptoms, like irritation and unusual discharge.  If a woman has had unprotected sex with a new partner, male or female, she would be well advised to have a swab taken to diagnose the problem.  If she has chlamydia or gonorrhea, she will need to take antibiotics.  Her partner(s) should also be treated.  Untreated chlamydia or gonorrhea can result in Pelvic Inflammatory Disease (PID) and eventual infertility or ectopic pregnancy.

I acknowledge that a woman who has had yeast infections in the past and is well aware of the symptoms may choose an OTC medication; but symptomatic BV requires an antibiotic.  It has also been linked to PID.

Bayer has a product that claims it can “permanently beat Bacterial Vaginosis”.

They say it restores the pH balance in the vagina.

There is no guaranteed prevention for BV.

Women coming to the sexual health clinic where I worked would frequently return with symptoms of BV.  I followed the research closely for years as scientists looked for a way to encourage and maintain the vaginal production of the necessary lactobacilli.  They did, however, discover some reasons why women may produce fewer of these bacteria critical to vaginal health.

“Vaginal douching or other washing practices are frequently cited as a cause of disturbance of the vaginal flora leading to the onset of BV. In a prospective study, douching was associated with loss of protective H2O2-producing lactobacilli and acquisition of BV. A case-control study…investigated associations between vulval washing, vaginal washing, and douching and BV… Use of bubble bath, antiseptic solution, and douching was more common in women with BV…”

Vaginas should smell like vaginas

Lysol was once used as birth control (nope, didn’t work) but also to help women practise “complete feminine hygiene”.  For decades, women were told they needed to stay fresh, clean and essentially cover up their natural odours.  But being aware of our personal odour is what helps us to monitor our vaginal health.  My feminist cohorts were railing about this issue from the early 1970s.  Have we come a long way, or are we still stuck in the rose bushes hoping we’ll smell like one?

 

Women in Lust – The Sex Goddess Project

In April of this year, I attended the Toronto International Porn Festival.  I spent a few hours watching films – and clips of films – curated from the last ten years of feminist pornography.  I am not a consumer, but I figured any sex educator worth her salt should dip in every now and again.  I’m glad I did: There was fun; there was joy; and consent was the order of the day.

My views of pornography had evolved over the years.  Consumer prevalence remains high.  An article in the Canadian Journal of Human Sexuality reports that, when asked about their recent online solitary arousal experiences, 91.7% of the men interviewed said they had watched sexually explicit videos involving men and women; and 47.4% of the women.  The sample: 239 young adults at a Canadian university.  Current mainstream heterosexual pornography, where the scenes are rough and misogynistic, appeals particularly to young adult males.  While they work for self-pleasuring, they are not so good at helping men figure out how to be good lovers.

There is quite a difference between what one considers to be great sex and popular depictions of sex aside from pornography.  On TV doc-and-police shows, the scene goes straight from the mutual recognition that two people want to get it on, to ripping off each other’s clothes at the nearest opportunity.  No slow build and little context.  And standard, gorgeous bodies.

In the new TV series, The Good Fight, so far, there is only one loving, ongoing intimate relationship – Maia and her wife – and sadly, their sexual intimacy gets splashed all over the Internet in retaliation for her father’s Ponzi scheme.  Maia’s mother has a long-term adulterous relationship with her brother-in-law.  Lucca the lawyer, (remember her from The Good Wife?) seems to be as cold blooded as The Good Wife’s Kalinda.  Diane Lockhart sleeps with her ex-husband, which she says the next morning, was nice, but then refuses to renew their relationship beyond friendship.

Perhaps the lack of relatable intimate relationships is a metaphor for the series’ theme of whom to trust.  After all, trust is the hallmark of a positive relationship.  And from vanilla to kink, consent needs to be the order of the day.

Enter Ricardo Scipio

Ricardo contacted me about his newest book, “The Sex Goddess Project”.  Huffington Post recently interviewed him about it and  included some of his photos.  I liked what I saw and willingly posted excerpts from his press release on my professional Facebook page.

Says Scipio,

“If sexual images were food, people would be inundated with cheap junk food. I wanted to create a body of work that offers something more nutritious and satisfying for the health conscious, more discerning palette.”

He sent me a preview of photos from his latest book.  Lucky me: I had the opportunity to peruse dozens of images of women having a lusty old time doing all kinds of sexual activities in a variety of positions with a variety of partners.  These images reminded me of those I had seen at the porn festival – except they are not porn.

Scipio is not producing porn, which he doesn’t watch and whose messages he abhors.

“I’m a lover of all things authentic, and porn isn’t authentic.”

“Women have for too long, and in too many cultures, had their sexuality suppressed – only to be pseudo-released within the stiflingly unkind world of porn. I’m extremely humbled and proud to provide a vehicle for women to unapologetically express themselves with love and authenticity; something porn cannot offer. Sex is way too important to leave in the hands of pornographers.”

His photos portray real people of all body types, skin tones, genders and orientations. One of his models said,

“This was important.  It was a chance to be an activist in the sensual world. To reclaim sex for the othered bodies. The fatties, the people of color. To call bullshit on the ones who say ‘we’ don’t do this simply because they had never seen it done.”

Many of the women in his photos are looking straight at the camera with a huge smile on their face.  It is not the come-on of porn: It’s “Look at me; I am having such a good time”.  Most of the focus is on their pleasure.

To be honest, I did not get a buzz from the photos; my pleasure as a viewer was aesthetic and political.

His models understand this:

“Let’s just say that the bloom is beginning to fade. I’m a 51-year old woman who is 150 lbs overweight…  After Ricardo asked if I would be photographed for his Sex Goddess book, I realized that showing the inner me – the one who loves sex and feels that it is her special, healing gift – should be shown in full daylight. Yes, I’m fat. Yes, I’m older. However, I don’t want to be shamed into feeling badly about my body because our culture deems it ‘ugly’ or ‘gross’ to be sexual if you’re of a certain age and size…”

I am looking forward to seeing the rest of the collection.  The book is not available to the general public – just to Scipio’s supporters and those who collect his work. However, in order to showcase the “ethos” of the project, he is planning an invitation-only online gallery screening for Canadians on May 20 and 21. Anyone can request an invitation.  I recommend that you do.

 

 

Hello, SOGC

Hello.  It’s Me.  I am ranting once again about HPV

Well, not about HPV, just the vaccines.  Actually, not just the vaccines: pretty much everything I heard at a day-long SOGC workshop with the long-winded title, “Women and their Reproductive Health Across the Continuum: Setting Priorities for Women’s Reproductive Health Research”.  Attending were both health professionals and interested individuals.  And me: women’s health advocate and HPV vaccine skeptic.

Regarding the latter, I waited till the very end of the day to finally screw up my courage.

“I am about to state a very unfavorable opinion.  There are reputable health professionals who are opposed to mass HPV vaccination; in part, because some of the research has been tainted by conflict of interest; and also because of the way public messaging has stigmatized parents who have decided not to vaccinate their children.”

I added that equating infection prevention and cancer prevention is what has made public health and Big Pharma messaging so compelling to the general public.

There was absolutely no response.

The Sunnybrook Hospital meeting space was set up like a dinner party, with long lines of tables, labelled with discussion topics for the afternoon.  Speakers’ topics were preceded by the title, “State of the Evidence”: Human Papillomavirus, Fertility, Contraception, Menopause and The Environment.  Three out of five talks set my teeth on edge.

First up, Dr. Nancy Durand.

After giving some basics about HPV types and statistics (10 – 30% of adults are infected at any given time – good one) and the risks for persistence (being over age 30, smoking, having multiple sub-types and immunosuppression) she launched into straight into HPV vaccines as public health strategy.

Dr. Durand assumed, correctly, that she had the room in terms of the evidence she presented on the three available HPV vaccines regarding efficacy and safety.  She said that doctors should treat these vaccines like flu shots and encouraged doctors to say, “Have you had your HPV shot yet?”  She suggested it could be administered to babies with their childhood vaccines.  She quoted research that indicated there should be no upper limit in vaccinating; and that even if one had already been infected, vaccination was still effective (first time I’d heard that).  And yet…

Hello from the other side

My electronic files are full of evidence of conflict of interest (COI) between researchers and pharmaceutical companies and the attempts to expose them.

Moreover, the accepted medical evidence also insists that the only adverse side effects are irritation at the site of injection and increased fainting.

Japan has changed direction on HPV vaccination.  France, Spain  and Denmark have also reconsidered their position.

Fertility

Dr. Heather Shapiro did not mention potential environmental causes of infertility.  When I asked her about this, she said that was a whole other talk.  She leapt into Assisted Reproductive Technologies starting at IVF without passing through less invasive techniques like IUI.  I did find out that 90% of IVF babies are healthy; and the rates of success decline with age; and that there are now fewer multiple births.  Her talk was less about fertility and infertility that assisted reproductive technologies.  One presumes the research is directed towards treatment rather than prevention.  No mention of Pelvic Inflammatory Disease.

Contraception

I was glad to hear Dr. Dustin Costescu discuss unintended births in the context of the social determinants of health.  He said they occurred more often in younger, racialized, poor and Indigenous women; and that the greatest risk was due to systemic factors.  Among the contributors to non-use were being a sexual or gender minority, funding, and failure to initiate contraception.  He also blamed health care providers who sometimes recommended a “washout”; i.e., stopping a method to see if side effects subsided without offering a replacement method.

He pointed out changing trends.  With women having their first child around age 30, they require about 11 years of contraceptive use.

I was glad to hear him say that researchers needed to understand women’s experience through qualitative research regarding access, counselling, decision making and understanding side effects.  In our discussion session in the afternoon, he acknowledged that front-line workers have a lot to contribute to research.  Here are some of my contributions in WordPress:

 

Menopause

Any of the women attending who had not already gone through menopause and were listening to Dr. Jennifer Blake were probably bug-eyed looking at the list of what sounded like inevitable symptoms.  Early on in her talk, she said that perimenopause, the 2 – 3 years preceding the cessation of menses, was the “best time to get help”.  Now if that isn’t a clear medicalization of menopause, I don’t know what is.

Dr. Blake was quite definitive.  The “pleats” that make women’s vaginas stretch more easily smooth out.  You’re going to shrink, was the message.  Not to mention the loss of bone mineral density, the release of lead stored in the bones, changes in blood vessels, changes in abdominal fat metabolism, decreased carbohydrate tolerance, loss of lean muscle mass, vasomotor symptoms (hot flashes that could last up to 20 years), mood changes, reduced stress tolerance and memory changes (or as comedian Sandra Shamas tells us, loss of nouns.

And, oh, yes, loss of libido.  I’ve had a few thoughts on that one as well.

Dr. Blake gave a nod to the importance of exercise and good nutrition before moving ahead with hormone therapy (HT), “the single most effective treatment”.  She spent a good deal of time discussing the history of research on the effects of estrogen, in particular, how the Nurses’ Health Study was written and interpreted.  One telling statement at the end of her remarks on HT: “there is a higher risk of breast cancer with later pregnancy than with hormone therapy”.  In other words, you don’t need to worry about using HT.

Not all women experience menopause the same way – and that also applies to women around the world, their diets and lifestyles.  Women who suffer greatly from menopausal symptoms who consider HT are well advised to limit the duration of its use.

Environment

I’ve saved the best for the last. Dr. Eric Crighton laid it all out.  There are currently 80,000 registered chemicals currently in use.  7,000 new industrial chemicals are introduced annually.  Pregnant women have 43 different chemicals in their bodies.

He pointed out that some people are at higher risk than others, most notably those Indigenous people who are living with contaminated water and mercury poisoning.  Of course, we are all exposed to environmental toxins.  According to Health Canada’s 2010 statistics, they caused 13% of disease burden, an increased risk of prenatal and early childhood effects.  He talked about pesticide exposure and its effects on the brain development of four year olds…in short, he scared the *&*^% out of his audience.  I was sadly familiar with some of these issues, in particular through the Canadian Women’s Health Network.

There is good work being done by CPCHE which has published a number of useful brochures, but he pointed out that individual actions are not enough.  Moreover, he said when someone is struggling, for example, to feed their family, environmental toxins are low down on their list.  If you can barely afford formula, the plastic in the bottle becomes a non-issue.

I spoke with him afterwards, thanking him for mentioning the struggle of nail salon workers to limit their exposure to workplace toxins.  He was aware of the work of the Toronto Healthy Nail Salon Network.

Hello from the outside.  At least I can say that I’ve tried

I’m not sorry I went.  I did learn a few things and have checked out a dozen links to the studies quoted.  But there was little opportunity to challenge the experts or change the tone of the discourse.  It does make me wonder why the SOGC invited us in the first place.

Aging and sex – what do we really want?

Recently over coffee, a friend complained that none of her friends seemed to want to talk about their sex lives any more.  Bear in mind, we are both hovering around 70.  You might be thinking: of course your peers don’t want to talk about their non-existent sex lives.

And you would be wrong.  Several of my aging women friends have healthy libidos and a strong sense of themselves as sexual people.  But they are sad that health issues get in the way.

Despite my friend’s regret that her friends did not want to open up, because I am a sexual health educator, other women have been very chatty with me.

“I miss it”, said one.  “It’s not like we aren’t loving with each other, but I miss sex, the way we used to enjoy it.

“I feel a sense of loss”, said another.  Because of my partner’s medication, his libido is completely gone.  He is happy to please me when I initiate, but it feels so one-sided”.

“We’ve worked something out,” said a woman whose husband is disabled due to a stroke.  In other words, they have figured out how to be sexual by getting around the impediments.

“My partner is like a teenager.  In his early ‘70s, he is ready – and able – at any time.”

“When my husband was in his early ‘80s, he found that he was unable to have an orgasm after his prostate surgery, so intercourse went on too long and too painfully.  We finally just gave it up.”

When I told one of my friends that I wanted to quote her in this article, she wrote:

“I would add that it isn’t just “health” issues per se that gets in the way, but our naturally aging bodies.  I don’t consider my thinning vaginal wall that makes sex painful a health issue as much as one of the unfortunate consequences of my body – at this age, biologically speaking – not needing so much estrogen anymore.”

Quite the range of responses.  And I haven’t even asked my lesbian friends.

What does the research say?

I have written before about sexuality and aging  as well as the “joys” of online dating and the sexual pleasures of aging.  I have given workshops on the issue and spoken at conferences, but I can’t seem to let this topic go.  And the personal stories are so compelling.

The studies tell their own stories.

“One such study noted that, “61% of all women in this cohort were satisfied with their overall sex life. Although older age has been described as a significant predictor of low sexual satisfaction, the percentage of…sexually satisfied women actually increased with age, with approximately half of the women over 80 years old reporting sexual satisfaction almost always or always.” This confirmed an earlier study by the National Council on Aging which concluded, “Seventy-four percent of the sexually active men and 70% of the sexually active women reported being as satisfied or even more satisfied with their sexual lives than they were in their 40s.”

And lest we forget, no matter how we define “sex”, intimacy generally trumps sensation.  Alex McKay of SIECCAN  said in a talk on mid-life sex and STIs, that there was, in his opinion, a “six-minute rule”.  Quoting a study on heterosexual use of condoms, he said 71% of women who had 6 – 10 minutes of post sex affectionate behaviour rated their last penis in vagina (PIV) intercourse as ‘very pleasurable’ as opposed to 44% of women who experienced 0 – 5 minutes.

Health Canada is encouraging us to carry on as is the Canadian Public Health Association.

“Along with better health and active aging comes sex! A nationally representative sample of 3,005 Americans between 57 and 85 years of age revealed that nearly three quarters of seniors aged 57 to 64 were sexually active; while more than half of seniors aged 65 to 74 and more than a quarter aged 75 to 85 reported being sexually active.”

However, medication can interfere with one’s sex life at any age.  For example, “currently available antidepressants may aggravate sexual dysfunction and make depression worse, a new survey of US adults with major depressive disorder (MDD) suggests.”

There are other meds that can get in the way of sexual functioning.

And people get scared to become “active” after an illness like a heart attack.

“Although most younger patients are sexually active 1 year after an acute MI [AMI], one in 15 women and one in 20 men never resume one of life’s greatest pleasures, a new report finds.”

Tell me what you want, what you really, really want

Another factor in maintaining sexual relationships into our ‘70s and ‘80s may be loss of interest, especially for those in long-term relationships.  Like lesbian bed death, for heterosexuals, the statistics are just a bit less “drastic”.

Then there are those older people having great sex, by which I mean at least connection and intimacy.  Others may be having more PIV sex because of erectile dysfunction medication, which may bring its own problems, like oppressive demands.  According to a study  back in 2003, “few studies have focused on the possible detrimental effects for women of Viagra use within a heterosexual relationship”.

“We argue that while previous medically-oriented research in this area has generally assumed an unproblematic link between Viagra use and the resumption of penetrative sex within heterosexual relationships, more attention needs to be paid to partners’ perspectives and desires, and to the specific dynamics of any given relationship.”

One wonders which people would choose: great sex without intimacy or intimacy without full sexual functioning.

I guess we want it all.  Love.  Intimacy.  Good sex, however we define “sex”.

Surely when there is open communication and a willingness to please, there is pleasure to be had.  If we see ourselves as desirable, some of that can translate into – if not desire and the mechanics that go with it – at least the desire to please.  And while some of us are wistful, others may be envious of others’ good fortune, however much of it “all” we have.

I look forward to hearing your stories.

Here are some disability resources that may be useful to people who are aging.

Do it Yourself Swabs

I was approached by a med-tech start-up company regarding their self-collection device for at-home screening “to prevent cervical cancer and Pelvic Inflammatory Disease (PID)”.  The Eve Kit’s promo video and Indiegogo funding campaign explains the device and their motivation for designing it.

Violeta Cobo, Territory Manager, said that “HerSwab™ (the device that collects the sample) has been approved for self-collection of cervico-vaginal samples” by Health Canada.  The device is to be launched in late 2016.

The promo video raised a number of questions for me.

The device was registered with Health Canada for “safety, efficacy and intended use”, but as I explained to Jessica Ching, co-founder and CEO, the term “approved” is open to interpretation.

But that was only a quibble.

How exactly did they intend to test for cancer, HPV and “STIs which could cause PID”?  Was the device a Pap test?  An HPV DNA test?  A swab for chlamydia and gonorrhea?

Ms. Ching explained that the device is not a Pap test.  It can sample for either HPV or gonorrhea and chlamydia depending on which test the woman prefers.  To detect HPV, the device collects the sample from the upper vaginal canal.  The lab uses PCR amplification to test for high-risk strains of HPV.

However, because Pap tests use cytology when they sample from the cervix, I expressed some concern in case the self-sample result was inaccurate.  A meta-analysis concluded that self-sampling and physician sampling were equivalent; but studies are ongoing.

Regarding the self-sample for chlamydia and gonorrhea a small study (189 women) found their swab for “easy, comfortable” and “suitable for diagnosis”.

As to what happens after diagnosis, Ms. Cobo responded:

“When a patient gets a positive result, she gets referred to one of the doctors we are going to work with. The doctor will follow up with her and prescribe treatment or refer to a screening visit (in case of HPV) if needed.  She could also grant us permission to share the results with her family doctor if she has one.”

However, when I asked about the availability of those doctors, Ms. Ching admitted that to date there were very few with whom they have been able to partner.  The ideal, she added, would be to eventually offer follow-up across the country; however, one of the rationales for the product is precisely the dearth of health care providers.

Do women want to do it for themselves?

The promotional material for the $85.00 kit argues that women find testing “awkward” and that they may not have time to see a health professional.  They also see at-home privacy as a plus.

I asked Ms. Ching about research they had done into whether and why women would prefer at-home testing.  They did focus groups with 20 women and spoke with 50 others from whom they gathered anecdotal information.  She also mentioned focus groups conducted by the Dalla Lana School of Public Health and St. Michael’s hospital and commented, “Our informal findings did mirror the findings of other published studies”.  A CMAJ commentary asks whether the time for self-testing in Canada has come.

The CMAJ commentary poses the question from a public health point of view about women at risk in Canada who might truly benefit.

In Australia, self-testing will be available in 2017 – to targeted women.  For me, this is the real public health issue.  In Australia,

“Women who don’t normally get pap smears – including indigenous women, victims of sexual abuse and those who avoid the test for cultural or religious reasons – have the highest rates of cervical cancer.  These are the women who, from 2017, will be able to collect their own tissue samples in world-first changes to the country’s screening program”.

Targeted self-testing strikes me as an improvement on the selling points of awkwardness, privacy and time constraints.

In Canada as in Australia, the women who get cervical cancer are not screened regularly and/or do not have follow-up and treatment for abnormal Pap tests.  They are poor, marginalized and Indigenous.  The Canadian government’s response has been expensive vaccinations for girls (and in some provinces, boys) against HPV.  Women’s health advocates would prefer to see better access to screening and follow-up through Pap registries; and improved access to health care, especially in remote areas.  According to the CMAJ commentary, some pilot testing of self-sampling has already taken place for these high-risk women.

The value of health professionals

 As someone who worked in a sexual health clinic as a counsellor for three decades, I have one more issue.

When a woman came in for testing, I explained the Pap test, what it was for and how it was done.  In fact, I often accompanied her to the examining room to translate (Spanish, French and occasionally very inadequate Portuguese) and in some cases, to hold her hand, especially when there had been past sexual trauma.

Counsellors use an intake sheet which covers not just medical, but also sexual history.  We find out if the woman has a history of sexual abuse, if she has been having unprotected sexual activity, if it was vaginal, anal or oral, if she understands the difference between the Pap test and STI testing.  We find out which STI she should be tested for depending on her risk factors.  We tell her about contact tracing in case we find a reportable STI.  We explain that HPV is very common and that only certain types may lead to cervical cancer unless the abnormal cells are treated.

These conversations are critical in helping a woman take control of her health in a way that DIY testing cannot.

Given the cost and limitations, it remains to be seen what role self-testing might play in this country.