medicine and sex

The Bioethics of Clitoral "Reduction" Alone Is Questionable Enough. Now This?

Posted by figleaf | Tags:
Mon, 2010-06-21 14:59

Via an email tip from reader HW, Alice Dreger and Ellen K. Feder of The Hastings Center’s Bioethics Forum call out a… peculiar form of aftercare for children who’s parents have subjected them to surgery to correct clitorises that are “too large.” They’re talking about an article in the Journal of Urology from 2007 called “Nerve Sparing Ventral Clitoroplasty: Analysis of Clitoral Sensitivity and Viability” by Jennifer Yang, Diane Felsen, and Dix P. Poppas.

Dreger and Feder say

Writing in the typically dry, quantifying language of modern medicine, the authors report why they believe Poppas, a pediatric urologist at New York Presbyterian Hospital, Weill Medical College of Cornell University, has left a group of girls still able to have sexual sensation after he has removed parts of the girls’ clitorises. With parental consent, these girls’ clitorises have been cut down in size after the physician deemed these clitorises too big.

...

But we are not writing today to again bring attention to the surgeries themselves. Rather, we are writing to express our shock and concern over the follow-up examination techniques described in the 2007 article by Yang, Felsen, and Poppas. Indeed, when a colleague first alerted us to these follow-up exams – which involve Poppas stimulating the girls’ clitorises with vibrators while the girls, aged six and older, are conscious – we were so stunned that we did not believe it until we looked up his publications ourselves.

Read the quote in context here.

They continue

Although we have tried, we have been unable to locate any other pediatric urologist who uses these techniques. Indeed, we doubt many would, because we think most would – as we do – find this technique to be impossible to justify as being in these girls’ best interests. We understand that these tests might produce generalized knowledge that shows whether Poppas’s techniques are better than some other surgeons’, but it isn’t clear to us how this kind of genital touching post-operatively is in individual patients’ best interests. If the testing shows a girl has lost sensation through the surgery, her lost clitoral tissue cannot be put back. However, the tests would seem to expose the girls to significant risk of psychological harm.

In the course of our inquiries, made in preparation for this publication, nearly all clinicians to whom we described Poppas’s “clitoral sensory testing and vibratory sensory testing” practices thought them so outrageous that they told us we must have the facts wrong.

I think that’s about right. Leaving aside the much larger bioethical question of tampering with the genitals of children who are perceived to be intersexed before they themselves are old enough to participate in the decision, let alone before they’re old enough to determine for themselves what their preferred sex, gender, orientation, and identities are there’s the whole question of… how the heck this follow-up experimentation is ethically justified?

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Vagismus, Dyspareunia, the Best Not-Foreplay and Not-Sex Ever... Oh, and Twisty Faster Too

Posted by figleaf | Tags:
Fri, 2009-02-06 00:10

Twisty Faster of I Blame The Patriarchy, while fulminating against the ills of vaginal penetration in general, efforts to relieve vaginismus and, especially, to treat it with injections of brand-name botulism toxin, also has a good point. In a footnote, sure, but still a good point.

This psychnet-uk.com is a real peach. It appears to reject the notion that anything short of “actual intercourse” may be classified as sex. Orgasms achieved through clitoral stimulation are categorized as “foreplay.” Seriously! in 200-fucking-9!

Read the quote in context here.

Um. Yeah, by their definition the partner I had the most memorable, whole-body-shuddering, hands-trembling, heart-thumping, can’t-speak-in-complete-words-let-alone-sentences, years-later-wake-up-dreaming-about umm… um… series of physical-relationship engagements while hardly ever having “sex” at all.

Frequent vaginal penetration, yes, but not with the body part Twisty loathes most, and frequently no part of mine at all. Nor at my instigation. Nor for that matter by my hand or any other part. (Well… actually sometimes with my hand, or most of it.)

But as far as I can tell since it wasn’t vaginal penetration with Teh Cock none of that was sex either.

Hmm… since she didn’t have (external) clitoral orgasms it wasn’t foreplay either.

Dang, we must have been bored senseless!

Worse, since what we did do never counted as sex then none of the other ways we gave each other and ourselves sometimes almost painfully intense orgasms wouldn’t have been foreplay either.

You know what we did do though? We talked a lot (we didn’t always live in the same place.) And we showed each other what we liked to do to ourselves. And we spent a lot of time with each other. Naked. Touching each other. All over. No, I mean all over. Like massage. Only erotic. Like back scratching. Like shoulder rubs. Like exploring each other, your hands on top of theirs not guiding but following, their hands on yours but again not guiding but following. Like tracing each others faces, and backs, bellies, toes, ribs, throats, insides of forearms, insides of knees, curling little wisps of unshaved hair and always, always trying to get as close to tickling as possible… without tickling at all… till your skin was almost electric, till just warm breath was erotic fire. Like licking, sucking, mouthing each other, slurping fingers, ears, lips, toes, breasts, labia, cock, throats. Like oiling each other and then sliding over and across each other, reveling in not just the sensation but the weight. Like cupping each other’s groins, hers wet, mine hard, glowing in the infrared with hot blood heat. Like jacking and jilling ourselves and each other…

But since she loved penetration… but was never moved by intercourse… at least not with me and maybe not with anyone mortal… what we discovered together instead was, well, some of the most erotically profound not-foreplay-nor-sex-according-to-psychnet-uk* I’ve ever had in my life.

—-

Here’s the thing about Twisty though. Everybody assumes she’s a lesbian. Or asexual. Or a survivor of this or that. Or an internet troll. Maybe so although unless she says so out loud it’s really none of our business. But even if she turned out to be the founding matriarch of the F(eminist)LDS with 131 husbands stashed away in a compound somewhere near Waco it still makes sense that patriarchal crap (like Psychnet-UK’s assertion that another vagina-related psychological disorder, dyspareunia, can be caused by insufficient foreplay or infection and can be treated by counseling and psychotherapy or with medication or lubrication) would drive her batshit insane.

Actually it would make more sense that the grand matriarch of 131 husbands would have zero tolerance for standards of phallocentrism so rigid that sex isn’t even defined for a woman without a jack lodged firmly in her pulpit. For that matter just assuming that she’s a polyandrist would also explain her sense that women, being human, should have sovereignty, acknowledgement, place, compensation, and co-location with men on the species definition of H. Sapiens Sapiens.

I’m not saying she is or isn’t any particular way because I either don’t know or don’t remember. Just saying it wouldn’t be necessary to be a radical feminist separatist lesbian to carry on the way she does. And therefore it’s not terribly useful to assume she is… and to use that assumption to rule out everything she says… instead of just the stuff you disagree with.

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Giving everybody a warm round of (self) applause

Posted by figleaf | Tags:
Mon, 2007-12-10 00:55

This is one of those tricky posts that starts out seeming to be exactly like one thing, but is actually about something else entirely.

Bad Influence Girl has a suggestion (not really a "sex tip") that I just can't speak highly enough of: don't feel weird about rubbing your or your partner's clitoris during intercourse.

for some reason i was always one of those girls who believed that masturbating yourself while having sex with a partner was rude.

...

when you’re making love you have to be sensitive to your partner’s feelings and you have to try to work your suggestions into the session without being quite as declarative about what you might want. or at least that’s what i used to think.

i thought that right up until i was fucking my ex-lover and he wanted to fuck and i wasn’t feeling really ready yet but i did it anyway and since i didn’t give a fig about him i reached down and i started to masturbate myself.

i did this cautiously because i really did believe that a man would get insulted by a woman helping herself out during sex. yeah, i don’t get what i was thinking either.

his response was, needless to say, not what i expected. he proceeded to get more turned on and say something along the lines of “oh yeah” and then charge forward with every evidence of greater enjoyment.

this was astonishing to me. wait wait wait, you mean if i help myself out that will turn you on???

Read the quote in context here.

Now it's really really important that you don't mistake encouraging women to get themselves off (with fingers or toys) as letting men off the hook or, even worse, as yet another way to put on a show to make the man think you're "hott." Nuh-uh. There's still plenty of ways he can cooperate with you to make sure you both have an equally fulfilling time.

But let's get over the notion that "She Comes First" means her/your orgasms are all his/my responsibility. It's not that it's not very, very nice of a partner... not to mention fun and intrinsically pleasurable... for a man to put their hands, tongues, thighs, and/or cocks to work with focus aforethought to his partner's climaxes. It's just that an awful lot of the "she comes first" mentality revolves around regressive ideas about men were designated the active party and women were supposed to receive passively whatever he he dished out, however capably or incapably.

And let's get over even the faintest fantasy that women's orgasms from hands-free intercourse are "normal" or "real" orgasms. First because that would make somewhere between 60% and 80% of women unreal and abnormal... and that's just not how rounding numbers up or down in arithmetic works. And second because, again, as Rachel Maines puts it, assuming cocks are the right, best, or most "natural" tool for producing orgasms is being pretty androcentric. Remember, this isn't saying nobody has orgasms from hands-free intercourse, just that nobody should assume that if they don't they or their partners are doing something wrong.

Speaking for myself I started out in that me-the-provider, she-the-beneficiatry mindset where no matter what position, I made sure I was in good contact with her clitoris, and no matter what there was no way I was going to come before her... which considering how cramped my wrist might get, or tired I'd get supporting all my weight with one free arm, wasn't all that difficult. And to be honest it's fun, it's sexy, it feels wonderful (for both of us) and most of the time, in most positions, in most situations, it's not hard to swirl slippery-slick fingers over the pencil-firm ridges under butter-soft hoods. And finally, immature thuggery notwithstanding my orgasms feel especially good when you're bucking and throbbing and squeezing your muscles through your own.

But! I'm just sayin' though that it doesn't have to be his job. There are some positions where my hands might be needed more to brace me, to hold you, to keep us at tempo, or upright (or even afloat!) And if not? Well, it's still ok, even great, for you to slip a free hand between or over or underneath us to press and roll your own flesh. Even if what I'm doing feels good, even if it feels very good, if you can make it feel even better then the more the merrier!

If the idea of women being responsible for their own orgasms would have been largely off the table for first-wave feminists and their partners (who weren't even allowed to vote let alone use birth control let alone express anything but puritanical virtue), and if the idea would have been infuriating to 2nd-wave feminists (who with 100% justification were dead sick and tired of men not even realizing their partners could have orgasms, and being slightly squicked -- in court! -- at the very idea) it seems like it seems perfectly logical to third-wave feminism where enjoying sex for one's self instead of "giving" yourself to a man was one of the earliest distinctions.

Anyway, while it might seem a little counterintuitive for a man to encourage his partners to take care of their own pleasure during sex, and especially for a man to be encouraging other men to encourage their partners to do likewise there's a method to my madness.

Two methods, actually. If the first method is that men and women both need to get over the notion that men should ultimately be the providers of women's pleasure[*] and women the passive recipients, what of my second method?

Well, Bad Influence Girl hints at it in her post...

...it's funny that i ever found [masturbating myself] strange since i always (and still do) liked it when a man helped himself during fellatio.  in fact it made fellatio more fun for me when they participated... and yet i still thought it was weird.

And this gets to the point I really wanted to talk about. Oh, but let me make one more little digression: almost everything we talk about when we talk about "immutable truths about sex" deals primarily with sex between the ages of, oh, fourteen and twenty four. Period. Anything after that is pretty much expected more of the same thing only maybe with more wrinkles and practice, plus some kind of something to do with hormones, yada-yada-yada.

Instead both men and women's interests and drives tend to continue to develop, converging to a considerable degree sometime in the 40s so that both men and women report that intimacy and sex are equally important. And, not infrequently, the roles occasionally reverse such that older men may be more content to snuggle while women begin to grow a little impatient with it.

So after that brief digression where are we? Oh yeah. If you look at the entire sexually active population rather than just the 14-24-year-old section, you start running into a lot of women who know what they like and how to ask for it, and you start running into a lot of men who've discovered the pleasures... and sometimes the necessity... of taking your time.

And given our weird little sexist tradition of women rejecting younger partners at much the same rate men reject older ones, and you wind up with a years-long period in the average heterosexual relationship where it's the man rather than the woman who many need to help himself out the way Bad Influence Girl helps herself.

And I'd like to add that it's no more good or bad when men do it than when women do. And, as with Bad Influence Girl's experience, it doesn't, and even shouldn't have to be "cheating" to do so.

This is not, incidentally, an invitation to, or justification for, the pornified convention of "facials" and "money shots" as a matter of course. Just making the point that not everybody, at every point in their lives, is able to come with the (stereotypical) effortless reliability of a teenage boy.

Oh, one final point for both men and women: there are a number of medications out there that suppress elements of sexual functionality. The anti-depressant Prozac was notorious for almost completely blocking orgasm while allowing lust to build, and interest in sex remain, unimpeded.

Years ago now I took a mild dose of a related anti-depressant and yeah, for about two years sex was great but orgasms elusive in the extreme! This was pretty demoralizing for my partner at the time who didn't object to my energizer-like endurance but did object to how pretty much everything she or I did left my cock standing happy with the attention but perplexed as to what to do next. In that situation, if I was going to have an orgasm at all it pretty much had to be me with my hand, moving at exactly the right speed, with an almost scary amount of pressure, for a really, really long time.

Again, because sex is actually a ton of fun even without orgasms, I really didn't mind a bit. But again, it left my partner at the time quite a bit less enthusiastic, and unsure of her own abilities. If I'd had the realization then that Bad Influence Girl raised we probably could have had more productive conversations and a lot less guilt on both our parts.

So. To conclude what's become a really unforgivably long post, At various times in one's sexual life we all might find it helpful to take mattes into our own hands during partnered sex. That's perfectly fine, but I'd like to add that it's also not necessary to wait till it's helpful as... it can also be a lot of fun, for both parties.

[* Note: Yes, even though through porn and knuckleheaded Details Magazine articles men seem increasingly content with unreciprocated blowjobs, the fact remains that *if* women are going to get orgasmic rather than service-related or "job-well-done" related pleasure from men the assumption is that it should be the men who do... or don't... "give" it to them. So I stand by my point. --fl]

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Sex education for cancer survivors and other medical patients

Posted by figleaf | Tags:
Mon, 2007-07-30 10:41

When I was in 10th grade my English teacher went into the hospital with some kind of abdominal complain and came back out with a full hysterectomy. Which didn’t sit very well with her, her being newly married, still childless, and still only in her mid 20s. She’d let it pop up in conversation every now and then and each time she’d cut it off with a remark along the lines of “well, I guess I’m supposed to feel lucky I’m alive.”

Hmm. Another interesting article from ScienceDaily.com, this time about sexual problems for long-term cancer survivors from the University of Chicago Medical Center. (I used to read ScienceDaily for work, well, daily. I’ll probably start dialing it back into my regular rotation again.)

“Discussions with a physician about sexual consequences of cancer and cancer treatment matter a great deal to many of these patients,” Lindau said. “But survivors report that such conversations infrequently occurred. If such discussions are not happening in this context,” she said, “we suspect that they are even less likely to occur when the connections between disease or treatment and sexual function are less apparent.”

“It seems unbelievable to me,” added one cancer survivor who responded to the survey, “that a surgeon would remove one’s sexual organs and never talk about sex.”

Read the whole article here.

Two points worth mentioning about the study. First, it focused on 20 year survivors and a lot (a lot!) has changed since then when it comes not only to quality of sex but general quality of life issues in medicine. The attitude back then was much more “you’re lucky to be alive, quit complaining.” Or at least a lot less than there used to be.

Second point being that only women survivors were studied but I’m pretty sure the findings and recommendations would benefit all survivors.

The first study to look at sexual function in very long-term female survivors of genital-tract cancer found that these women were pleased with the quality of their cancer care but less satisfied with the emotional support and information they received about dealing with the effects of the disease and treatment on sexuality.

While 74 percent of the women in this study believed that physicians should initiate a discussion about sex, 62 percent of women who had undergone “severe compromise to their reproductive and sexual organs” said their physicians had never brought up the effects of their treatment on sexuality.

Women who had not had such a discussion were three times as likely to suffer from multiple sexual problems at the time of the survey, the researchers report in the August 2007 issue of Gynecologic Oncology.

And of course a disconnect between treatment of non-sexual vs. sexual side effects isn’t limited to cancer survivors. Any number of other medical procedures, and all kinds of prescription drugs also affect sexuality in all kinds of ways from instant menopause after hysterectomy to instant impotence from major nerves severed during prostate surgery to a simple inability to reach orgasm on some antidepressants or loss of interest on others. Oh yeah, and some people wind up with frequent, spontaneous, uncontrollable-and-therefore-unwelcome orgasms.

I know some of my readers are in school to become sex therapists. If I was looking into careers in sexology, medicine, and/or sex and relationship counseling I think I might do worse than specialize in the study and treatment of medically-induced problems with sex. Unless I’m terribly behind the times I think it would be a wonderful area to go into where I think you could help a lot of people.
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