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Uh–oh… Using saliva for lubricant may not be good for you!

A study finds that saliva use as a lubricant for anal sex is a common sexual practice in MSM, and it may play an important role in gonorrhea transmission. Almost half of rectal gonorrhea cases may be eliminated if MSM stopped using partner’s saliva for anal sex.

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Lubrication makes sex… easy, thus fun. Arguably particularly for men who have sex with men (MSM), with the backdoor known for not naturally producing lubrication, so that – sans the use of personal lubricants/lubes – soreness could happen from all the friction. There are of course three main categories of lubes (water-, silicone- or oil-based), with the water-based lubes by far the most popular (they’re water soluble, so skin and mucous membranes will absorb them; they’re easy to clean with just water and soap; and they’re condom-compatible as they don’t corrode condoms).

However, it may be time to admit that the use of water-based lubes in the Philippines is not as pervasive as it should be – in fact, even if many HIV-related service providers may deny this, when distributing condoms as part of HIV-related programs, water-based lubes are not always distributed with condoms. Suffice it to say, many Filipinos use different kinds of “pampadulas (lubrication)”.

Yes, yes… no research has been done on this yet; but – at least anecdotally – some of the “pampadulas” used particularly by men who have sex with men (including gay and bi men) and transgender women that were reported to Outrage Magazine include:

  1. Laway”/saliva (also known as “La pwah!” lotion, so-named after the spitting sound)
  2. Shampoo or conditioner
  3. Cooking oil (at times even if already used for frying fish)
  4. Egg white
  5. Hair gel
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The sad news now is that, according to one study, saliva – a top choice for “pampadulas” for many – may actually not be good for you.

In “Saliva use as a lubricant for anal sex is a risk factor for rectal gonorrhea among men who have sex with men, a new public health message: a cross-sectional survey”, published in journal “Sexually Transmitted Infection”, E.P. Chow, V.J. Cornelisse, T.R. Read, D. Lee, S. Walker, J.S. Hocking, M.Y. Chen, C.S. Bradshaw and C.K. Fairley evaluated – after noting that apart from penile-anal intercourse, other anal sexual practices (rimming, fingering and saliva use as a lubricant for anal sex) are common among MSM – whether these various anal sexual practices are risk factors for rectal gonorrhea in MSM.

The authors conducted a cross-sectional survey among MSM attending Melbourne Sexual Health Centre between 31 July 2014 and 30 June 2015. Rectal gonorrhea cases were identified by culture.

The results?

Among 1,312 MSM, 4.3% (n=56) had rectal gonorrhea. Other anal sexual practices were common among MSM: receptive rimming (70.5%), receptive fingering or penis dipping (84.3%) and using partner’s saliva as a lubricant for anal sex (68.5%). Saliva as a lubricant (adjusted OR 2.17; 95% CI 1.00 to 4.71) was significantly associated with rectal gonorrhea after adjusting for potential confounding factors. Receptive rimming and fingering or penis dipping were not statistically associated with rectal gonorrhea. The crude population-attributable fraction of rectal gonorrhea associated with use of partner’s saliva as a lubricant for anal sex was 48.9% (7.9% to 71.7%).

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“Saliva use as a lubricant for anal sex is a common sexual practice in MSM, and it may play an important role in gonorrhea transmission,” the authors concluded. “Almost half of rectal gonorrhea cases may be eliminated if MSM stopped using partner’s saliva for anal sex.”

Makes you think that it’s now really time to invest in those water-based lubes…

Health & Wellness

Fathers may protect their LGB kids from health effects of discrimination

LGB individuals who report being discriminated against but who feel close to their fathers have lower levels of C-reactive protein (CRP), a measure of inflammation and cardiovascular risk, than those without support from their fathers.

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Photo by Julie Johnson from Unsplash.com

This is assuming members of the LGBTQIA community have accepting fathers, of course.

Lesbian, gay, and bisexual (LGB) individuals who report being discriminated against but who feel close to their fathers have lower levels of C-reactive protein (CRP), a measure of inflammation and cardiovascular risk–than those without support from their fathers, finds a new study from researchers at NYU College of Global Public Health.

The findings, published in the journal Psychoneuroendocrinology, suggest that fathers can play a role protecting against the negative effects of discrimination and, surprisingly, mothers may not play the same role. More generally, the study illustrates how prolonged exposure to stress can hurt sexual minorities.

LGB people experience stress and discrimination related to their sexual orientation, including dealing with stigma, microaggressions, and the process of coming out. Research shows that prolonged or repeated exposure to stress, including discrimination, leads to the production of inflammatory proteins such as CRP and raises one’s risk for heart disease.

“I’m interested in understanding how discrimination gets under the skin and is linked to poor health outcomes,” said Stephanie Cook, assistant professor of biostatistics and social and behavioral sciences at NYU College of Global Public Health and the study’s senior author. “What factors make people more resilient and can protect them from these health effects? We know that social support can act as a buffer, but wanted to better understand the role parents play in how their children experience discrimination and its health effects.”

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In this study, the researchers analyzed data from the National Longitudinal Study of Adolescent to Adult Health. Adults 24 to 33 years old were surveyed about their sexual orientation, how close they felt with their mothers or mother-figures and fathers or father-figures, and whether they felt discriminated against or treated with less respect than others in their day-to-day lives. The researchers focused on 3,167 adults describing their relationships with their fathers and 3,575 describing their relationships with their mothers. Blood samples were used to measure CRP levels.

The researchers found that when LGB people felt discriminated against in their day-to-day lives but described being close to their fathers, they had lower CRP levels than other sexual minorities who were discriminated against but did not have close relationships with their fathers.

Relationships between LGB people and their fathers can act as either a buffer or an additional source of stress. On one hand, positive social support from a father appears to protect sexual minorities from harmful experiences related to discrimination. On the other, poor social support from one’s father–for instance, fathers who do not accept their children’s sexual orientation after they come out–may lead to exacerbated stress and less ability to shield against harmful experiences related to discrimination.

Interestingly, the researchers found that closeness with mothers did not act as a buffer for LGB or heterosexual individuals who experienced discrimination.

“We often talk about the importance of support from mothers and how mothers can help buffer the negative effects of discrimination on health broadly. But this study suggests that we’ve been neglecting the role of fathers, and their role is really important when it comes to their LGB children,” said Cook, who leads the Attachment and Health Disparities Research Lab at NYU College of Global Public Health.

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“If we’re trying to understand the effects of discrimination on sexual minorities and figure out what we can do to intervene or prevent these outcomes, we should look beyond support from just peers and mothers to include fathers in our efforts,” said Erica Wood, a research scientist in the Attachment and Health Disparities Research Lab at NYU College of Global Public Health and the study’s first author. “For instance, professionals can work with fathers who reject their children because of their sexual identity to show them the importance of the father-child relationship in reducing the negative effects of stress.”

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Health & Wellness

Gender identity conversion efforts associated with adverse mental health outcomes

Reported exposure to conversion efforts before the age of 10 also was associated with greater lifetime odds of suicide attempts.

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“Conversion efforts” to try to change a person’s gender identity to match their sex assigned at birth were associated with increased likelihood of adverse mental health outcomes, including suicide attempts.

This is according to a study helmed by Jack L. Turban, M.D., M.H.S., of the Massachusetts General Hospital, Boston.

The study, tiled “Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults”, and which appeared in JAMA Psychiatry, involved nearly 28,000 transgender adults from across the US. This observational study is based on the results of a survey distributed through community outreach to transgender adults in all 50 states, the District of Columbia, some territories and overseas U.S. military bases.

Of 27,715 transgender adults who responded, 19,741 (71.3%) reported having spoken to a secular or religious professional about their gender identity, and of these, 3,869 (19.6%) reported exposure to gender identity conversion efforts.

That exposure was associated with severe psychological distress during the previous month and prior suicide attempts during their lifetime compared with transgender adults who reported talking about their gender identity with a professional but weren’t exposed to conversion efforts.

Reported exposure to conversion efforts before the age of 10 also was associated with greater lifetime odds of suicide attempts.

Limitations of the study include its inability to determine causation; it didn’t capture conversion efforts by others such as family members; and it’s possible that some adults with worse mental health might have sought conversion therapy.

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The study findings support that gender identity conversion efforts should be avoided in children and adults. Professional organizations, including the American Psychiatric Association, have called conversion therapy for gender identity unethical and ineffective, and some countries have already outlawed the practice.

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Health & Wellness

Pregnant trans men at risk for depression and lack of care, Rutgers study finds

Older transgender men who become pregnant need better mental health care than female counterparts.

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Transgender men who become pregnant are at increased risk for depression and difficulty getting medical care due to a lack of knowledge among health care providers, a Rutgers study reports.

The study, published in the journal Maturitas, examined health care research on transgender men who become pregnant at or after age 35 to determine their medical and mental health needs.

“Despite the increased visibility of transgender people — there are about 1.4 million who have transitioned in the United States — medical providers are largely unprepared to care for them and most have had limited educational opportunities,” said lead author Justin Brandt, an assistant clinical professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at Rutgers Robert Wood Johnson Medical School.

Transgender men who have transitioned hormonally and are taking testosterone but retain their female reproductive organs have the potential to become pregnant. Since the U.S. medical system has been tracking these patients as female, no data exists on how many transgender men give birth each year, but Brandt said the number is likely higher than people realize. While some plan to become pregnant, the research suggests that unintended pregnancies occur in up to 30 percent of transgender men.

According to the U.S. Transgender Survey, nearly 40 percent of its 28,000 respondents reported attempting suicide — nearly nine times the national average. That risk can be increased in transgender men with the unwanted physical changes resulting from pregnancy, according to Brandt. “The process of transitioning is long and arduous, and pregnancy, which is regarded as a feminine condition, forces these men to almost fully transition back to their sex assigned at birth, which can worsen gender dysphoria,” he said.

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Surveys used to screen pregnant and postpartum females for depression are not designed to assess the impact of pregnancy on gender dysphoria in transgender men.

The study also found that nearly 25 percent of transgender people reported negative health care experiences in the last year. This correlates with the finding that about 44 percent of pregnant transgender men seek medical care outside of traditional care with an obstetrician. Rather, they may seek out non-physician providers, such as nurse midwives, with 17 percent delivering outside of hospitals — a higher rate than with women.

Although data is limited on how transgender men give birth, the review found that 64 percent had vaginal births and 25 percent requested cesarean delivery.

The report also noted that transgender men who requested cesarean deliveries reported feeling uncomfortable with their genitalia being exposed for long periods of time while those who went through labor reported that the process of giving birth vaginally overcame any negative feelings that they had with the female gender that they had been assigned at birth.

“Although Rutgers physicians have not yet had a pregnant transgender male patient, our healthcare professionals are trained and ready,” Brandt said.

The researchers also found that about 51 percent of transgender men breast or chest fed their infants even if they had breast surgery.

Brandt recommended that transgender men planning to conceive should visit their doctor before becoming pregnant to address routine issues, such as folic acid supplementation and screening for genetic disorders, and to be counseled on the risks of advanced-age pregnancy, such as infertility, miscarriage, gestational diabetes and pre-term delivery. Transgender men also likely will need to update health screenings that could have lapsed during transition, such as pap smears and, when indicated for those who have not had chest surgery, mammograms.

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After delivery, Brandt said doctors should address long-acting and reversible methods of contraception if the individual is at risk for unplanned pregnancy. “Transgender men who intend to restart testosterone after delivery may decide to defer contraception since they perceive that their male hormone therapy induces a state of infertility, which is not always the case,” he said.

Co-authors included Amy Patel, Ian Marshall and Gloria A. Bachmann at Rutgers Robert Wood Johnson Medical School.

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Health & Wellness

Little link found on popper use and dependency; no correlation with mental health or psychological stress

A survey of more than 800 men aged 18 to 35 found little evidence of typical dependency characteristics, including health, social, legal and financial problems, and no correlation between popper use and mental health or psychological stress.

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Young gay and bisexual men are frequent users of alkyl nitrites, or poppers, but few show signs of addiction, risky consumption habits or other psychosocial problems. This is according to ‘Harmless? A hierarchical analysis of poppers use among young gay and bisexual men’, by Dr Daniel Demant and Dr Oscar Oviedo-Trespalacios, and published in Drug and Alcohol Review.

A survey of more than 800 men aged 18 to 35 found little evidence of typical dependency characteristics, including health, social, legal and financial problems, and no correlation between popper use and mental health or psychological stress.

The study is particularly noteworthy considering some efforts to control popper use and distribution – e.g. in Australia. Dr. Daniel Demant, public health researcher at the University of Technology Sydney (UTS), who conducted the study, said that the decision by Australia’s Therapeutic Goods Administration (TGA) to step back from prohibiting poppers is commendable. The TGA, instead, elected to classify them as a Schedule 3 drug, available over the counter in pharmacies from February 2020.

An interim decision by the TGA in 2018 recommended poppers be classed as a prohibited substance, in the same category as methamphetamine and heroin, which would have made “overnight criminals” of the estimated 100,000 plus Australian users.

“What we see with this research is that poppers are a very commonly used drug in the LGBT community, both recently and over their lifetime,” Demant said. “Most of the users are already oppressed or marginalized based on their social identity as gay or bisexual men. This creates a question as to whether there would have been a discriminatory element in banning a substance with such a low risk profile.”

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Demant added that banning a substance that is used by so many people would create a “new class of criminals, basically overnight.”

Currently, poppers are available on prescription from pharmacies, but they are more commonly bought illicitly, in sex-on-premises venues and LGBT bars. A vial containing 25-30mL of the clear, strong-smelling fluid, possibly labelled as “VHS tape cleaner”, “leather cleaner” or “room deodorizer”, sells for up to $50 (or equivalent in countries like the Philippines), despite costing a couple of cents to manufacture.

The new TGA decision to regulate poppers rather than banning them hopefully paves the way for some measure of quality control as well as the removal of the “extreme profit margin” that exists now, Demant said.

Demant said that with poppers becoming a pharmacy-only medicine, safety standards would have to be met and pharmacy staff could provide guidance in cases where poppers might react badly with users’ other medications, particularly Viagra.

“We could stop pretending that poppers are sold for anything other than getting people high. And once we do offer it in pharmacies, we would have something made to the highest standards for people to use,” Demant ended.

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Health & Wellness

LGBT people more likely to develop dementia, according to study

More than 14% of sexual and gender minorities (SGM) reported subjective cognitive decline, significantly higher (p<0.0001) than the 10% rate among cisgender heterosexual participants.

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More than 14% of sexual and gender minorities (SGM) reported subjective cognitive decline, significantly higher (p<0.0001) than the 10% rate among cisgender heterosexual participants. Even after adjusting for factors such as income, age and race, SGM participants were 29% more likely to report subjective cognitive decline (SCD).

This is according to a study presented at the Alzheimer’s Association International Conference (AAIC) 2019 in Los Angeles in the US. The study noted that to date, few studies have investigated the symptoms and disease progression of Alzheimer’s and other dementias in the LGBT community. And so to examine these associations, Jason Flatt, PhD, MPH, assistant professor at the Institute for Health & Aging at the University of California, San Francisco, and colleagues analyzed data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS), a large phone-based survey led by the Centers for Disease Control and Prevention.

The study analyzed data from 44,403 adults aged 45 and older across nine states in the US (Georgia, Hawaii, Illinois, Minnesota, Nevada, Ohio, Virginia, West Virginia and Wisconsin) that participated in the 2015 BRFSS optional modules on the Healthy Brain Initiative, which included subjective cognitive decline and Sexual Orientation and Gender Identity. Roughly three percent of participants (1,253) identified as a sexual or gender minority (SGM). Subjective cognitive decline was defined as self-reported confusion or memory problems that have been getting worse over the past year.

The study – as noted – found higher rates of subjective cognitive decline among LGBT people compared to their cisgender heterosexual counterparts.

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“Given that one in seven adults who identified as a sexual or gender minority reported subjective cognitive decline, it is critical that more opportunities exist for people in these communities to receive regular evaluation for cognitive impairment and Alzheimer’s disease,” Flatt said. “There is also a need for greater education on Alzheimer’s risk, signs and symptoms, and training of health care providers to ensure inclusive and welcoming care for LGBTQ+ populations.”

Flatt added that “while we do not yet know for certain why sexual or gender minority individuals had higher subjective cognitive decline, we believe it may be due to higher rates of depression, inability to work, high stress, and a lack of regular access to healthcare.”

According to Flatt, less than half of SGM adults with SCD in the study talked to their health care provider about it. SGM adults with SCD were also more likely to report that they had to give up day-to-day activities (39% vs. 29%, p=0.003) and needed help with household tasks (44% vs. 35%, p=0.01) than cisgender heterosexual participants. Both groups were similar in terms of talking to their health care provider about their SCD.

LGBT people living with dementia and their caregivers often have difficulty accessing information and support services, which can be especially challenging when memory loss and dementia enter the equation.
Photo by Cristian Newman from Unsplash.com

To advance research into Alzheimer’s in the LGBT community, Karen Fredriksen-Goldsen, PhD, professor and director of Healthy Generations Hartford Center of Excellence at the University of Washington, created the “Aging with Pride: Innovations in Dementia Empowerment and Action (IDEA)” study. A multisite study in Seattle, San Francisco and Los Angeles, this is the first federally-funded study on dementia intervention specifically designed for LGBT older adults with dementia and their caregivers.

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The researchers had previously identified unique risk factors of LGBT older adults living with dementia through the first longitudinal study of this population (Aging with Pride: National Health, Aging, and Sexuality/Gender Study). Using longitudinal data with three time points (2014, 2015 and 2016), modifiable factors predicting physical functioning and quality of life (QOL) among LGBT older adults with dementia (n=646) were identified.

LGBT older adults living with dementia were significantly more likely to live alone (nearly 60%), not be partnered or married (65%), not have children (72%), and not have a caregiver (59%), when compared to older non-LGBT adults living with dementia. Previous experiences of discrimination and victimization (b=-0.19, p<.001) were negatively associated with QOL among LGBT older adults living with dementia. Socializing with friends or family (b=1.11, p<.05) was positively associated with QOL, and physical activity (b = 0.26, p<.001) were associated with better physical functioning.

Also as reported at AAIC 2019, “Aging with Pride: IDEA” includes a tailored approach in which trained coaches identify and modify challenging behaviors that are adversely affecting older adults living with dementia and their caregivers, either of whom are LGBT. The coaches delivered an individualized program of exercise, and behavioral and coping strategies designed to improve physical function, independence and QOL.

The exercise intervention is a low-impact physical exercise program including nine one-hour sessions over six weeks designed to improve physical functioning and maintain independence. The behavior and coping strategies include: techniques for working with LGBT-specific trauma, identity management and disclosure of their LGBT identities to providers and others, plus support engagement in the LGBT community and dementia services. Testing of the intervention is now underway and will be delivered to 225 pairs of LGBT older adults living with dementia and their caregivers.

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“Given their lifetime experiences of victimization, discrimination and bias, many LGBT older adults forgo seeking needed medical care,” said Fredriksen-Goldsen. “LGBT people living with dementia and their caregivers often have difficulty accessing information and support services, which can be especially challenging when memory loss and dementia enter the equation.”

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Health & Wellness

Psychotherapy should be first-line treatment for depression in young people, trial finds

If antidepressants have a role, they have more of a role in people at the older end of the age range. The take-home message from the study is that the first-line treatment for young people with depression should be psychotherapy.

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Young people seeking support for depression should be offered psychotherapy as the first line of treatment, a clinical trial by researchers at Orygen, the National Centre of Excellence in Youth Mental Health, has found.

Associate Professor Christopher Davey, head of mood disorder research at Orygen, said the clinical trial results emphasised the importance of a multi-faceted approach to treating depression in young people.

“The results suggest that we should really be focusing on providing good quality psychotherapy, such as cognitive behavioural therapy, to young people and keeping medication as the second line of treatment,” Associate Professor Davey said.

Psychotherapy refers to a range of psychological therapies provided by a counsellor, psychologist or psychiatrist. Cognitive behavioural therapy is the most common psychotherapy for treating depression in young people.

The randomized, double blind, placebo-controlled clinical trial involved 153 young people aged 15-25 who had been diagnosed with depression and were being treated at youth mental health services in north-west Melbourne. All trial participants received cognitive behavior therapy for 12 weeks coupled with either the common antidepressant fluoxetine or a placebo medication.

The trial results have been published in The Lancet Psychiatry.

Associate Professor Davey said at the end of treatment there were no significant differences in symptom improvement between the two groups, suggesting that the addition of fluoxetine did not affect the participants’ mental health outcomes.

However, this does not suggest that antidepressants should not be used in treating depression.

“Antidepressants can be very useful for some people,” Associate Professor Davey said. “Anyone considering the role of antidepressants in their treatment should discuss this with their doctor or clinician.

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“Our study found some evidence to suggest that if antidepressants have a role, they have more of a role in people at the older end of our age range. The take-home message from the study is that the first-line treatment for young people with depression should be psychotherapy.”

This is of particular interest to members of the LGBTQIA community because 41% of non-binary people said they harmed themselves in the last year compared to 20% of LGBT women and 12% of GBT men. One in six LGBT people (16%) said they drank alcohol almost every day over the last year.


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