Sexual and Reproductive Health

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What is the G-shot?

Dear Reader,

The “G-shot” is a medical procedure originally intended to help treat urinary incontinence (typically for older women), but has sometimes been used to augment the G-spot, all in the hopes of increasing the area’s sensitivity and orgasmic potential. It’s no wonder you’re curious – some claim more intense and lasting orgasms as a result of the shot (which, by the way, consists of collagen). Evidence of the procedures effectiveness is lacking as is information on its safety; however, there are numerous, non-medical ways to intensify and magnify your orgasm. But before getting to that really good stuff, let’s discuss the G-spot and the G-shot in greater detail.

The G-spot is a sensitive area right behind the front wall of the vagina, between the back of the pubic bone and the cervix and it has been an anatomical topic of debate for some time — sex educators have touted its capacity as an erogenous zone, while at the same time, many medical experts have questioned its legitimacy. Some people describe G-spot orgasms as very intense and lasting longer in comparison to other types of orgasms, while others don’t find the G-spot to be a sensitive area.

Using the G-shot for the purposes of increasing sensation to the G-spot is considered an “off-label use.” This term is used to indicate that a health care provider is using a medication or device that has not been specifically approved for the current intended use by the Food and Drug Administration (FDA) — this practice is legal and used in many areas of medicine. However, by using a medical product or prescribing a drug in this way, it’s understood that s/he has based their decision on sound medical evidence and scientific research. Patients who opt for the G-shot often have concerns about their ability to orgasm and the size of their G-spot. As mentioned before, the injection is composed of collagen (similar to injections used in plastic surgery for the face or lips), and may need to be repeated every four to six months to remain effective. To date, there are no scientific studies that exist to suggest that the G-shot improves orgasmic function.

You also asked about the safety of the procedure — it can be costly and there are certainly a lot of unanswered questions that remain about benefit versus risk. Side effects and potential risks of the G-shot procedure include:

  • scarring
  • numbing
  • loss of sensation
  • lack of any change in sensation/function from pre-procedure

Another option to consider: Avoiding the medical route altogether and, instead, investing some time in experimenting, exploring, and discovering new ways to expand your pleasure, whether it’s by focusing on your g-spot exclusively or “working” on the entire package. G-spot orgasms are not particularly common and definitely not necessary for a happy, healthy sex life — everyone experiences sexual pleasure, sensitivity, and arousal in different ways and this can often evolve as we grow older. So, a word to the wise: Never stop exploring. Here are some ideas:

However, if you want more information about the G-shot specifically, you may want to talk with a health care provider. Columbia students can make an appointment with Medical Services (Morningside) or through the Student Health Service (CUMC).

Here’s to healthy sexploration!

Alice

Stages of male sexual response

Dear Reader,

Since you asked so politely, let’s start from the beginning. The male orgasm is just one part of the sexual response cycle for men. What you’re likely referring to is the human sexual response cycle, published in 1966 by William Masters and Virginia Johnson. Interestingly, though this model is decades old, it’s still the most commonly taught model. As you’ve mentioned in your question, it’s generally explained by the progression of four stages. However, it's good to note that these stages vary quite a bit between individuals and their own personal experience (more about that later). Before talking more about male anatomy and physiology, let’s define a few terms of the male sexual and reproductive system first:

  • Penis. The penis is the external sex organ of male anatomy and is where both urine and ejaculate exit the body. It has lots of nerves focused in a small surface area, making it a very sensitive body part. It is also made up of erectile tissue that allows it to grow in size and harden when stimulated.
  • Urethra. The urethra is a tube that runs through the penis and it transports both urine from the bladder and semen from the testes from inside the body to the outside of the body.
  • Testes. Also known as testicles, the testes are typically in pairs and are the gland in the male reproductive system responsible for semen production.
  • Scrotum. The external pouch-like area of the body that hangs under the penis and holds the testes or testicles.

And now that you’ve got the terminology down, onto the male sexual response system:

Stage One: Excitement

The excitement or sexual arousal phase kicks off the male sexual response cycle. Arousal can be triggered by thoughts, images, touch, scents, or any number of stimuli. Physiological signs of arousal can include muscle tension, increased heart rate and breathing, elevated blood pressure, flushed skin, hardened or erect nipples, and blood flow to the genitals and pelvic region. This blood flow can cause the penis to begin becoming erect and the testicles to increase in size and elevate towards the body. Distraction, anxiety, stress, depression, and lots of other factors can impact erection and arousal. People may shift between heightened or lowered excitement, depending on stimulation and level of distraction or stress. The excitement phase can last for just a few minutes or for hours, depending on the person and the circumstances.

Stage Two: Plateau

The plateau phase is somewhat of an intensified version of the excitement phase. During plateau, the penis and testes continue to increase in size due to blood flow. Heart rate, muscle tension, and some involuntary body movements or contractions are also not uncommon, especially in the feet, face, and hands. This is also the time when pre-ejaculate may become visible at the opening of the urethra. Pre-ejaculate is responsible for adjusting the pH balance of the urethra so sperm can survive during ejaculation. Semen from past ejaculations or sexually transmitted infections can also be present in pre-ejaculate. So you may want to take precautions for pregnancy prevention and reducing the risk of STI transmission.

Stage Three: Orgasm & Ejaculation

Stage three is generally when orgasm and ejaculation occur. These two events are often lumped together as one, but they are actually two separate functions of the body. Orgasm can be described as a cerebral or the brain’s response to ejaculation (regardless of whether ejaculation occurs). Orgasm is also often described at the climax or peak of the sexual response cycle. The length of orgasm can vary — for some, orgasm lasts a few seconds to a minute, while others may be able to prolong orgasm for longer. Some people may experience an internal sensation that orgasm is about to happen, described as ejaculatory inevitability. During ejaculation, semen exits the body through the urethra and rhythmic contractions may be felt at the head of the penis, in the pelvic area, and near the anus. Those contractions are responsible for propelling semen through the urethra and out of the head of the penis. The orgasmic and ejaculation phase is often noted by increased involuntary muscle movements and pelvic thrusts.

Stage Four: Resolution

Resolution is the phase when the body begins to return to an unexcited state. Blood begins to flow out of the penis, and erection begins to gradually subside. Muscles often begin to relax and skin returns to a non-flushed color. Resolution can be marked by feelings of drowsiness, as well as feelings of increased intimacy, relaxation, and contentment.

Following ejaculation and orgasm, many people experience what is known as the refractory period. The refractory period is a time when the body recalibrates, erection and subsequent orgasm are unlikely to occur again, and sexual stimulation may feel too sensitive or even painful. The length of the refractory period can vary widely person to person.

Just four steps, from start to finish, right? One issue found with the Masters and Johnson model is that it doesn’t account for those who don’t follow a linear sexual response (for example, a person may not experience these stages in order, some may experience stages simultaneously, or due to sexual dysfunction, may not experience one or more stages). It’s good to note that not following this model doesn’t mean a person is “abnormal”. Over the years, several researchers have identified missing pieces to this model and proposed new models to help explain variance in the human sexual response. Some missing factors include how culture, relationship issues, and sexual desire factor into sexual response — none of which are physiological. So, while it’s good to have a basic understanding of how many people experience sexuality and orgasms, it may not account for everyone’s individual experience. That’s a lot for just one model! If you’d like to learn more about sexuality and orgasms, check out Alice!’s sexual and reproductive health archives.

Alice

Recent aversion to sex with long-term love — What to do?

Dear Reader,

You have articulated your experience with immense compassion and insight — something that is not easy to do when an issue feels so emotionally intricate. Recognizing your feelings and asking for additional support are courageous first steps for your own well-being and your relationship.

You describe a very loving and open connection with you boyfriend. And also clearly indicate you are very physically attracted to him. It sounds like you two have begun to talk about the shift in your feelings towards sex, which can be important for your emotional and physical trust. You two also share physical affection in ways other than sex — by holding one another, being physically near, and touching one another — which are wonderful ways to maintain intimacy while exploring the change in your sexual desire.

So, now to your question — what to do?

While there is no step-by-step guide to understanding sexuality or resolving sexual concerns, there are a lot of routes to better understand our sexual health and desire. Here are a few options to you might consider:

  • Invest time in understanding the shift in your sexual response. There are lots of reasons why your sex drive can change — side effects of medications, stress, hormone fluctuations, and past trauma are just a few. It’s not always easy to identify the root cause(s) on your own. This may be a good time to talk with a trusted health care professional about both what may have caused this change, and also how to feel good sexually now. Mental health professionals like a counselor or therapist (or even a sex therapist) can often help you process and better understand confusing feelings or physical responses in the body and mind.
  • Expand your sexual relationship with yourself. Consider making time, if you don’t already, to explore your libido and sexuality on your own. You may discover new components to how you like to be touched or turned on. You may also simply enjoy having time to be sexual without another person. Taking time to masturbate or explore different types of self-intimacy can also help you gauge the level of your libido, when solo.
  • Explore sex, intimacy, and physicality, minus the sex. It sounds like, even if your boyfriend isn’t pressuring you to have sex when you feel uncomfortable or self-protective, you may be putting pressure on yourself. Consider giving yourself a little sex break to relieve some of those expectations. Fear of unmet desires may be adding to your aversion to physical contact when you and your boyfriend are taking your clothes off. One way to reduce this pressure may be exploring other ways you two can feel sexy and be sexual with one another, outside of intercourse. You mentioned holding one another feels good — that is one great example. You may also consider making out, massage, mutual masturbation, watching a sexy movie, or reading erotica together. You may also want to explore your sexual desires by taking a trip together (or solo) to your local adult toy store, like Babeland or Good Vibrations. These stores are generally stocked with books, toys, videos, and lots of educational and playful resources for both individuals and couples.
  • Expand your sexual and relationship horizons as a couple. Growing as a couple can require a lot of emotional intelligence and dedicated communication. You have already identified feelings both you and your boyfriend are contending with currently. Sometimes, enlisting the guidance and insight of a couples counselor can create a safe space to explore your respective feelings further and foster an even deeper understanding of your relationship dynamic.

If you’re a Columbia student interested in therapy or counseling, you can make an appointment to speak with a mental health professional at Counseling and Psychological Services (Morningside) or the Mental Health Service (CUMC). You can also make an appointment to speak with a health care provider on the Morningside campus through Medical Services or through Student Health at the Medical Center.

One consideration that may be very worthwhile as you continue to seek support and answers is the strong reaction your body and mind seem to be having during this time. While some people may have advised you to “just push through”, try to remember you should never feel obligated to have sex when you do not feel ready or comfortable. If you force yourself to have sex when you do not want to, it may only compound the aversion you are currently experiencing, rather than help the situation. Paying attention to the signals your body is sending you, emotional, psychological, or physical, is truly important now and as you move forward.

Hope this helps,

Alice

Compulsively watching porn - addiction?

Dear focus on us,

Let's put aside the "can he really be addicted to porn" question for a brief moment. Let’s focus on the two of you and what is known: First, you and your boyfriend are having much less frequent sex than in the past (and you are, presumably, disappointed about this). Second, your boyfriend told you he believes he is addicted to porn and, despite his best efforts, is finding it hard to abstain. When a person is compulsively doing anything, so much so that it causes her/him distress, interferes with relationships, or otherwise negatively impacts day-to-day life, it’s important to consider reaching out for help. This is especially true when attempts to stop the undesired behavior are not successful. One option is for your boyfriend to seek out the expertise of a mental health professional, many of whom can assist with strategies to overcome compulsive behaviors. Alternatively, or in addition, both you and your boyfriend could try therapy together, in the form of couples counseling. Columbia students can make an appointment with a counselor through Counseling and Psychological Services (Morningside) or Mental Health Services (CUMC).

Have you talked with your boyfriend about what he enjoys about porn? How about what it does for him (feelings, emotions, thoughts, etc.) that he may feel like is not getting from other sources in his life? In some situations, compulsive behaviors are linked to other thoughts and needs in the person’s life. If your boyfriend is unsure about these issues or not comfortable discussing them with you directly, a mental health professional is likely a good next step.

Let’s get back to your question about whether your boyfriend could actually be addicted to porn. There’s quite a lot of debate in this area. The general consensus among researchers is that compulsive porn consumption isn’t a true addiction, at least as defined in the traditional clinical sense. This doesn’t mean that your boyfriend’s porn habits aren’t causing him troubles, just that many in the field don’t find it helpful or particularly appropriate to classify this as an addiction. Further, medical professionals seem conflicted on whether or not problematic consumption of pornography should be considered a disorder of its own or a symptom of other disorders; however, it has been generally documented that heavy and compulsive use of pornography occurs, has neurological effects, and can be treated through therapy (and, in some cases, medication). Regardless of an official diagnosis, compulsively viewing pornographic materials so often that it affects other areas of your life, such as your health, job, or relationships, can be a serious problem and something worth exploring.

Lastly, let’s focus on YOU for a few moments. Clarifying your feelings and thoughts about this situation may help you decide how to proceed. So, a few reflective questions for you to ponder: What would an ideal sex life with your boyfriend look like? How often would you like to be intimate? What are your general feelings toward pornography or erotica? If the decrease in sex is related to something else, not his use of porn, will you still view his porn usage negatively? All questions for you to consider as you think about next steps.

Wishing you the best,

Alice

Sexy experimentation among friends?

Dear Adventurous Virgin,

You’ve asked some great questions about venturing into the arena of video sex. Exploring your sexuality and sexual interests is definitely natural and healthy. It also sounds like you have found someone you feel safe with and the two of you are learning together — here are some tips to help maintain that open and trusting relationship and tackle some of your concerns if you decide to go live:

Check in early and check in often. Concerns about letting too much of your guard down may be alleviated by talking about boundaries and desires in advance. Ask yourself some questions about what you want, don’t want, and even what you’re unsure about. Then, bring your friend in on the conversation so you both can be on the same page. Here are some questions for you and your friend to consider:

  • What type of ground rules do we both want for our sexual relationship and our friendship?
  • What about other people? How do we want to handle communicating about potential relationships/sexual encounters with others?
  • What about a safe word? Safe words are typically established to alert partners to slow down or stop during sex play. Use a word or words that won’t be confused with the sexual content of the moment — like “red” for stop, “green” for keep going, or “yellow” for slow down. Safe words can also be integrated into your sexy communications via text, phone, or video chat.
  • What are your turn-ons or turn-offs?
  • What can make us both feel safe, respected, and comfortable as we consider our on-screen debut?

Answers to these questions may shift over time — try to be up front with your friend and touch base from time to time to discuss if either of you feel differently or have changed your mind about your initial agreements.

Consider cyber security. The reality of the internet includes computer hacking, viruses, and other avenues that may lead to your private time becoming more public than you intended. Consider talking about ways to secure your exchanges. Some issues that you may want to discuss:

  • Try to avoid showing your face and your body on screen at the same time — it’s harder to identify a person without the whole picture!
  • Check out the security settings on the program you use to communicate with your friend — some may be more secure than others.
  • Saving your chats and/or videos? Consider saving them with a file name that will remind you not to send them to the wrong recipient, e.g. “do not send to anyone other than XXX”. Also consider saving them on a private/personal computer and using document or folder security option might also prove helpful.
  • Consider the security of your internet network, too. Using a password protected personal network provides more security than a public network or a network without a password.

Prepare to be prepared. There are lots of ways to get ready for a video debut — and preparation can be a great way to relieve some of the nervous anticipation leading up to a new adventure! Here are some possibilities:

  • Talking about how to prep may even build additional excitement for you both!  Since you’ve already established an open dialogue, you may want to discuss aesthetic options like shaving and what clothes to wear (if any).
  • Consider recording yourself ahead of time or use a mirror to plan for positions, angles, or even just to get a sneak peak of what your friend will get to see. That said, sexual adventures are often somewhat unpredictable which can certainly be part of the excitement! So, it might be best not to worry too much about planning your every move.
  • Want to learn more about masturbation (solo or with a partner)? Check out stores like Babeland or Good Vibrations for helpful books, guides, and toys. You can also peruse the Go Ask Alice! masturbation category.

In your question, you ask if this type of exploration is normal and healthy. For some, this type of dynamic found within a friends with benefits situation or other types of uncommitted or non-romantic sexual relationships can be liberating and exciting. They may also be more common due to the number of available and semi-anonymous forms of technology at our finger tips — like photo sharing, video chats, and texting. Exploring your sexual self with a particular distance afforded by various types of technology may allow for unique understanding and expression.

Considering new sexual acts or interests may also bring up unexpected questions or feelings. If you’re feeling unsure about the nature of your relationship or even the type of activities you’re considering, talking it out with your friend or another supportive person in your life may be helpful. Many people also begin to understand their sexual selves more fully with the guidance of a counselor or sex therapist. Columbia students can discuss counseling options with Counseling and Psychological Services (Morningside) or the Mental Health Services (CUMC). You might also be interested in speaking with a sex therapist through the American Association of Sexuality Educators, Counselors, and Therapists.

No matter what you decide, Adventurous Virgin, try not to rush yourself — it’s perfectly healthy to allow yourself the time and space to explore any questions or reservations fully before/if you decide make plans for your video date. Hope you have fun on your sexy journey!

Alice

Orgasms and making babies?

Dear Reader,

The quick answer to your question is no — orgasm is not necessary for someone to become pregnant. It may, however, make the baby-making experience more exciting! Conception and pregnancy are typically dependent on the convergence of a few factors: namely, a healthy egg, healthy sperm, and favorable cervical mucus all being in the same place at the same time. Penis-in-vagina intercourse is the most practiced method for getting the egg and sperm together; however, check out Sperm motility for alternate routes of joining the two (e.g., in vitro fertilization). The role of orgasm as it relates to penile-vaginal intercourse and conception, no matter what your anatomy, is still highly up for debate.

With that being said, there’s some interesting research on how orgasm may increase the likelihood of pregnancy. Orgasm is thought to heighten the sperm-meets-egg probability by both positively reinforcing ejaculation from the penis (in other words, making the ejaculate shoot further), as well as increasing uterine contractions. These pelvic contractions happen due to the presence of oxytocin, which is released from the brain during orgasm. Uterine contractions help sperm towards the goal of fertilizing an egg by moving them up the vaginal canal and into the uterus.

Here’s something else to ponder: Women are much more likely to experience orgasm from clitoral stimulation than from vaginal-only penetration. The vaginal wall contains relatively few nerve endings (unlike the clitoris which contain 6,000 – 8,000 nerve endings), making the in-and-out of intercourse less likely to lead to the big “O” for many women. Unless, of course, there’s some simultaneous touching, pressing, or other type of clitoral stimulation happening. So, biologically speaking, the “purpose” of female orgasm in terms of baby-making isn’t clear, beyond the very simplistic (yet important) element of pleasure.

Penile orgasms on the other hand are very common with vaginal intercourse. And while ejaculation can occur without orgasm, the co-occurrence lends itself more strongly to the idea that this type of orgasm has a purpose beyond pleasure.

All those fun facts aside, there has yet to be any definitive studies that show a connection between orgasm and fertility trends. As far as we know now, orgasm is less of an evolutionary tool and more of a sexual bonus.

Enjoy!

Alice

STI transmission via skin-to-skin contact?

Dear Reader,

Since your question was submitted via a reader response for the question Shedding light on viral shedding, you are most likely referring to skin-to-skin transmission in the context of herpes and other STIs. Information about STI transmission can be confusing, so kudos to you for seeking clarification. In general, most STIs are transmitted either through bodily fluids (such as semen, vaginal fluids, blood, breast milk, or saliva) or skin-to-skin contact. An uninfected individual doesn’t necessarily have to have an opening in the skin for transmission to occur via skin-to-skin contact. Many STIs can also be transmitted through mucous membranes, such as the mouth and lips, nostrils, eyelids, ears, anus, and parts of the genitals. Transmission is possible only when an infected person’s mucous membranes, bodily fluids, open lesions, or infected shedding skin cells come into contact with an uninfected person’s mucous membranes or open lesions. And yes, antiviral creams can decrease the chances that an infected person will transmit the herpes virus to her or his partner. If a person doesn’t have herpes, however, using an antiviral cream on her- or himself won’t prevent the possibility of contracting herpes from an infected partner. Antiviral creams and medicines are not intended for prophylactic use by uninfected individuals.

STIs spread by skin-to-skin contact include oral and genital herpes, HPV, and syphilis. Skin-to-skin contact occurs when an infected site of one individual’s skin (for example, the genitals of an individual with human papillomavirus, or HPV) come into direct contact with a mucous membrane or lesion on an uninfected person’s body. For example, if an HPV-infected shedding skin cell were to touch an uninfected person’s cut-and-scratch-free hand, the HPV virus would have no route of transmission — the hand is not a mucous membrane, nor does it have any open lesions. However, let’s say that the infected shedding skin cell were to make contact with the mouth of an uninfected person (or any other mucous membrane or lesion on her or his body), transmission would be possible in that case.

Take note of one exception: molluscum contagiosum, a superficial skin disease than can be transmitted sexually and is therefore often classified as an STI, can be spread not only through the avenues mentioned above, but also through indirect contact. The small bumps that arise from molluscum contagiosum infection can inhabit any surface on the body, and there are documented cases of molluscum contagiosum transmission via wrestling, surgery, towel or sponge sharing, pool and gym equipment sharing, and sauna and communal bathroom use. Fortunately, molluscum contagiosum resolves naturally after 6 to 12 months.

To reduce your risk and protect yourself from STIs, consider the following:

  • Ask your partner about her or his sexual health. It doesn’t have to be awkward — there are lots of ways to approach this conversation. Consider getting tested together!
  • Although oral and genital herpes and HPV are commonly spread when an infected person has no symptoms, the highest risk for transmission occurs when s/he experiences a flare-up. Avoid direct skin-to-skin contact during active outbreaks.
  • Use barriers such as condoms and dental dams to prevent transmission through skin-to-skin contact. If you’re a Columbia student, refer to the Safer Sex Map for free safer sex materials on campus.
  • Wear protective clothing if you are a healthcare worker or athlete who is in physical contact with others’ skin, mucous membranes, lesions, or bodily fluids on a regular basis.
  • Females between the ages of nine to 26 and males between the ages of nine to 21 may receive Gardasil, the HPV vaccine. This can help curb the spread of HPV and reduce risk for cervical cancer.
  • To prevent spreading herpes through childbirth, women with genital herpes can take antiviral medication from 36 weeks into pregnancy until delivery.

For more information, take a look at the Sexually Transmitted Infections section of the Go Ask Alice! archives. Columbia students who wish to speak to a medical provider about skin-to-skin contact, antiviral medications, or any other medical concerns can set up an appointment with Medical Services on the Morningside campus via Open Communicator, or with Student Health at the Medical Center at 212-305-3400.


Hope this clears things up!

Alice

College students and STIs

Dear Readers,

Sexually transmitted diseases (STDs) or sexually transmitted infections (STIs) are infections transmitted through sexual activity or behavior. Most college students are between the ages of 15 to 24 (most commonly 18 to 22), which has been found to be the group that is most susceptible to new STI infections. In fact, people in this age group acquire almost half of all new STIs every year, with individuals between the ages of 20 to 24 accounting for the highest infection rates. This annual increase of new infections can be explained by many sociocultural phenomena, including lack of sex education, insufficient access to safer sex materials, inability to pay for testing and treatment, discomfort with reproductive health facilities and services, and concerns regarding confidentiality. However, the risk of STI infection is palpable, and there are many ways you can protect yourself.

Although young adults are the age group most affected by new STI infections with approximately 9.5 million new cases each year, STIs do not discriminate on the basis of age. STIs affect individuals of all backgrounds, races, ethnicities, genders, and ages. With that said, according to the Center for Disease Detection, the following STIs are most common among college-aged young adults:

  • One of the most common STI among people between the ages of 15 to 24 is chlamydia. In fact, chlamydia is the most prevalent bacterial STI in the United States, with over 1 million new cases reported annually. Rates of reported chlamydia infections continue to increase steadily with time: between 2010 and 2011, chlamydia infection rates increased by 10.5 percent among women and 12.4 percent among men between the ages of 20 to 24.
  • Also very common among the young adult population is herpes infection. Herpes Simplex Virus 1 (HSV-1), or oral herpes, is so common that epidemiologists believe it infects between 50 to 80 percent of adults in the United States. Herpes Simplex Virus 2 (HSV-2), or genital herpes, affects one in five college aged students in the United States.
  • Human papillomavirus (HPV) affects many: there are approximately 5.5 million new cases of it every year, which accounts for 33 percent of all new STI infections annually. There are many strains of HPV, many of which show no symptoms. Fortunately, the Gardasil vaccine, which is recommended for everyone under the age of 26, protects against four strains of the virus, including two that cause warts and two others that are associated with the development of cervical cancer.
  • Another prevalent STI among young adults in gonorrhea. Between 2010 and 2011, gonorrhea infection increased 5.4% among women and 6.2 percent among men aged 20 to 24. Again, the young adult age group demonstrates the greatest increase in number of infections compared to all other age groups.
  • Trichomoniasis, commonly referred to as “trich,” is a parasitic STI that can be treated with antibiotics. It affects approximately 7.4 million previously uninfected individuals on a yearly basis, and is unusually difficult to detect in men.
  • The last STI commonly found in young adults between the ages of 20 to 24 is syphilis. Syphilis presents in several stages: primary, secondary, and late or latent stages. Syphilis is relatively rare, but infection rates are on the rise particularly among men within this age group. The shift of syphilis infection to younger adults reflects a trend; it used to be more common among men between the ages of 35 to 39, but now affects more college-aged men.

Many STIs are able to remain dormant and not show symptoms for years after infection occurs. This is true for both bacterial and viral infections. For example, up to 90 percent of individuals infected with HSV-1 or HSV-2 never exhibit symptoms. For this reason, you might consider undergoing a routine STI screening before having unprotected sex. Better yet, you and your partner can show each other your test results, which is the only fail proof way to tell if someone has an STI or not.

If you have any symptoms or test positive for an STI, don’t fret. Your doctor will help you decide how to treat the infection, and many STIs, including chlamydia, gonorrhea, and syphilis can be treated with antibiotics. Although herpes cannot be completely cured, there are prescription medicines that can help reduce the frequency and severity of HSV-1 and HSV-2 breakouts.

If you’re a Columbia student and you think you might have an STD, contact Medical Services on the Morningside Campus or Student Health at the Medical Center Campus to schedule an appointment. For HIV testing, counseling, and treatment, reach out to the Gay Health Advocacy Project. Finally, consider picking up some free condoms, dental dams, lubricants, and other safer sex materials on campus by checking out the Safer Sex Map. If you’re not a Columbian, find an STI clinic in your area for testing and treatment.

Alice

Arousal while breastfeeding

Dear Reader,

Breastfeeding is often pleasant for women because of feelings of closeness and tenderness with their child, and yes — sometimes it can even be arousing. In fact, in some studies up to 50 percent of women found breastfeeding to be an erotic experience, but sadly a quarter of these women also experience shame and guilt over this. Although feeling sexually stimulated during breastfeeding may be uncomfortable and jarring, it is actually a completely normal response.

The hormones released during lactation explain some of the connection between breastfeeding and arousal. When a baby suckles at her/his mother’s breast, the nipple stimulation causes the release of prolactin and oxytocin. Affectionately known as the "cuddle hormone," "trust hormone," and "love hormone," oxytocin is also released in large quantities during childbirth, and in lesser quantities during hugging, touching, and orgasm. The release of oxytocin can sometimes cause uterine contractions, similar to those experienced during orgasm. Again, while these sensations may feel odd and uncomfortable in the context of breastfeeding, it does not mean this sexual desire is directed towards the child. It simply means these hormones are working properly!

As mentioned, some women feel embarrassed and “wrong” because they experience pleasure during breastfeeding. Some even go so far as to cause themselves pain during breastfeeding to combat their feelings of arousal or stop breastfeeding altogether. If you are breastfeeding and facing shame or guilt such as this, you may want to seek support from a counselor, from an online or in-person mommy support group, or from your friends and family. If you are a Columbia student, you can make an appointment with a therapist by contacting Counseling and Psychological Services (Morningside) or Mental Health Services (CUMC).

Alice

My boyfriend wants me to hit him

Dear Reader,

Talking openly about your previously secret fantasies can be a big step in a relationship — it shows a building of trust, willingness to be vulnerable, and the desire to explore together. It sounds like you and your boyfriend are at a unique place to try new things and support one another in that discovery. But before you switch things up between the sheets, taking your time and picking up your pillow talk where you left off may be a good place to start.

Many people take on different roles when they have sex, often referred to as “role-play.” Your boyfriend asking you to be more aggressive and physical with him during sex is one example of role-play.  When one partner acts out a more powerful role (sometimes by hitting, restraining, biting, etc.) they may be referred to as dominant, while the other partner may be referred to as submissive. This power/pain dynamic in relationships often falls under the category of BDSM (Bondage, Discipline, Domination, Submission, Sadism, and Masochism). It sounds like you have some familiarity with the terms dominant and submissive. Power dynamics in healthy relationships, especially during sex play, benefit from a lot of communication — before, during, and even after roles are acted out. Each partner should feel physically and emotionally safe and able to communicate their needs throughout.

As someone new to a more physically dominant role during sex, taking the time to talk and establish guidelines you both can agree on first really sets the stage for playing later.

Here are some tips to get you both started:

  • Pick a neutral time & place — Finding a time and a place will allow you to both speak comfortably and in depth about what you want and don’t want sexually/erotically. It’s a good idea to have this conversation outside of the bedroom, so as to avoid mixing business with pleasure.
  • Avoid assumptions — Try not to assume either one of you already knows the ropes of how to navigate a fantasy. Asking each other lots of questions helps to clarify desires, fears, and boundaries. Making a commitment to do some learning together will help ensure that you are both on the same page.
  • Consent to consent — One critical aspect of healthy sexual relationships is mutual consent, especially during role-plays. Agreeing to respect a “go,” “slow down,” or “stop” request — no matter what you are doing — is a way to establish guidelines for communicating each other’s wants and needs clearly. There may be times when one person wants to stop or slow down, and there may be moments when one person wants to make sure it is okay to keep going. Discussing how to navigate those feelings before they come up will help you both feel prepared and safe.
  • Make a list — Sometimes, it’s helpful to actually put pen to paper and write out what you want and don’t want. Try making a list of “yes,” “no,” and “maybe” columns for each of you. You can both write what you are completely open to sexually/erotically, what you are not interested in at all, and things you are maybe interested in, but just not sure about yet. This is a good way to learn more about one another, discuss boundaries and limits, and share ideas about potential role-play scenarios and sex. You can revisit these lists, as people’s desires can shift or change over time.
  • Pick a “safeword” — A “safeword” is an unambiguous word that will signal you or your boyfriend want to stop, slow down, or check-in. Some people simply use “safeword” as their signal. Others use “red” for “stop,” “yellow” for “slow down,” and “green” for “keep going.”
  • Start slow — Because it’s hard to predict what you will like or dislike until you try something out, consider starting out slowly as you take on a new adventure in your sex life. Agreeing to be patient with one another and checking-in regularly can help you both along the way.

If you both agree to experiment with aggressive sex play, many BDSM practitioners advise creating what is known as a “scene,” as opposed to using real-life frustrations as inspiration. Your scene is a guide for each of your roles during your agreed upon time and dynamic. Scenes can help partners maintain clear boundaries between reality and fantasy. Beginning to experiment with hitting, slapping, or other forms of “inflicting pleasure” can start with more gentle versions of the desired act (e.g. gentle pats that become progressively more firm).

Resources are available for introductions to BDSM guidelines and practices in print, online, and sometimes in workshops facilitated by community groups, sex toy stores (like Babeland and Good Vibrations), and even health promotion offices on some college campuses. If you’re a Columbia student, there is a student run BDSM education group, Conversio Virium, which organizes educational workshops and discussions.

As far as working out those real-life frustrations, it's generally a good idea to keep them separate from the bedroom. Consider talking about those in a different setting with your boyfriend, a friend, or a counselor. If you’re a Columbia student, you can contact Counseling and Psychological Services (Morningside) or the Mental Health Service (CUMC) if you want to pursue counseling options.

Learning more and continuing to talk honestly about what you both want (and don’t want) can make your sex life more enjoyable, as well as increase intimacy in your overall relationship. Have fun and play safely!

Alice

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