Monday November 23, 2009
StoryCorps, an independent nonprofit whose mission is to honor and celebrate one another's lives through listening has designated November 27 a National Day of Listening. They are encouraging everyone to take one hour on Friday, the day after Thanksgiving, to sit down and record a conversation with someone important to you. Their website has tips on how to do the technical part and they also offer suggestions on questions you might want to ask.
I'm a big fan of StoryCorps, and usually stop what I'm doing when it comes on NPR. But I'm always keenly aware of the stories I don't hear on those StoryCorps moments, and how many of them have to do with sexuality and gender. Our experiences of our sexual selves and our experience of gender is intimately linked to how we experience the rest of the world. These are stories that say so much about the unique time and place we live in. These are stories that should be archived for history as much as stories about loved one's lost to war, schoolyard triumphs, work, and family life. In fact sex is in all these stories too, only it rarely gets spoken about.
Which brings me to this. I think it would be great if at least some of us who participate on Friday decided to take a risk and ask at least a few questions about sex and/or gender. You could even make your whole conversation about it, but that might be too much for this first year.
If you're game, but not sure where to start, I thought I'd offer my own question generator below. If you're reading these questions and bristling at the idea of asking a friend, family member, or partner any of them, it's hard for me to make an argument here, but I promise that there is little that is as powerful as letting someone talk about their feelings about sexuality. It takes good listening skills and compassion, but the payoff is worth it. Remember, these are only suggestions.
National Day of Listening, Sex & Gender Questions
How did you learn about sex? Who was the first person to talk to you about sex? Do you remember what they told you?
What do you remember about learning about your body as a child?
How was nudity dealt with or talked about in your family?
How did you learn what it means to be a man/a woman?
Can you remember (and tell me about) a time when you felt you didn't live up to others expectations of you as a man/a woman?
Can you describe a time in your life when you felt happiest sexually?
How important is sex in your life?
Who was your first crush? What do you remember about how that felt?
What do you remember about your first great love?
Do you remember anyone in your family talking to you about sex? What did they say?
Can you remember what you thought about sex before you ever had it?
Do you remember how you felt after the first time you had sex?
Do you remember the names that you first learned for going to the bathroom?
Do you remember the names that you first learned for your body parts?
How would you define pleasure?
How do you think people should treat each other when it comes to sexual and gender differences? What do you notice about how people actually do treat each other?
Thursday November 19, 2009
I just had a chance to talk briefly with Caroline Earle from CREA about what sounds like a great new project. It's an online course offering training in disability, sexuality and rights for people working in development, health and rights NGOs and social activists. Who could this training be good for? Caroline gave the example of someone working in an HIV/AIDS clinic who would certainly be aware of how HIV impacts people's lives, but might not have made the connection to disability and get how powerful (for both individuals and organizations trying to make change) linking sexuality, gender, and disability can be as sites of political struggle.
This is such a needed training. I find that in even the most sexually progressive organizations there is still a general lack of acknowledgment of disability rights in general and folks living with disabilities in particular. And on the other side, it's often hard to get disability rights groups to take up sexual rights as part of their mandate.
The training is entirely online and they seem committed to using as accessible technologies and formats as possible. It's nine weeks and will take about five hours a week, but people can work, to some extent, at their own pace. Each week offers a power point and lecture notes, readings, and activities/assignments.
It sounds like a great primer for anyone interested in opening up the work they and/or their organization does and shifting away from a model of exclusion (which, lets face it, is how most organizations function if you identify as disabled). I also love that assignments will focus on helping each participant find ways to bring what they are learning back to their organization in a really practical and concrete way.
Lastly, it's only $50! And they offer a fee waiver if you or your agency simply has no money at all. I've been part of workshops and courses like this in the past, but always in person and always when I had the time and money to attend. Two privileges a lot of folks working around sex and disability don't have.
The course developed out of a panel at a conference called Disabled Queer Women Working Together for Our Sexual Rights and the format of doing an online course came from CREA collaborator and one of the course instructors Janet Price.
The deadline for signing up is December 18th. The course runs from February 1 to April 1, 2010.
You can find more information, download the course brochure and application form at the top of the CREA homepage (it's small, and easy to miss).
Related - Sex & Disability on About.com
Tuesday November 17, 2009
Pharmaceutical maker Boehringer Ingelheim (BI) is looking to create a lot of pre-emptive buzz for its gamble on the female sex drug market, flibanserin. Flibanserin is being developed as a non-hormonal treatment for low sexual desire in women, a market that's thought to be more financially lucrative than even the $2 billion dollar erectile dysfunction market.
On Monday they orchestrated several media releases, webcasts, and a presentation at a major sexual medicine conference in Europe, all to release data from Phase III trials on pre-menopausal women labeled with low sex drive (also known as hypoactive sexual desire disorder, or HSDD). The next few days and weeks will reveal how effective this first of many blitzes is likely to be.
All of this has everything to do with marketing and little to do with science. The data hasn't been released and no breakthroughs have been discovered. Still it's an opportunity to get a little more acquainted with a drug that changes brain chemistry and they hope will change, or direct, the global conversation on female sexuality.
Defining Sexual Desire
Sexual desire is a difficult thing to define, as even researchers involved in the flibanserin studies acknowledge. The model presented by BI researchers involves breaking down desire into three elements, which include:
Drive, referring to spontaneous sexual interest that is somehow biological or hardwired (what that actually looks like is only a guess).
Belief & values, including social, cultural, ethnic, religious, and other factors that impact how often we might feel sexual desire, how intensely we feel it, and how comfortable we are with it.
Motivation, which considers all the psychological and interpersonal factors creating a willingness to be sexual and feel sexual desire.
The pitch from BI researchers is that while good treatments exist for low sexual desire caused by beliefs, values, and motivation, we don't have anything to treat the drive component (which they call the "biologic" component). They believe that flibanserin treats the drive component of sexual desire.
How It Works
What they don't know is how flibanserin is supposed to achieve this. They know that the drug reduces serotonin levels, and their current guess is that it impacts sexual desire by reducing inhibitory effects in the brain (basically it's removing whatever is stopping you from feeling desire). But this is just a guess.
What It Does
On Monday November 15 the company did a major media push, releasing some of the data from their clinical trials with pre-menopausal women who had been diagnosed with HSDD. They released data at a sexual medicine conference, through media releases, and via phone/webcasts (one of which I listened in on). Here's a summary of what they have released:
BI conducted several studies in North America and Europe involving over 5,000 pre-menopausal women who had been diagnosed with HSDD. In their publicity campaign, they focus on the North American studies (more on that below) and included just over 1300 women. The average age was 35 and most of the women were married and the average length of relationships was over 10 years.
The women were assessed for both desire and distress caused by desire and then followed for 6 months. Every day the women were asked to record their subjective evaluation of their own sexual desire and their sexual activities, defined as Satisfying Sexual Events (SSEs). One particularly nice aspect of the study was that sexual events weren't defined solely as intercourse or orgasm. An SSE was defined as sexual intercourse, oral sex, masturbation or genital stimulation by the partner, which was subjectively evaluated by the woman as satisfying (with prompts like gratifying, fulfilling, satisfactory and/or successful).
Comparing the women taking daily doses of flibanserin with women taking a placebo, the pooled data show:
Women taking flibanserin increased their SSEs by 1.7 per month while on the drug. Women taking the placebo had 1 more satisfying sexual event per month while taking the placebo.
Women taking flibanserin reported an increase in sexual desire and a reduction in distress about sexual desire. Women taking the placebo also reported increase desire and decreased distress, but the difference between the two groups was statistically significant.
Notably, in the European study there wasn't a significant increase in sexually satisfying events.
Questions Remain
To be fair, BI hasn't completed it's research. At the same time they are making the calculated business decision to get publicity for this data, so it also seems fair to start raising questions now about what they are reporting.
They haven't offered any rationale for why the drug produced statistically significant results in the "biologic" component in North American but not in Europe. I suspect the answer to that question may be messy as it would likely refer back to non-"biologic" elements of sexual desire, thus pointing out a problem with the premise of the research.
After the six month study there were participants who stopped taking the drug reported that their sexual desire did not diminish. Whether this suggests that the drug is having a permanent effect on brain chemistry, or that brain chemistry is not in fact a significant factor in most cases of low sexual desire remains to be explained.
Finally, I was interested to hear one of the researchers say that most women in the study reported that their low sexual desire crept up on them over a period of time. If, as the researchers argue, problems with low desire are drive related, hard-wired or biological, why would they appear slowly? Are they suggesting there are precipitating factors influencing low sexual desire? If so, would effective treatment not want to address those factors before they go altering the brain chemistry of otherwise healthy women? One consideration in a low desire creep may be age, but these studies were of pre-menopausal women with an average age of 35. These seem like pretty important questions to consider.
What What We Don't Know
Currently the only safety data we have is for women who have been on flibanserin for six months. They have been following women for over a year (after the studies are done women are given the option of continuing on the drug) but haven't released data on those women. In a telephone media presentation researchers propose that no significant safety risk is expected to emerge. This seems a little like hubris given the "unexpected" discoveries of risks associated with long term use of SSRIs, which weren't found in clinical testing.
We also don't know when flibanserin would be an appropriate treatment. Is it meant to be a first line treatment or used only when safer, more proven treatment options have been exhausted? Once the media and a splashy BI advertising campaign create the myth of a pill that'll make you want sex, how prepared are physicians going to be to explain the actual complicated nature of desire, never mind finding the time to do it versus the time it takes to write a prescription.
The Bottom Line (for now):
In truth, it's much too early to be evaluating the potential benefit versus harm of flibanserin. It's a smart strategy on the part of pharmaceutical companies to generate press for a drug that's not yet approved as a way of mobilizing a lazy media, generating a public buzz and setting the terms of the public discussion on the topic. Unfortunately what's good for business isn't always good for public health.
Read more - Petra Boynton Offers a Behind the Scenes Look at the Flibanserin Release
Related - Bloomberg News: Desire Drug May Prove Sex Really Is All in Her Head
Boehringer Ingelheim Press Release - Boehringer Ingelheim Announces Pivotal Phase III Data of Flibanserin in Pre-Menopausal Women with Hypoactive Sexual Desire Disorder
Monday November 16, 2009
Bisphenol A (BPA) is an industrial chemical primarily used in plastic production (it's in everything from baby bottles to the inside of food and drink containers to sex toys). Its use is so common that in one study of BPA levels in the U.S. adult population, it showed up in more than 90% of urine samples. The main human health concern about BPA is its impact on reproductive health and reproductive systems. There are also environmental concerns about the amount of BPA that is seeping into the water system and its negative effect on both plants and fish.
So far research has looked at BPA exposure in animals and BPA levels in humans, but hasn't offered direct evidence for a link between levels of BPA and sexual or reproductive harm in humans. A study published this month in the journal Human Reproduction has done just that.
The study compared workers who were exposed to high levels of BPA in a factory with workers who had no such exposure. They found that those exposed had a significant increase in sexual dysfunction, specifically reduced sexual desire, erectile difficulty, ejaculation difficulty and a reduction in sexual satisfaction. They also found that the greater the exposure, the higher the risk of sexual dysfunction.
The researchers point out that this study needs to be replicated and that the levels of BPA exposure in this study is around 10 times higher than what most men are exposed to, two factors which call for some caution in interpreting these results.
There's a secondary sexual link to this story, which is that BPA is likely used in the manufacturing of many sex toys. As always, it's hard to get information from the major manufacturers about what's in their toys, but the Danish Environmental Protection Agency report on sex toys did find levels of BPA in some of the sex toys they sampled. If it is in sex toys the next question would be if, and how, BPA could migrate from the toy to the person during use. The answer may be that it doesn't, the problem for me is that I doubt testing sex toys is high on anyone's list. Maybe knowing that almost 50% of adults have used a sex toy might push this consumer product group a bit further onto health researcher's and government radar. Maybe.
Read more - AFP: Chemical in plastic linked to sexual dysfunction
