Sexual and Reproductive Health

Share this

HIV prevention with PEP, PrEP, and ART medications

Dear Reader,

It’s great that you recognize that there are ways to be sexually active with your partner while also minimizing your risk of contracting human immunodeficiency virus (HIV). You mentioned four important ways that HIV risk can be minimized, both before and after potentially infectious contact. Since you and your husband are in what is referred to as a HIV-discordant or sero-discordant relationship (where one of the two of you, not both, are HIV positive), understanding the many medications that may help reduce the risk of HIV transmission can go a long way to fostering a healthy, safer, and fulfilling sex life.

Post-exposure prophylaxis (PEP), refers to the drugs that can be taken immediately after someone who is HIV negative is exposed to potentially HIV positive body fluid like blood or semen. Who might need to take PEP? A health care worker who got accidentally stuck with a needle that was used to take blood from someone who might be HIV positive, or someone who got blood or body fluid into their eyes, mouth, or skin that was blistered, chapped or cracked, might be evaluated for PEP use. Other people who might need PEP are those who had a single episode of unprotected sex with someone who could be (or is) HIV positive. Under these types of circumstances, PEP is typically administered within 72 hours of exposure. It’s also recommended that other protective measures (sterilizing needles, using condoms and other barrier methods) are used as well just in case you did contract HIV. PEP is not 100 percent effective, but if it’s used properly, it could reduce your risk of developing HIV. For greater detail about PEP, including where you can get it check out the AIDS.gov website.

Unlike PEP, which is intended for short-term, emergency use directly after risky contact, the three other tools you mentioned: anti-retrovirals for your husband, using condoms, and pre-exposure prophylaxis (PrEP) are all intended for ongoing use to minimize the transmission of HIV between HIV-discordant sexual partners.

First, let’s chat a little about PrEP. PrEP is a prevention method endorsed by the Centers for Disease Control and Prevention (CDC) for people (like you) who are HIV negative but who could be at risk of getting HIV. PrEP combines two drugs, 300 mg of tenofovir disoproxil fumarate (TDF) and 200 mg of emtricitabine, into one pill that is taken once a day. For people who take the drug every day, and engage in other HIV prevention activities (e.g. consistent condom use, HIV couples counseling), research has found that (depending on the population) PrEP is between 62 to 92 percent effective at preventing HIV transmission. In one recent study with subjects who identified as men and transgender women who have sex with men, an effectiveness rate of 0.0 infections per 100 person-years was found among those who took four or more doses of PrEP weekly during the study period. In pregnant women, PrEP might also be a good way to reduce the risk of HIV transmission to the fetus.

Next on the list: the antiretroviral medications that your husband takes. Yep, antiretroviral therapy (ART) consist of a combination of medications that are recommended as ongoing therapy for those who are HIV positive, in order to keep the viral load of HIV in check. ART can be used in combination with PrEP — so for example, your husband could be on ART and you could take PrEP daily. However, the use of ART and PrEP does not completely eliminate the risk of transmission or infection, therefore, an important final step to minimizing risk of transmitting HIV is by using a barrier such as a condom or dental dam when having sex.

Finally, you mention you want to “complete the process like normal.” What is considered “normal” when it comes to sex may be different for different couples. While there is no 100 percent effective way of preventing transmission of HIV while having sex, it's possible to have a satisfying sex life while also taking steps to minimize the risk.

To your health!

Alice

For more information or to discuss these medications, check out these recommended resources:

Gay Health Advocacy Project (Morningside)

Medical Services (Morningside)

Student Health Services (CUMC)


Impetigo + oral sex = gential herpes?

Dear kitten,

The quick answer is nope! If you have been diagnosed with impetigo, oral sex with your boyfriend could transmit the impetigo to him but it won’t cause genital herpes. While impetigo is a contagious skin infection, it's caused by bacteria (either staphylococcus or streptococcus strain) while herpes simplex (both type 1 and type 2) are caused by viral infections. It’s true that both of these skin infections are contagious and can be passed on by sexual contact, but impetigo infections can’t cause herpes outbreaks and vice versa.

Let’s chat a bit more about impetigo: It is a very contagious skin infection, one that is often seen in babies and children. The infection will usually appear as red sores on the face, often clustering around the nose and mouth, and when they burst the sores develop yellow or honey-colored crusts after a few days. Unless the condition clears up on its own (typically in a couple of weeks), a doctor will prescribe an antibiotic to accelerate healing and limit how contagious the condition is. Bullous impetigo is a different, less common form of the disease, which will appear as larger blisters on the trunk or groin area. Ecthyma is another more severe form, which will cause painful fluid or pus-filled sores that can become ulcers deep in the skin (this type happens more commonly in older adults with diabetes or a compromised immune system).

Impetigo is transmitted by touching the sores of an infected person or by coming into contact with items that they have touched like clothing, linen, towels, or in the case of children (or big kids at heart), toys. Impetigo can start because bacteria have gotten into a small cut or insect bite, or even a scratch on the skin. Impetigo is entirely curable with antibiotics. Impetigo is not usually dangerous however sometimes there are complications. Ecthyma has been known to cause scars and one type of bacteria can cause kidney damage.

Herpes, on the other hand, is transmitted by the viruses HSV-1, HSV-2, or the herpes varicellus-zoster virus. (See What is herpes? for information on the difference between the viral strains and the possible resulting conditions. For even more info, visit the Go Ask Alice! Herpes archive.) Herpes is transmitted through skin-to-skin contact, and unlike impetigo it’s pretty unlikely that just sharing a towel or t-shirt with someone that is infected will lead to contracting the virus. While there’s no cure for herpes, medication can help manage outbreaks.

Until the bacteria causing the impetigo infection has been eradicated, the condition is highly contagious, so it might be best for you and your boyfriend to take a break from sexual contact until then.

Here’s to a speedy healing so you can go back to playing like the kitten you are!

Alice

Relationship with HIV positive man — Can I have kids?

Dear Reader,

Kudos to you and your boyfriend for taking some valuable steps in building a trusting and healthy relationship! Talking about HIV status can be a sensitive and daunting task — especially with someone you care about deeply. While HIV status may influence how or when you decide to have kids, it does not mean you can never have children. There are many ways for couples and individuals to choose to become parents — adoption, artificial insemination, conception via sexual intercourse, surrogacy, and so on. When one or both partners are HIV+, talking with a health care provider who is well versed in HIV care and family planning might help you talk through options to find what’s right for you and your partner. Below are some possible options for you both to consider, depending on your circumstances.

  • If you’re an HIV-negative biological female, you may consider:
    • Pre-exposure prophylaxis (PrEP) — Use of this prior to conception can greatly reduce your risk of contracting HIV (if you are currently HIV negative and having oral, anal, or vaginal sex with your boyfriend). PrEP is the procedure of taking anti-retroviral medications, if you’re HIV-negative, in order to prevent you from acquiring the disease. There is ongoing research being conducted about using PrEP to prevention transmission while attempting to conceive. In one study, among heterosexual couples with an HIV negative female partner, the use of PrEP during attempted conception was evaluated. No females in the study became HIV positive and pregnancy rates were high. Research is ongoing to evaluate whether the use of PrEP is safe to also use during pregnancy and lactation to prevent transmission to the baby.
    • Spermwashing — If you’d like your HIV positive boyfriend to be the biological father, one option for conception is spermwashing. This involves removing the seminal fluid surrounding a sperm, and then implanting that sperm in one of your eggs. HIV is carried by seminal fluid, but not by the sperm itself. Recent research shows spermwashing to be safe, if done by qualified medical personnel. Spermwashing is approved by the World Health Organization, however, the U.S. Centers for Disease Control and Prevention (CDC) recommend against it as an option due to at least one documented case in which a female partner became infected with HIV via spermwashing.
    • Semen analysis — Your partner may be advised to get a semen analysis before you try to conceive. If he has semen abnormalities, you may have a lower likelihood of getting pregnant. If you know that it’s unlikely that you can be pregnant using his sperm, you may choose to avoid unnecessary exposure to HIV.
    • Conception with an HIV-negative sperm donor or sexual partner via sexual intercourse or artificial insemination — Sperm banks test all donor sperm for HIV.
  • If you’re an HIV-positive biological female, you may consider:
    • Beginning or continuing antiretroviral drugs (ARVs) — You may already be taking ARVs. If you are, your health care provider can tell you if the ARVs you’re using right now would be safe during pregnancy. Your provider may also make adjustments if you are trying to conceive. If you’re not on ARV drugs, and you do become pregnant, you can start taking them at the beginning of the second trimester of pregnancy. If you are unable to do that, these drugs can also be administered during labor and delivery.
    • Caesarian delivery — Many HIV and family planning experts recommended that you deliver via Caesarian section (C-section) to reduce likelihood of HIV transmission during childbirth.
    • Choosing an alternative to breastfeeding — Breast milk is one way that HIV can be transmitted, so breastfeeding is not advised if there is a risk of transmission. Formula feeding can be an alternative to breastfeeding.
    • A combination of all three — Combining ARV, C-section, and formula-feeding can reduce the risk of transmitting HIV to the baby to below two percent.
  • If you are a biological male (cis- or male-to-female transgender), or have a condition which would prevent you from carrying a child to term, you could choose a surrogate mother. With spermwashing, even if the biological father is HIV positive, HIV negative surrogate mothers have carried HIV negative children to term at little risk of infection to the mother or child.
  • No matter what your circumstances, you may also consider adoption. Some things to keep in mind when considering adoption as a couple with a HIV positive parent:
    • The Americans with Disabilities Act makes it illegal for adoption agencies to discriminate against potential parents because they are HIV positive. Consider asking your health care provider for help locating an adoption agency.
    • Adoption agencies outside of the United States may have no such laws. If you try to adopt from abroad, you may end up being rejected because of an HIV positive diagnosis.
    • If you’re a same-sex couple, you may face a similar problem — Same-sex parent adoption is illegal in many countries, as well as some states in the U.S..
    • One way to hopefully avoid these examples of discrimination is to seek out adoption agencies that specialize in HIV positive and LGBTQ parenting. You may be able to find resources at your local LGBTQ community center. You can also find information from the Human Rights Campaign.  

 Here are some additional considerations for HIV+ individuals and family planning:

  • Genital tract infections — Whether or not you’re HIV+, HIV health care providers recommend screening and treatment for genital tract infections before you attempt to conceive. Genital tract infections can increase the reproduction of HIV in genital areas. Sometimes, HIV isn’t detectable in a person’s bloodstream, but is detectable in their genital tract.
  • Viral suppression — Before attempting to conceive, your boyfriend may be advised to take steps to suppress (or lower) his viral load as much as possible. Note: even if your boyfriend is at maximum suppression, there is still a chance that he could transmit the HIV virus to you if you’re having vaginal, oral, or anal sex.

Couples HIV testing and counseling is recommended and will likely help guide and support your family planning decision making. This service involves discussing your test results with a supportive professional. In turn, they can recommend treatment, support, and prevention of transmission of the disease, if you are HIV negative.

Lastly, it’s wonderful that you are choosing to use protection together. You may already be aware that condoms and other barrier use can greatly reduce the likelihood of HIV transmission. However, no form of protection is completely failsafe. Consider making an appointment with your health care provider if you would like to talk about your specific health concerns.

Alice

For more information or to make an appointment, check out these recommended resources:

Medical Services (Morningside)

Gay Health Advocacy Project (Morningside)

Student Health Services (CUMC)


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

Migraines around my period — What's up with that?

Dear Reader,

What a pain in the… head! And, dear Reader, you do not suffer alone. Migraines that occur exclusively around your period (sometimes called perimenstrual migraines) seem to affect between one or two out of every 20 women. They are more common for those in their late 30s, often declining after menopause. It appears that the hormone estrogen and the hormone-like compound prostaglandins are likely the culprits of this painful experience. Let’s explore some of the reasons this pair can cause pain as well as shed some light on treatment options.

The Big E — Estrogen

There seems to be a special relationship between estrogen levels and migraine headaches. Though both men and women produce estrogen, the hormone levels fluctuate much more for females (both during the menstrual cycle and between puberty, reproductive age, and menopause), than for males, whose estrogen levels remain relatively stable throughout their lives. For women, estrogen typically decreases at the end of the luteal phase of the menstrual cycle or when those on hormone therapy are at “trough” (right before their next hormone administration). Studies have shown that minimizing these drops may help reduce migraine frequency. Combined hormonal contraceptives (pills, patches, and rings containing both estrogen and a progestogen) have been shown to have some effect on reducing fluctuations in estrogen subsequently decreasing perimenstrual migraines. It also appears that migraines can occur when estrogen levels are artificially manipulated as well. Scientists have also studied male-to-female transgender women on estrogen hormone therapy and discovered that migraine headaches tended to increase in this group when they began their hormone therapy.

P is for… Prostaglandins!

Prostaglandins are a hormone-like compound involved in the regulation of the menstrual cycle and nervous system functioning. These compounds may also play a role in the regulation of the nerves sensitive to facial pain, also a possible link to perimenstrual headaches.

Prostaglandin levels in the body have been found to be highest during perimenstrual migraine and are often accompanied by dysmenorrhea (aka strong menstrual cramps, typically interfering with normal activities). If you take medicine that inhibits prostaglandin production, you may be able to reduce the likelihood of both perimenstrual migraines and dysmenorrhea.

These are just a couple possibilities that researchers have found that might explain monthly migraines — and future studies will hopefully provide more answers. Perimenstrual migraine can also sometimes indicate a menstrual disorder, such as abnormal hormonal cycles with elevated estrogen levels or excessive menstrual flow — so you might want to check in with your health care provider about possible causes and treatments that are best for you. You may also want to check out the National Headache Foundation for resources and tips.

Hope you find some monthly relief soon!

Alice

For more information or to make an appointment, check out these recommended resources:

Medical Services (Morningside)

Student Health Services (CUMC)


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

Buying a vibrator — Is it normal?

Dear Reader,

Have no fear! Vibrator use and sexual exploration is both common and healthy throughout the lifespan. In one internet-based survey of women between ages 18 to 60, over 50 percent of survey participants reported vibrator use. That said, there remain many misconceptions and myths and about female sexuality and sexual health ­— vibrator use included! There is also a lot of historical negativity when it comes to female sexuality. It’s about time we changed that, don’t you think? Here are some sexy facts to hopefully demystify any rumors that still abound:

Vibrators can be good for you!

Vibrator and sex toy exploration are great ways to discover and enhance sexual enjoyment — and also become more familiar and comfortable with your body. Whether you sexual vibrations are solo or with a partner, sex play of all kinds can have both physical and psychological health benefits.

Vibrator use may also be associated with positive health behaviors and sexual function. Remember that internet survey mentioned above? Participants who reported vibrator use were also more likely to:

  • Have had a gynecological exam during the past year.
  • Have performed genital self-exam during the previous month.
  • Score higher on sexual function tests, indicating a healthy level of sexual arousal and satisfaction.

Everyone may actually be doing what you’re doing.

It’s pretty common to think you’re the exception to the rule in many situations — and our beliefs about sex are no exception. While vibrator use is common and viewed positively by many, there still seems to be a disconnect between what women believe and what they do. One study revealed that while female participants believed most women self-penetrate during masturbation, the majority of respondents masturbate via clitoral stimulation (vibrators can help in that process). Some women also viewed masturbation as a routine part of their day to help relieve tension. However, they expressed discomfort about discussing their masturbation habits with others. This is a good reminder that many times when we think we are alone in our thoughts, beliefs, desires, etc., but in fact there are many other people with similar experiences and feelings.

Good vibrations — friend! Not foe!

Another study revealed that, perhaps contrary to popular belief, respondents (both male and female) had highly positive views of women’s vibrator use. In fact, those surveyed viewed vibrator use as adding to the sexual experience. Positive thoughts about vibrator use are also associated with a healthy sex drive, sexual arousal, and overall sexual well-being.

So, what is normal? Defining what is “normal” is often a challenge, dear Reader. Research does tell us that vibrator use is common and the sexual and health benefits of masturbation are numerous. There are lots of different types of vibrators out there and questions you may want to consider in your pleasure pursuits — you can have lots of fun finding the vibe (or vibes!) that suits your interests. You may also want to find a sexpert (expert on sexual exploration!) to answer questions as you make your way on your sexual discovery journey. Consider checking out MySexProfessor.com, founded by Debby Herbenick, Ph.D., MPH, a research scientist at the Center for Sexual Health Promotion at Indiana University, author, and sexual health educator at the Kinsey Institute. And, for more information about sex toys, sexual health books, or otherwise, consider checking out Babeland, Good Vibrations, and Eve’s Garden just to name a few!

Here’s to many more good vibrations!

Alice

Syndicate content