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What’s Your Fantasy?

Whether you’re an expert at swinging from the ceiling vines or a nervous newcomer to the idea of dressing up and getting down, check out these ideas on fantasy sexual role play and open a new world of sexual possibilities.

Sexuality Spotlight10

We're Making Vaginas?!

Saturday April 12, 2014

Humans have been making vaginas for a long, long time. Until recently, as far as most of us knew, the manufacturing of these organs took place in uteri around the world, usually finishing up 14 to 16 weeks after receipt of raw materials.

Manufacturing may not be the best analogy for this process, at least not the kind of manufacturing that involves machine automated assembly lines pumping out perfectly identical products. Even when humans do it on their own, it's more of a bespoke or artisanal situation.

And so it is now that science has delivered us the first, fully tested, tissue-engineered vaginas.

A paper, published yesterday in The Lancet describes a pilot study where four young women who were born with partial or absent vaginas had new vaginas engineered in a lab, grown from their own tissue, implanted in their bodies successfully. The researchers followed all four women for up to eight years post implant, and in all four cases the implanted vaginas successfully integrated into their bodies.

The image on the right, provided by the researchers at Wake Forest Institute for Regenerative Medicine, shows the beginnings of a new vagina. Actually at this point much of the work has been done.

The process begins when a small piece of tissue (1 cm by 1 cm) is taken from the patients vulvar area. The tissue has both skin and muscle cells, and (somehow) the cells are separated. They are then "cultured" and "expanded" and they separately "seeded" onto biodegradable scaffolds. Then comes the artisanal part. For each patient they determine what size and shape vagina will fit best. Then they hand stitch the scaffold around an appropriately sized object (what you're seeing on the right) and ultimately implant the vagina (or is it a potential vagina at this point?).

According to the researchers what happens next is that the body begins to integrate the new organ, growing cells around and within it. The scaffolding fades away and what is left is a vagina that is hard to distinguish from what they call a "native vagina" under examination both visually and through biopsy. They describe the vaginas as having "adequate vascularisation and innervation" meaning there is both good blood flow and distribution of nerves to the area. All of this happens within 6 months of the implant.

The researchers are careful to note that this is just a pilot study, but they believe that what makes this procedure effective at all, and offers better outcomes than current methods of vaginal reconstruction, is that both skin and muscle cells are used and that the cells come from the patients own vulvar region.

I'm curious, of course, not only about the look-what-we-can-do! science of it all, but about how these vaginas feel, what is the experience of having one. The four women who received implants were each asked to fill out a "sexual function index" where they rate their experience of desire, arousal, lubrication, orgasm, and satisfaction, as well as the absence of pain during intercourse. All four women scored themselves high across all domains.

The press release for the study was accompanied by a few short videos, including an interview with one of the women in the study. As translated from Spanish (all the vaginas were made at the Tissue Engineering Laboratory, Children's Hospital Mexico Federico Gomez, in Mexico City) the woman describes feeling perfectly "normal."

In some sense, I wish that research like this, and the need for it served more as a reminder that what is normal is sort of a fantasy. But this hardly seems the time or place for that conversation. For now I'm going to contemplate what it means to say there's more than one way to make a vagina and what happens next.

The Lancet: Tissue-engineered autologous vaginal organs in patients: a pilot cohort study (abstract only, subscription required for full access)

Read More - CNN: Creating Body Parts in a Lab: 'Things Are Happening Now'

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Sex and Lung Cancer: Missing the Forest for the Trees

Friday April 11, 2014

Last month at the 4th European Lung Cancer Conference in Geneva, a professor of urology and a radiation oncologist led a rare morning session that focused on sex. During the one and a half hour workshop, Stephane Droupy and Luca Incrocci spoke about the importance of considering sexual function and satisfaction among patients being treated for lung cancer.

I learned about the session through a prepared release about the workshop in which the presenters called for more attention to be paid to sexual dysfunction in lung cancer patients.

A few times a year a release like this pops up, calling for more awareness of the impact on sexuality of cancer, diabetes, arthritis, and more.

Taken individually, these calls seem not only reasonable but important. We should be paying more attention to the role of sexuality in people's lives.

Taken as a whole, this approach begins to feel like we're missing the forest for the trees.

What It Means to Raise Awareness About Sexuality and Condition X, Y, or Z
When we say that we need to pay more attention to the sexual function of people with, say, lung cancer, we aren't doing or saying one thing. Many things are happening.

Most medical professionals, researchers, and sex educators understand sexuality and sexual function as something that is either normal or not. Normal, or normative, sexuality is what they believe describes most people. Abnormal sexuality is what happens when a body or a mind (or both) deviate from the norm.

In this case, in the absence of cancer one's sexuality is not notable. When you have cancer, your sexual life has changed, and those changes need to be attended to, or so this logic would say.

This is both true and not true. It's true that cancer changes your body and your life. But that's not all that is being said here. When we say that cancer is a change worth noting, we ignore other changes, and we make bodies (and people) with cancer remarkable in ways that they aren't.

Moral Values and Change
Our bodies change constantly. Our sexuality is also changing all the time. We pay a lot of attention to some changes: puberty, the loss of a limb, injury or illness especially when it impacts the genitals. We pay little or no attention to other changes: the gradual development of our own sense of ourselves and our bodies in the world, the difference between a life where we have access to rights and freedoms that allow us to consent to sex and a life where we don't.

The changes that come with something like cancer can be significant, and they do matter. But they are not necessarily changes of a different order than other kinds of changes that happen throughout our lives. Who decides what changes matter most and how those decisions get turned into medical and social assumptions are not primarily matters of science. They are moral and ethical evaluations that are produced and play out on a systemic level.

They also play out on our bodies and in our lives. All of the ways we change sexually, fast and slow, obvious and hidden, socially valued and socially devalued, happen in the context of our lives.

When we focus only on a condition, we strip away the context. All our experiences up to this point, our identities (relationally: as parent, child, spouse, lover, friend, mentor, as well as systemically across race, gender, class, ethnicity) become faded and less visible to the experts who are presumably there to help us, and eventually to us as well.

When we do this we are looking very carefully at the tree, but we forget that we're in a forest, with root systems that run deep and are connected. And we, not the individual, is deciding that what is most important is that the leaves look green and the tree grows tall.

Creating a Before and After
Another thing we do sometimes when we focus on how our sexuality is impacted by one condition or one event is that we can begin to think that the goal of support or intervention is "getting back to normal".

When "normal" refers to a narrow definition of physical functioning, it may make sense. If you were able to play piano and you sustain an injury to your hands, a goal of rehabilitation will likely be to get you back to a place where you have as much function in your hands as possible.

But sexuality is much more than the functioning of a hand (or any other body part). And because our bodies are always changing and our sexuality changes as we age, going back is never really an option. When you're 40 you can't have sex like when you were 20. Because you aren't 20, you're 40. Whether or not you get cancer when you're 32, this fact remains the same.

The idea of going back to normal is appealing, but it's simply the wrong metaphor for rehabilitation. Come to think of it it's not such a great metaphor for life (unless you aren't alive...I think it might work for vampires and zombies). We can't go back ever, because we're alive, and we keep changing. I know many of us feel like we get stuck sexually, like we can't move forward, but the truth is that time moves and experience accrues.

What is the Alternative?
I'm not proposing that we stop thinking about something like the impact of lung cancer on sexuality. As Droupy and Incrocci pointed out at in their session, there are aspects of a lung cancer diagnosis that are different than other kinds of cancer, and they have an impact not only on one's experience of sexuality but on how healthcare providers approach the subject. They offer the example of palliative care, which may be a more likely outcome of a lung cancer diagnosis, and which may change the way healthcare providers think (or don't think) about bringing up the subject of sexuality.

I'm glad they are thinking about these things and bringing the topic to professional meetings.

But I also want to imagine what it would be like if we were able to make a paradigmatic shift away from the idea that there's a normal sexuality and then there are the exceptions that arise from aging, illness, and disability, and toward the more realistic understanding of sexuality as something that is constantly in flux, changing as our bodies change whether or not those changes are marked as "natural" or "abnormal."

Related: The Trouble with Normal ; Sexuality and Palliative Care ; Sexuality and Lung Cancer (from About.com's Lung Cancer site)

Photo credit: Stephen Spraggon/Stockbyte/Getty Images

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What Does Normal Sex Look Like?

Monday April 7, 2014

What do you imagine when you think of normal sex? Is having normal sex like getting a gold star, or is it more like a rubber stamp? When taken out of context many may feel as if normal sex equals boring sex. And yet the pull of normal is strong, as it can feel like protection against the shame of our individual sexual desires.

When I worked in sex shops I would get this question all the time in different forms. People would disclose something they had done sexually or something they fantasize about and then ask if I thought it was normal. Sometimes they would use those exact words (usually with a laugh, and in a tone that indicated they both did and did not want me to answer). Sometimes they would preempt judgement of them by talking about or asking about the "weirdos" who frequent sex shops.

One of the greatest things about working in sex shops is that often we would have a lot of time to talk to customers. Some would stay for hours. And over time I developed an answer to this question. The answer keeps changing, but it came up recently in a question I answered on this site, and I thought it was about time I shared it here.

Read More: What Is Normal Sex?

Previously - The Trouble with Normal

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If You Thought Circumcision Debates Were Heated Before…

Thursday April 3, 2014

Things are about to get much, much hotter. That's because the authors of a new review of research, which was published online this week and will be in the May issue of the Mayo Clinic Proceedings, have taken the already contentious topic of circumcision and super-charged it by introducing another infant intervention flashpoint, vaccinations.

The paper begins with an explanation that rates of circumcision in the US have not been properly reported, and what seems like an increase over time in circumcision rates is actually a slight decrease. But the authors have a lot more on their minds than prevalence data.

Their position on circumcision is clear. Based on their analysis, the benefits of circumcision so outweigh the risks that not to circumcise should be considered unethical. They bring up vaccinations early, as they describe (with what feels like more than a little derision) our current "era of autonomy" where "even vaccinations can be refused by parents for their children."

I don't think we really need any one else making bold public pronouncements about either circumcision or vaccination. There's a long line of people ready to tell you why parents should or should not vaccinate or circumcise (and for that matter why you're a horrible person if you breast feed too long, or not long enough, or let your kids watch TV before they are four, or never let your kids watch TV, and on and on). I don't want to add to that, and my opinion doesn't really matter that much (since I don't have kids on whom to visit such practices). But after reading the paper I felt like I wanted to share my disappointment.

What disappoints me most about the paper is how ineffective I think it will be at moving the medical/research debate along or at offering guidance for parents who aren't sure about whether or not to circumcise.

What the paper does is offer support for those who think circumcision is beneficial and not harmful and plenty. It also offers many holes to poke through for those who think otherwise. And it continues the long tradition of researchers (on both sides of this issue) who address this complicated social practice, one that lies at the intersection of medicine and culture, family and society, class, race, gender, ethnicity, and more, as if it were an object of scientific inquiry that can be easily resolved through quantitative data.

The idea that we can talk about circumcision as if it is either beneficial or harmful, and never both, sort of baffles me. Unfortunately this paper, like others that take an opposing position, continues to maintain that such a simple minded approach is the best science has to offer.

For now I'll continue to be confused and keep waiting for something better.

Read More - NBC News: Circumcision Rate Falls Despite Health Risks

Hear from the Author - YouTube: Circumcision Rates in the US: Rising or Falling?

Related: Phrase of the Week: Uncircumcised Penile Environment ; Circumcision and Penile Sensitivity: Accepting the Data Rejecting the Premise ; Put Down the Knife and Back Away Thoughtfully

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