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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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How Do I Make Masturbation More Enjoyable?

Tuesday March 25, 2014

Is it the mood lighting? The sweet talk? The touch that seems to always know the right spot, the right pressure, the right next move? Just what is it that makes masturbation enjoyable?

For many (most?) of us it's probably none of those things. How many of us sweet talk ourselves into bed? How often is our self touch something magical as opposed to something that works, that gets the job done?

If I've learned anything over twenty-five years of talking to people about their sex lives it's that you can't take anything for granted. Including the quality of our self-pleasuring activities.

So this week's sex question, from a young woman who is not enjoying her masturbation routine, wasn't a surprise. Finding an answer that would satisfy was.

Read More: How Can I Make Masturbation More Enjoyable?

Related: About.com Sex Questions and Answers


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New Blog Explores the History of Sexuality, One Notch at a Time

Friday March 21, 2014

One of my favorite nerdy pleasures is lurking on academic sexuality listservs. It must stem from my many unrequited love/lust relationships with academic supervisors when I was in school. It's all a twisted mess in my mind, and while that might not be healthy, it's definitely sexy.

One listserv I read religiously is devoted to the history of sexuality, and I was excited when I learned that three participants in had started up a new blog called Notches: (re)marks on the history of sexuality. I wanted to know more about it, so I emailed Justin Bengry, Julia Laite, and Amy Tooth Murphy to ask a few questions about their new blog and just where and when the history of sexuality begins, or ends.

Is there a story behind the name of the blog?

JL: The title was actually crowd sourced amongst our imaginative historian friends online. The credit goes to Rob Boddice, who works on the history of emotions and not the history of sexuality, but Justin and I liked it because it was playful, put sex at the centre of the project, but also threw up all kinds of problematic issues about gender, power, the place of sex in society.

It's also made for a great pun with (re)marks in the subtitle: marks, as in on the bedpost; (re)marks, with parentheses, as our little tribute to the postmodern traditions that have been so influential on the field; and finally remarks in that we aren't striving to have the last or definitive word, but to start conversations.

When exactly does the history of sexuality begin? And what gets included as "sexuality" in your field?

JB: What isn't included in the history of sexuality? Well, very little in fact. Social and cultural histories, political histories, religious histories, economic histories, warfare, nation-building, gender relations, all are inflected by sex and sexuality, and can be understood better by considering the role of sex and sexuality more fully in relation to them.

That's what really excites me about this field: nothing is off limits! And I understand other histories better when I rub them up against sex and sexuality.

JL: This is, in fact, an ongoing debate. Some allege the history of sexuality has lost a sense of itself because of the immense variety of topics and issues it grapples with. I think it just makes it more interesting, important. I don't see it as a discrete field, myself, but rather a thread that runs through a lot of historical work, including my own.

ATM: Think these guys have covered it pretty well!

An early post which I loved was titled "Are Historians of Sexuality Sexier than Other Historians?" which was less of a hot-or-not throw down than an earnest exploration of how much or little people who study sexuality need to account for themselves and their own sexuality in their work. Is this something you do in your own work? Is Notches a space where academics will be called to situate themselves more than they might in journals and academic conferences?

JL: I do reflect a lot about my own sexuality and how that might influence my own work, but I struggle all the more with how to actually situate myself within the seriously under-theorized category of 'heterosexual'. My personal experiences certainly help me to question categories and binaries of sexuality in my professional work.

JB: I'm a white western gay man who researches primarily white western gay male history, so I'm always conscious of trying not to further marginalize those who are often left out of so much queer history: women, the aged, minorities of all sorts, the economically marginal, and others. So, I think reflecting on my own sexuality, and also my own privilege, helps me to recognize where my research can go further, and also to reflect on whose voices I leave out and why.

Contributors to the blog are not called upon to situate themselves or self-identify publicly, but are welcome to do so if they wish. I hope Notches is a space where they can feel more comfortable doing so than they might a more formal professional setting.

ATM: My own experiences are inextricably bound up with the work that I do. To pretend otherwise, and to make claims of 'objectivity', would be seriously flawed.

For one thing, if I weren't a lesbian I wouldn't have ended up in this field. My motivations to study LGBTQ history and culture came directly from my own experiences and a desire to 'find' my heritage as a queer person (which turned out to be a lot more complicated than I realised as a young teenager!).

As an oral historian, putting myself in my work has also been hugely beneficial. When I go to interview LGBTQ people and they read me as queer that helps to establish an instant rapport, which leads to a better interview.

Of course there are downsides to being so much a part of your work, or vice versa. As an academic, a typical ice breaker in a room full of other academics is 'What do you work on?'. Although I'm out about my sexuality in all aspects of my life, I might not always feel like outing myself to a room of complete strangers when I don't know how they might react. And, although it shouldn't, saying, 'I research lesbian history' is almost always heard as, 'I'm a lesbian'.

Who do you want to be reading Notches? And as editors who are you hoping to have as contributors to the blog?

JL: We hope that Notches will strike the balance between being of interest to anyone interested in history and/or sex, but also raise questions and deal with themes that will engage professional historians in the field and outside of it. For contributors, while we aren't necessarily looking for academically trained historians, we are asking that anyone who contributes have a strong historical background and an ability to reflect historically.

JB: Everyone! Notches was organized to provide a space to reflect on sex and sexuality in a historical context that is informative, challenging, relevant, interesting and fun. We ask our contributors to avoid jargon and write for a mainstream, intelligent, engaged audience. We are supported by the Raphael Samuel History Centre, whose mission is to make history accessible to the widest possible audience, and we are committed to that goal for the history of sexuality.

ATM: Since Notches launched we've been thrilled with the response. Personally, lots of friends who aren't historians, and who aren't academics in any way, have told me how much they enjoy reading the blog. Now I just need to convince them to comment!

A friend said to me the other day, 'I've thought several times about posting a comment but I just think about all the credentials of the people on there!'. But one of the aims of Notches, and one of the great things about blog culture, is that it can offer the opportunity to break down perceptions about hierarchies of authority and knowledge, and just engage people in interesting discussion. It's also great to have a space where academics can be playful and provocative in their writing.

What are some of your favorite posts so far on the blog?

JL: I've really liked them all, their diversity of focus and their different tones. I think one of the most engaging so far has been Onni Gust's What Should LGBT History Month Say About Empire?. It asked some difficult questions not just about historiography, but also about popular history, commemoration, and intersectionality that are extremely important to people working in the field as well as readers at large.

JB: One of my favourite posts so far is Ben Mechen's Ageing and the History of Sexuality, in which he challenges historians not only to think of the aged as valid historical subjects, but to think of aging itself as a process intertwined with sexuality, sexual desires and as a 'queer' act itself. So, while we might not all experience the range of identities that historians of sexuality study, we are all sexual and all aging!

ATM: I loved how Elisabeth Brander's Edward Bliss Foote and Alternatives to Monogamy challenged common assumptions about 'Victorian morals' and troubled cosy notions of our own twenty-first century 'progressiveness' by reminding us that we didn't invent the concept of critiquing monogamy! That, to me, is one of the great joys of history; constantly bringing us back to reflect on our own cultural context and our own place in history.

Visit the blog: Notches: (re)marks on the history of sexuality


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Sex Question of the Week: De-Fetishize Me

Monday March 17, 2014

Is it possible to get rid of a fetish? I'm sure there are plenty of recovery centers that would answer this question with a resounding YES (followed quickly by the appearance of dollar signs in their eyes and the sound of an old fashioned cash register ringing).

I'm no therapist, and I answer questions for free, which may be why my answer is a bit longer, and a lot less certain. Because I was asked this question directly I didn't want to start by questioning why the person wanted to get rid of their fetish. But I got there eventually. See what you think.

Sex Question of the Week: Can I Get Rid of My Fetish?

Read more - About.com Sex Questions, Answered

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Why Your Orgasm Won't Ever Come at the Push of a Button

Wednesday March 12, 2014

A North Carolina surgeon has been working for more than a decade on an idea for a medical device which he claims will, at the push of a button, deliver an orgasm.

An article in the New Scientist claims that the surgeon, Dr. Stuart Meloy, expects clinical trials to begin "later this year" on his spinal implant that delivers electrical impulses to targeted nerves in the spine producing spontaneous orgasm in the wearer of said internal device (do you wear something that's inside your body, or does it wear you?).

It's an odd claim since it is verbatim what New Scientist said he claimed back in 2001 when they first reported on the invention. I wouldn't hold my breath.

I'm skeptical on many levels, but it all starts with the origin story provided by the good doctor. He's been quoted many times over the years explaining how he came up with the idea. Here from the Huffington Post:

"I was placing the electrodes and suddenly the woman started exclaiming emphatically," Meloy said. "I asked her what was up and she said, 'You're going to have to teach my husband to do that'."

The woman was being treated for a pain condition at the time. What he's claiming is that this woman was neither thinking about sex nor desiring it, and in a completely non-sexual context she experienced an orgasm as a result of nerve stimulation. This story is told as a stupid sex joke (the joke being that all men are bumbling fools incapable of having mutually satisfying sex and all women are incapable of communicating clearly about their sexual desires and needs...that's funny, right?)

So if the sex jokes and 13 year gap in promises weren't enough to make you wary of this idea, here's why it's never going to work.

Orgasm isn't only a physiological response. Orgasm isn't just muscle contractions, just blood flow, or just nerve stimulation. The things that our bodies do that we recognize as part of orgasm aren't the sum total of what an orgasm is. An orgasm is an experience. It is something that WE experience. Which means it involves our perception of an experience.

Even if this spinal implant could reliably deliver specific physiological responses, they won't be orgasms. And the idea that you can push a button and give yourself or someone else an orgasm regardless of the context is a sort of mind-blowingly reductive understanding of sexual response.

It's not a bad way to get people to click on an article though. And it may not be a bad way to get attention for your practice, or to attract the attention of investors. But if you aren't looking for money or clicks money, and what you really want is an orgasm, here are some better orgasm leads for you.

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The Things We Do for Sex (Education)

Monday March 10, 2014

I remember last year when the author and activist Kate Bornstein was having a health crisis a community came together and raised over $100,000 for Kate's health care expenses. A friend said, without irony, that this is what many people's health care plans look like now. That same year when the only worker co-operative sex store on the planet, Come As You Are, was in financial peril, they asked for help, and they got it. At the time I thought that this is what venture capitalism looks like for a queer, commie, sex shop.

Today I read that Scarleteen, the busiest and, in my opinion, best sex education resource for young people on the Internet, is going on strike. Or at least they might have to.

Whether you can support their work financially or not, the article by executive director (and, full disclosure, friend) Heather Corinna is well worth reading.

As Heather explains, far too many of us assume that something that happens on line isn't something that should be paid for. But real sex education, by which I mean sex education provided by people who care and who are trained and who are supported as professionals in their work, needs to be paid for. A website that offers static platitudes, whether it's by text message, tweet, or email, isn't the same thing as a service where you can interact with real live people, both professionals and your peers.

While the site is chock full of amazing material on sexuality the heart of Scarleteen is their moderated message boards. Simply put there is no place like that place any place.

And it could all be gone, if we don't do something about it.

I'm sorry it's come to a strike but I think the analogy that Scarleteen is using is apt. I also think that what they are asking for is completely reasonable. As another blogger pointed out, if they are striking that means all of us are management. So here's your chance to do right by labour (if you haven't had a chance before).

You could do it for the kids or you could do it for the workers. Most of all I hope you'll just do something.

Read More: May Day 2014 - Scarleteen Strikes (or, with your help, we don't).

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Choosing to Have Sex Again

Thursday March 6, 2014

Last week I met a stranger who quickly became not a stranger as we started talking about sex. When this no-longer-stranger-but-not-quite-friend found out what I did for a living they asked me if I could explain the difference between celibacy, chastity, and abstinence.

I came up with some vaguely satisfying response but in the process I realized that I didn't really know. I could think of plenty of examples of people using the words interchangeably. So why use one over the other?

I went to work this week to dig a bit deeper, and clicking on the links above will take you to the answers I found. But I was equally interested in why I hadn't bothered to think of this before.

In sex education we put a lot of emphasis on the decision to have sex the first time. When is the right time? Who is the right person? This is fair, but I wonder about the next decision, and the next. Does it make sense to only think about the first time we decide to have sex?

The answer, I think, is no. It doesn't make sense. Each decision to have sex matters and whether you've decided it once or one hundred times, the next decision may not be any easier if the circumstances are different.

This assumption, that we only need to help people think through the first time feels a bit like the assumption that underlies compulsory monogamy, that once you make the decision to enter into a monogamous relationship, no more decisions need to be made.

I think this is completely wrong, and am going to make an effort to spend more time writing about not having sex this year. Because I tend to avoid connecting my writing or education to my personal life I will abstain from commenting on the timing of this new interest.

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