below the waist


‘Come As You Are’: Book Explores Old Lies And New Science On Women And Sex

Author and sex educator Dr. Emily Nagoski (Courtesy of Jon Crispin)

Author and sex educator Dr. Emily Nagoski (Courtesy of Jon Crispin)

“You were taught to value and expect something from your sexuality that does not match what your sexuality actually is. You were told a story about what would happen in your sexual life, and that story was false. You were lied to. I am pissed, on your behalf, at the world for that lie. And I’m working to create a world that doesn’t lie to women about their bodies anymore.”

— From: “Come As You Are: The Surprising New Science That Will Transform Your Sex Life.”

I will be grateful forever to “The Hite Report.” Ditto “The Happy Hooker.” Certain books, at key moments, open our eyes to sexual reality — not the distorted reality of porn or bodice-buster novels, but the real-life reality of what our fellow humans do in private and how our own bodies and brains really respond.

I predict that for some, “Come As You Are” by Emily Nagoski — subtitled “The Surprising New Science That Will Transform Your Sex Life” — will be one of those books.

Nagoski, 37, is a sex educator, proud “sex nerd” with a PhD and past work at the Kinsey Institute, and director of wellness education at Smith College. (Also a blogger at Her book focuses in part on a fine irony: Research over the last couple of decades in pursuit of a female version of Viagra — an effort that has failed — has nonetheless added new science to the study of women’s sexuality, science that can be applied to improve sex lives without any little pink pills.

Our conversation, lightly edited:

You say that we were lied to. How?

From the beginning, the day we’re born, the model of sexuality that all of us are given is the one that comes from the expectation of how male bodies work — mostly because, for so long, men were the scientists and the medical providers, they just sort of assumed that the way a man works is how women are supposed to work. So the extent to which a person in a female body does not match a person in a male body is the extent to which they have ‘failed’ to be sexual people.

And what are the ways that women are likeliest not to match?

There are two ways in particular. The first is in what’s called ‘arousal non-concordance.’ Arousal is the activity of your central and peripheral nervous systems in response to sexually relevant stimuli. And it turns out, for men there’s about a 50 percent overlap between what his genitals are doing and how turned on he feels. Basically, if his genitals are responding he’s feeling pretty turned on. That’s not always true, but largely.

“Sex is most satisfying for most women when you’re in a context that is low stress, high trust, high affection and explicitly erotic.”

– Emily Nagoski

For women, there’s about a 10 percent overlap between what her genitals are doing and how aroused she feels. And most of the time, that’s because women’s genitals tend to respond to sort of anything, it’s like a ‘just in case’ genital response. It doesn’t mean that she likes or wants what’s happening, it just means that it’s sexually relevant.

And we look at the way women’s bodies respond to sort of anything and we think, ‘Why don’t they actually like or want all these things? What’s going on with that?’ And it doesn’t mean anything is wrong. It just means the way female bodies work is not the way male bodies work. And that’s OK.

So arousal non-concordance means, if you’re a woman and you’re having genital response — wetness, blood flow — that doesn’t mean that, in your head, you’re necessarily turned on. And what’s another big one where men and women don’t match?

The other non-matching thing is in this idea of desire. The model we’re given is that desire should be spontaneous. It occurs out of the blue. You have one stray sexy thought and suddenly your engine is revving and you’re think to yourself, ‘I would like to go find someone to hook up with.’

And that spontaneous desire, out-of-the-blue desire, totally is one way people experience desire. And there’s another way of experiencing desire called ‘responsive desire’: You’re sort of in neutral, you’re reading a magazine, you’re flipping through channels, and your partner comes over and starts kissing your neck or caressing your arm, and every cell in your body goes, ‘Oh, right, that’s a really good idea!’ But it doesn’t occur spot out of the blue. It emerges in response to arousal, instead of the desire coming before the arousal.

You also discuss these interesting, research-based concepts of having a sexual ‘accelerator’ and sexual ‘brakes.’ How does that work? Continue reading

Cancer From Oral Sex? Michael Douglas Is Not Making It Up

Actor Michael Douglas in a 2004 photo (Wikimedia Commons/US Navy)

Actor Michael Douglas in a 2004 photo (Wikimedia Commons/US Navy)

Michael Douglas: Oral Sex Gave Me Cancer, The New York Post headline blares. The story begins:

Michael Douglas has made a jaw-dropping revelation about his throat cancer: He didn’t contract it from smoking or drinking — but from oral sex.

The Oscar-winning Hollywood star set tongues wagging after he told The Guardian newspaper that he contracted HPV, or human papillomavirus, through a sex act and it developed into cancer.

“Without wanting to get too specific, this particular cancer is caused by HPV, which actually comes about from cunnilingus,” he told the British newspaper in an interview published yesterday.

Your first reaction may be suspicion that Douglas is trying to scapegoat sex when other factors could be to blame, particularly his past smoking.

‘HPV-positive oral cancer cases could soon surpass cervical cancer diagnoses.’

But in fact, a growing body of research suggests that his claim is not entirely far-fetched: Rates of head and throat cancer linked to HPV have been rising dramatically in American men. (File under: Reasons the new HPV vaccines are recommended for boys as well as girls.)

Here are some basics courtesy of the Dana-Farber Cancer Institute:

HPV is the most common sexually transmitted disease. It may cause cervical cancer and increasingly a type of throat cancer called oropharyngeal (or-o-fair-en-jeel). Unlike cervical cancer, there is no screening test (like a Pap Test) for this form of head and neck cancer. According to the American Cancer Society, there will be an estimated 41,000 new cases of head and neck cancer this year – 14,000 being cancer of the pharnyx (which includes the tonsils and base of the tongue). Most of these patients will be young and three out of four will be male.

And here’s some background from a prize-winning story in the cancer magazine Cure: “Facing The Facts: HPV-Associated Head and Neck Cancers Get A Second Look.”

HPV-positive oropharyngeal malignancies—most typically found on the tonsils or at the base of the tongue—increased 225 percent from 1988 to 2004. If current trends continue, HPV-positive oral cancer cases could soon surpass cervical cancer diagnoses, according to a 2011 study published in the Journal of Clinical Oncology.

I just spoke with Dr. Barry Benjamin, an ear, nose and throat specialist who has been practicing at Dedham Medical Associates for 35 years and has seen the prevalence of HPV-related head and neck cancers skyrocket in recent years. Continue reading

Questioning The Ads For Below-The-Waist Surgery


By Judy Foreman
Guest Contributor

Not surprisingly, the headline about “designer vagina” procedures in a press release this week from BMJ Open, an online publication of the esteemed BMJ (formerly the British Medical Journal) caught my eye — and stopped my coffee cup in midair.

It appears that women are flocking to surgeons for things like “vaginal rejuvenation,” “G-spot amplification,” “revirgination” and “labiaplasty.” According to the BMJ authors, a team from University College Hospital in London, vaginal cosmetic surgery is a growing thing for women who “simply don’t like the way their genitals look.”

Good Lord.

These women are apparently concerned about the visibility of vaginal labia through tight clothing (I must be getting old. Why not just wear looser clothing?). Or, as the BMJ authors put it, they want their labia to look “sleeker” and “more appealing.” The women in question seem to have an “awareness – courtesy of a partner or magazine pictures – of larger than normal labia.” (What kind of partners would say….oh, well.)

There is an actual point, beyond sheer prurient interest, to the authors’ concerns. They are worried, with good reason as I discovered, that Internet ads touting these vaginal cosmetic procedures are of “poor” quality. That is, they often contain inaccurate and misleading information. (Are we surprised?) Continue reading

In Defense Of Female Circumcision? Panel Presents Seven Facts

female circumcision

A roadside sign in Uganda (Amnon Shavit/Wikimedia Commons)

What? How can there be counter-arguments? Isn’t the genital cutting performed on girls in Africa the very definition of barbaric?

Not according to a provocative set of articles just out from The Hastings Center, the bio-ethics think tank. They argue that Western media have mis-portrayed genital surgery as worse than it is in a variety of ways. From the press release:

Despite widespread condemnation of female genital surgeries as a form of mutilation and a violation of human rights, an international advisory group argues that the practice is poorly understood and unfairly characterized. In a public policy statement in the Hastings Center Report, the Public Policy Advisory Network on Female Genital Surgeries in Africa, a group that includes doctors, anthropologists, legal scholars, and feminists, argues that media coverage of the practice is hyperbolic and one sided, “painting the now familiar portrait of African female genital surgeries as savage, horrifying, harmful, misogynist, abusive, and socially unjust.”

The advisory network’s statement takes no position on whether the practice should continue. It aims to “move the coverage of the topic from an over-heated, ideologically charged, and one-sided story about ‘mutilation,’ morbidity, and patriarchal oppression to a real, evidence-based policy debate governed by the standards of critical reason and fact checking.”

…Female genital surgery – a neutral term used by the advisory network instead of other terms, such as female genital cutting and female circumcision – has been condemned as a violation of the human rights of girls and women by a wide range of experts and organizations, including the World Health Organization and the United Nations. In several African countries, including Egypt, Guinea, Sierra Leone, and Somalia, more than 90 percent of women ages 15 to 49 have undergone such surgeries.

In its statement, the advisory network focuses mainly on two types of female genital surgery, which they state comprise 90 percent of procedures in Africa. These practices involve reducing the clitoral hood and tissue and reducing or eliminating the labia and the clitoris. A third type, referred to as infibulation or sealing, involves narrowing the vaginal opening with stitches or some other sealing method.

The authors put forth seven facts that they hope will change the scope of media coverage and lead to a better understanding of the cultural complexities underlying female genital cutting:

♠ Medical research has found that a high percentage of women who have had genital surgery “have rich sexual lives, including desire, arousal, orgasm, and satisfaction, and their frequency of sexual activity is not reduced.”
♠ Reproductive health and medical complications linked to female genital surgery happen infrequently.
♠ Those who value female genital surgery view it as aesthetic enhancement, not mutilation.
♠ In almost all societies where female genital surgery is performed, male genital surgery also takes place. Broadly speaking, then, such societies “are not singling out females as targets of punishment, sexual deprivation, or humiliation.”
♠ The link between patriarchy and female genital surgery is unfounded. Almost no patriarchal societies adhere to the practice and, at the same time, the practice is not customary in the world’s most sexually restrictive societies. Continue reading

HuffPost: Hundreds of Genital Injuries, Hidden Toll Of Afghanistan

Source: Wikimedia Commons

The Huffington Post describes here a toll of Afghanistan combat that I’ve never heard mentioned before — hundreds of horrible genital injuries. Of course it stands to reason that IED’s blasting upward would cause such harm, but it surely took special courage by the young men featured in the story to talk about it and its unimaginably difficult emotional aftermath. From the HuffPost:

The decade of U.S. combat in Afghanistan has left Afghans and Americans with a seemingly endless series of woes. But among the most devastating are the blast wounds that have left more than 16,000 young Americans severely wounded.

Several hundred have suffered genital injuries in addition to amputations and burns, leaving them unable to father children and struggling to engage in something resembling the sex they used to have, often without the aid of what many view as the primary symbol of their manhood.

“Who’s going to want to be with me now?” wondered Marine Staff Sgt. Glen Silva, 39, after an IED blast shattered his leg, ripped open his lower torso and severed most of his penis.

Read the full post here.

What Went Wrong With Vaginal Mesh: The Podcast

Radio Boston ran a short piece on the problems with vaginal mesh earlier this week, but a key voice didn’t make the final cut: Dr. Anne Weber, a urogynecologist, formerly with the NIH, was the lead author of a clinical practice bulletin on pelvic organ prolapse published by the influential professional group, the American College of Obstetricians and Gynecologists.

In the bulletin, published back in 2007 Dr. Weber used the word “experimental” to describe a type of surgery in which synthetic mesh is implanted vaginally to repair prolapse, a condition many women face after childbirth and as they age in which tissues become stretched and weakened and pelvic organs, such as the bladder, can sag or bulge into the vagina. Seven months after the original bulletin was published, it was pulled, and replaced with another bulletin on prolapse, this one with the word “experimental” gone.

Dr. Weber says the revision, which she opposed, was based on some doctors’ fear that insurers would not cover a procedure deemed experimental. “I think ACOG was choosing to protect its clinicians’ insurance incomes over patients’ well being,” she told me in an interview.

You can read more about the controversy, and about why vaginal mesh surgery is now under scrutiny, here.

So, for the record, here’s the full Radio Boston segment, with Dr. Weber’s comments included.

Surgery Under Scrutiny: What Went Wrong With Vaginal Mesh

On a rainy night in early September, six women gathered for dinner at a Macaroni Grill restaurant in Gaithersburg, Maryland. They had come from around the country: Utah, Georgia, Florida, New York, Texas. But their mood wasn’t festive. All six were in town to speak publicly about their personal medical traumas in front of an advisory panel for the U.S. Food and Drug Administration.

Between them, the women figured they had undergone 45 surgical procedures to try to undo the damage resulting from vaginal surgery using synthetic mesh devices. The mesh implants were supposed to free them from the intimate discomforts that millions of women face after childbirth and as they age: pelvic organ prolapse, in which stretched, weakened tissues can allow the bladder or other organs to sag or bulge into the vagina, and stress urinary incontinence, which can lead to involuntary leakage with every laugh or cough. Once implanted, the hammock-like mesh was meant to shore up the supportive pelvic tissues and help keep sagging organs in place.

But rather than fix their problems, the mesh led to a range of far more awful complications. For some, the material eroded through the vaginal lining, causing infections and nerve damage, as well as excruciating pain, the inability to sit down or urinate without a catheter, multiple hospitalizations and a halt to their sex lives.

“I was in the most horrendous pain I’ve ever experienced,” said Amy Gezon, a 43-year-old mother of three and one of the women who testified before the FDA advisory panel. “I finally ended up in the ER after expressing a desire to end my life just to escape the pain. If I knew one-tenth of the information out there in the literature…I would have never consented to this surgery.”

A Higher-Risk Device

The FDA, which has already detailed the serious complications linked to vaginal mesh surgery in a series of public health alerts – one in 2008 and an update this summer – is now considering reclassifying some of the devices into a higher-risk category that would require more evidence of safety and effectiveness, including clinical studies. Continue reading

CDC: 8 In 10 Teen Boys Use Condoms When Losing Virginity

I know they say that the brain’s planning areas tend to develop particularly late in teen boys, but the latest figures from the CDC on condom use are highly heartening: The number of teen boys who used condoms “at first sex” rose 9 percentage points between 2002 and 2010.

Clearly, when it matters, they’re planning ahead.

The full release from the CDC is below — including the latest snapshot of teen sex nationwide — and the full study is here.

More teen males using condoms

The percentage of teen males aged 15-19 years in the United States who used a condom the first time they had sex increased between 2002 and 2006-2010, according to a report from the Centers for Disease Control and Prevention.

The report, “Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, 2006-2010 National Survey of Family Growth,” from CDC’s National Center for Health Statistics, found that 8 in 10 teen males used a condom at first sex, an increase of 9 percentage points from 2002. The study also found that 16 percent of teen males used a condom in combination with a female partner’s hormonal method, a 6 percentage point increase from 2002.

Other findings include:
In 2006-2010, about 43 percent of never-married female teens (4.4 million), and about 42 percent of never-married male teens (4.5 million) had had sexual intercourse at least once (were sexually experienced). These levels of sexual experience have not changed significantly from 2002, though over the past 20 years there has been a decline in the percentages of those who were sexually experienced. Continue reading

Did ‘Our Bodies Ourselves’ Change Your Life?

One after another, the women of all ages came to the audience microphone and instead of discussing the film they’d just seen, they paid homage and offered heartfelt thanks to Judy Norsigian for a book that changed their lives.

At least, that’s my memory from a screening and panel discussion I attended a few months ago — and the film was quite a provocative one, too. It’s just that women whose eyes have been opened by Our Bodies, Ourselves, which is written by a collective that Judy helped found, tend to feel a burning sense of gratitude — and this was a rare chance to express it.

This weekend offers another chance: A celebration and conference on global women’s health at Boston University, marking the iconic book’s 40th anniversary and the release of its latest version. I see from the Website that the event is already full, but there’s a waiting list and it will be Webcast here.

Readers, did Our Bodies Ourselves change your life? Let us know how, below (and you can email your account to the book’s blog, as well, here.) I’d share more if my own memory weren’t such a sieve, but my recollection is that it was my most important source of information about sex and my own anatomy when I was a teenager and beyond.

Radio Boston aims to air a segment with Judy Norsigian sometime soon, and USA Today does a wonderful job today of summing up the era that spawned OBOS, as it’s widely known, and the book’s sweeping impact. It also shares the disturbing news that the OBOS collective is ever on the verge of going under, and now is no exception:

More than 4 million copies of the book have been sold; an additional 300,000 have been donated to women’s groups worldwide. It has been published in more than 20 languages and updated in nine incarnations, yet the collective struggles, Norsigian says.

“We’re always on the edge of going under,” she says. “Part of the problem is we have all these principles — we won’t take drug company money, or advertising, plus we’re about raising consciousness. … We’re too radical for some funders and not radical enough for others. We’re facing possibly going under next year.”

Are Romance Novels Bad For Your Health?

The scorn among tweeters is already mounting, as word spreads that a new journal article suggests that romance novels are unhealthy: “Come on!” “Really.” “Puh-leeze.”

But I don’t care. I don’t know about my health, but I have no doubt that romance novels were hideously bad for my psyche when I read them as a teenager. I remember emerging from “Sweet Savage Love,” staring into the mirror and grieving the fact that I would never, ever look anything like the exquisite heroine with her long auburn locks and green gypsy eyes. And the sex scenes! It takes decades to get over the false ideas conveyed, the effortless simultaneous orgasms and uncontrollable passions…

So I’m happy to pass along the article that’s raising the Twitter hubbub: It’s here in the “Journal of Family Planning and Reproductive Health Care,” under the title ““He seized her in his manly arms and bent his lips to hers…’. The surprising impact that romantic novels have on our work.” It describes the typical fare of romance novels, including the “beautiful but passive virgins whose sexual desire was awakened by their perfectly-choreographed seduction at the hands of a highly-skilled alpha male.” Then it warns:

Clearly, these messages run totally counter to those we try to promote. We don’t condone non-consensual sex. We want women to be aware of their own desires rather than be ‘awakened’. We aim to reassure our female clients that their first time may not be utterly joyful and that they may not gain reliable orgasms through penetration, but that they themselves are none the less existentially valid and that with affection and good humour things can improve immensely. We warn of the stresses of pregnancy and child-rearing, and we discourage relentless baby-making as proof of a relationship’s strength. Above all, we teach that sex may be wonderful and relationships loving, but neither are ever perfect and that idealising them is the short way to heartbreak. But are our lessons falling on deaf ears when compared to the values of the Regency heroine gazing adoringly across the Assembly Rooms to catch a glimpse of her man?

There’s a final, worrying difference between sexual health professionals and the producers of romantic fiction. To be blunt, we like condoms – for protection and for contraception – and they don’t. In one recent survey, only 11.5% of romantic novels studied mentioned condom use, and within these scenarios the heroine typically rejected the idea because she wanted ‘no barrier’ between her and the hero. Even more worryingly, while the romance readers interviewed said that they knew that such episodes were fiction, and that spontaneous sexual encounters are never risk-free, nevertheless there was a clear correlation between the frequency of romance reading and the level of negative attitude towards condoms and the intention to use them in the future. Continue reading