Monogamy as Mandatory?

Our society is enraptured by monogamy. So much so that other forms of intimate relationships never cross the minds of most people. It’s talked about in nearly every movie and nearly every song: finding one’s soul mate, getting married and being extremely jealous because another individual is stepping on their romantic territory. Even the scientific community is participating in this love affair with monogamy. Animals and genes are being observed and analyzed to discover the roots of the one and only true way to be in a relationship. Now, as you should know by now from reading my other blog posts, I am not a fan of being told I only have one option. Life is never that simple and when someone tries to claim that life is that simple, something is very wrong. So what is monogamy? Why does society love it so much? And are there other options?

Monogamy is a type of relationship in which two individuals decide to have sex/be intimate only with one another. One recurring idea that I have come across in life and while researching for this post is the idea that monogamy is pure and natural. When I typed in the word “monogamy” or the phrase “monogamy in humans” in Google Scholar I was pretty shocked by all of these articles enthusiastically supporting the naturalness of monogamy. I could not help but wonder why was it so important to find examples of monogamy in the animal kingdom? Would discovering that monogamy exists in animals and even in animals closely related to humans really prove that monogamy is the only natural way? First of all, I have never understood the argument that something that is natural is automatically good. Obviously, that is not the case. Poison, diseases and hurricanes are natural, but they certainly are not things that people tend to want more of. Secondly, there are also many instances of non-monogamy in the animal kingdom. In their article, “The Benefit and the Doubt: Why Monogamy?,” G. A. Schuiling states, “The fact that humans can be monogamic is exceptional for an Ape: of the Apes, only the gibbons are [solely] monogamic” (56). They go on to say, “Chimpanzees live in relatively large, promiscuous groups (although there is a strict hierarchy with an ‘alpha male’ at the top, who mates with the majority of females). Male gorillas, on the other hand, have a harem of several females, while orangutans are polygamic” (56-57). Schuiling argues from an evolutionary theory perspective which I tend to dislike in discussions of sexuality, but I do find it amusing that nature readily challenges the “naturalness” of monogamy.

That being said, I should explain why I tend to dislike evolutionary theory in discussions of sexuality. In evolutionary theory (and in everyday life) monogamy automatically refers to a heteronormative couple. Also monogamy is described as the pinnacle of evolution and as absolutely necessary because how else will females obtain resources in order to care for their offspring without a male present? In evolutionary theory, males are on the hunt for young fertile females to impregnate so their genes will be passed to future generations and females are on the hunt for a big, strong male who has lots of resources and who seems healthy enough to provide them with offspring (Schuiling 57). Well what about individuals who are not straight? What does evolutionary theory have to say about them? Pretty much nothing. People who are not heteronormative are seen as failures evolutionarily speaking because they will not procreate and spread their genes (which is obviously the only thing we live for), but at least, they can help care for the children of their heteronormative relatives in order to be evolutionarily useful according to the kin selection theory (this theory, by the way, is incorrect). Now, one could argue that these evolutionary theories only reference the past and obviously have no bearing in our modern world. I would disagree. These theories still influence the ideas and beliefs held by our society today. When society proclaims the naturalness of monogamy, they are also proclaiming the naturalness of heterosexuality and ‘traditional’ gender roles. This is evident in how ridiculously difficult it is for non-heterosexual people to gain equal marriage rights in this country. It is evident in the idea that in order for homosexuality to be seen as acceptable, a gene has to be discovered or examples in nature have to be found in order to prove its “naturalness” and by proxy, its goodness. It is evident in the idea that virginity (and the virginity of women, in particular) is still prized in this society. What better way to control women and their sexuality than to demonize them if they do not keep themselves ‘pure’ so they can be worthy of their future husbands who will provide them with resources? And it is evident in the idea that young (barely legal) women are the sexual ideal in this society. Obviously, one has to make sure they are fertile enough to spread a man’s genetic material.

If monogamy is the only true and natural way, then why is divorce so common and necessary? Shouldn’t it be extremely easy to stay with the first person one falls in love with for the rest of their life? But it isn’t. People break up, divorce and cheat on their partners every day. Monogamy also has this connotation of being the more moral option because no one wants to be “promiscuous”. That is just not what good people do. Christian Klesse in their article, “Polyamory and its ‘Others’: Contesting the Terms of Non-Monogamy,” states, “The derogatory term ‘promiscuity’ implies that a person has ‘unreasonable’ numbers of sexual partners. It is frequently associated with immaturity, character-deficiency, shallowness, narcissism, egocentrism, relational incapacity, lack of responsibility, and worthlessness” (573). This reminds me of a theme I constantly bring up: Normal vs. Abnormal. When I see a phenomenon described as abnormal or “unreasonable,” I cannot help but take a critical look at the argument being made. What exactly is an unreasonable amount of partners? Is it any partners other than the person one intends on marrying (if that’s even an option)? And is everyone capable of being promiscuous? I would postulate that only women have that dubious honor. I rarely hear teenage boys being told to be careful not to become “one of those boys”. So if having an “unreasonable” amount of partners makes a person an immature and worthless individual with a character deficiency, it is no wonder why many people do not even consider anything beyond monogamy (and lie about how many partners they’ve had). Interestingly enough, Schuiling comes to the same conclusion I do, using evolutionary theory in all of its essentialism. They conclude, “Culture, with its temptations but also with its system of bans and commandments, may strongly frustrate urges deeply rooted in the human mind” (Schuiling 59). Schuiling believes that although men and women desperately want to find that one perfect mate, they also want to mate with as many people as possible in order to ensure genetic security and survival. Schuiling thinks that cultural institutions, like religion and marriage, evolved to control these other urges as much as possible. As a result, according to Schuiling, compulsory monogamy is not natural for humans and flies in the face of other urges, which has the potential for conflict.

Now that I have discussed the ‘natural origins’ of monogamy, I want to discuss social influences and pressures. One idea that seems to be very powerful in this society is the idea of the “soul mate”. A soul mate is said to be the one and only person out there for everyone. No one else in this entire world will ever be better suited. This soul mate will have everything a person ever needed and will be everything they could possibly ever want. All someone has to do is find them. And if a person is in a relationship with someone who doesn’t have everything they want, the person either must deal with it and accept that they will not be completely fulfilled in this relationship or leave and find someone else because clearly that original person wasn’t their soul mate. This could lead to serial monogamy and eventual frustration because that one person who solves all of their romantic problems seems so elusive. Can one person really fulfill all of a person’s needs? Should there only be one person in one’s life to fulfill all of their needs? Society does not have this expectation for friendships. No one is forced to have only one best friend who MUST be able to handle all of their friendship needs. If there is enough room in one’s heart to love all of our friends and family in various ways and capacities, then why can’t there be enough room for multiple romantic/sexual/intimate relationships?

This brings the discussion to the topic of polyamory and other types of non-monogamy. There are many different types of non-monogamy, but three common types are: Swinging (being in a relationship with one person, but being able to have sex with others with the consent of the partner), casual sex (sex with multiple people without building committed relationships), and polyamory (building various types of relationships with multiple people). I should state that all 3 forms of non-monogamy are valid and none of them are better than others. For the purpose of this post, I will talk a bit more about polyamory. Jin Haritaworn, Chin-ju Lin and Christian Klesse, in their article, “Poly/logue: A Critical Introduction to Polyamory,” assert that polyamory “tries to provide languages and ethical guidelines for alternative lifestyles and sexual and intimate relationships beyond the culture of ‘compulsory monogamy’ (518).” In essence, it is about options and providing people with other ways to love or relate with others if monogamy does not make them happy. Two common reactions that I receive when I bring up the topic of polyamory with someone new are “Oh no, I would get too jealous” and “Isn’t that just cheating?” The role of jealousy in a relationship is very fascinating to me. It almost seems as if jealousy is a required part of a monogamous relationship. Jealousy is a horrible emotion. It is based out of insecurity (regarding one’s self and the relationship) and the idea that another person might pose a threat to the relationship. I am sure most people would agree that it is not a pleasant experience, but for some reason, it is still seen as something that just happens, just another aspect of being in a relationship. But honestly it does not have to be this way in any relationship, monogamous or non-monogamous. A successful relationship, whether it is monogamous or non-monogamous, requires communication and honesty. Without these things, relationships are doomed to fail. Being honest to partners about one’s feelings and encouraging open discussion about them will assuage negative feelings. Jealousy is a powerful emotion, but that does not mean people should let it get the best of them. Acknowledging one’s own jealousy and then discussing it with your partner(s) is a healthier and more positive way of dealing with it without damaging the relationship in question. And as for cheating: No, being poly is not synonymous with cheating. Cheating involves hiding/lying to your partner(s). As long as you are honest with your partners and communicate with them clearly about your needs and desires then no, it is not cheating. And being poly, just like any other form of relationship, requires honesty and communication to make it work.

As I said before, for me, it is all about giving people the ability to choose what is best for them. Polyamory is not for everyone just like monogamy isn’t for everyone. People deserve options and shouldn’t be forced into one type of relationship. One type of relationship is not more “natural” or better than another. Monogamy is not mandatory and no one should feel ashamed for living a life that fulfills them.

Neonatal Male Circumcision: Harmless Tradition or Child Abuse?

For the purposes of this blog post, I am defining ‘neonatal male circumcision’ as the ‘nonreligious tradition of surgically removing the foreskin from a male newborn baby’s penis as practiced in American hospitals’. Let me just say that I firmly believe that circumcising a male infant is wrong. Period. It’s really an issue of consent for me. The infant cannot consent to having a piece of their penis cut off. I really cannot think of any significant reason why infants should be circumcised. I think it’s just another way for medical practitioners to make a little money and just another tradition that most people follow without truly thinking of the their reasons for doing so. In this post, I am going to list three of the most common arguments for male circumcision that I have heard personally and then I will pick them apart. Enjoy.

Common Arguments for Neonatal Male Circumcision:

• Protection Against Future STIs

In their meta-analysis of multiple research studies, “How Does Male Circumcision Protect Against HIV Infection?,” Robert Szabo and Roger V. Short state that “…circumcised males are two to eight times less likely to become infected with HIV. Futhermore, circumcision also protects against other sexually transmitted infections, such as syphilis and gonorrhea…” (1593). HIV is thought to initially attach to CD4 and CCR5 receptors found in genital and rectal mucosa and much of these receptors are found in the foreskin of the penis. So the assertion that circumcision has the potential to act as protection against STIs is valid. However, there are confounds to this research. Most of the research that focuses on male circumcision and HIV are conducted in Africa with adult men. As Robert S. Van Howe asserts in his article, “A Cost-Utility Analysis of Neonatal Circumcision,” “The HIV pandemic in Africa demonstrates distinct epidemiological differences from the outbreaks in North America or Europe. For example, most infections in Europe and North America are transmitted by nonheteroexual means” (591). Stephen Moses et al agrees, “It has been pointed out that different sexual practices or hygienic behaviors can confound the association between circumcision status and HIV infection…different risks of becoming infected may be due to behavioral factors, not circumcision status” (369). In short, it would be inaccurate to take research conducted in Africa and try to apply it in America. The cultures, traditions and sexual practices differ. For example, in Africa, HIV is mostly transmitted though heterosexual PV intercourse. In contrast, MSM (men who have sex with men) are one of the main high-risk groups in the US. Also many of these studies conducted in Africa are with adult males who are already deeply embedded in a widespread HIV pandemic, not currently seen in the US. One major thing easily overlooked in this research is the role of condom-use. Although, in the studies conducted in Africa, condoms are readily available to the participants, it is admitted that most of the men “never used condoms, and condom use did not seem to influence the rate of transmission of HIV” (Szabo and Short 1592)”. Of course, condom-use did not influence the rate of HIV transmission. They were not being used! According to the CDC (Center for Disease Control and Prevention), “Laboratory studies have demonstrated that latex condoms provide an essentially impermeable barrier to particles the size of HIV... [and] particles the size of STD pathogens”. Condoms protect against HIV and other STIs. Is surgery really necessary? Those who support neonatal circumcision as a preventative mechanism against HIV in America are basically using the argument: ‘Circumcising a male infant will probably protect males from possible future transmission of STIs if your son decides to have unprotected sex’. Neonatal male circumcision costs, on average, between $200 and $400. Condoms are given out freely at any healthcare facility and college. How is it in any way preferable as a parent to spend at least $200 on a painful surgical procedure to protect your son from possible future STIs when the same protection could be given for much cheaper with a condom and a lesson in proper bodily and sexual hygiene? And, for that matter, how can one ever be certain that one act in infancy will really protect adult men against anything in the future? The individual has an entire life’s worth of behaviors to confound any kind of neonatal protection. And let me restate, the baby is being put through a painful procedure that they cannot consent to. If it is not ok to cut off a piece of an adult’s anatomy without their permission, why is doing it to an infant perfectly fine? If an adult male wants to be circumcised to lower his present risk for HIV by undergoing this procedure, than that’s fine. That’s his decision. However, putting a male infant through a painful (and costly) procedure that may or may not protect him for possible future STI transmission is sick in my opinion. Also there is a risk of complications, like accidental (further) mutilation of the genitals, infections and, rarely, death. The risks, at least in my opinion, outweigh the benefits of possible future protection.

• Aesthetics

People seem to be concerned about whether or not a penis is circumcised for aesthetic reasons, i.e. circumcised penises are believed to look better. Let me tell you a secret: All erect penises look the same. Problem solved. Cutting off part of your infant’s genitals just because you think they will be more sexually appealing in the future is disturbing. Please stop thinking the aesthetic appeal of your infant’s genitals.

• “Oh, they won’t feel/remember the pain.”

Really? Although at first glance, their status is questionable, newborns are definitely humans. Therefore, they have nerves and they can feel. In their article, “Circumcision Practice Patterns in the United States,” Howard J. Stang and Leonard W. Snellman reveal, “all too frequently, the physician performing the circumcision denies the infant the benefits of anesthesia because of inaccurate perceptions of the risks of anesthesia or denial that the procedure warrants such amelioration of pain” (3). The idea that infants are denied anesthesia just because it is assumed that they probably won’t feel the pain is troubling. And as for the belief that circumcision is ok because the infants will not remember the pain: So I can hurt anyone I want as long as they forget about it later?

Males should be allowed to make the decision of whether or not to be circumcised on their own when they are adults. At the point of adulthood, they will be able to assess their own risk for STIs and will make the decision of whether or not to be circumcised. In an area facing an HIV pandemic, like Africa, where condoms are simply not being used, than it is easy to see why circumcision could be a viable option for adult men who want to lower their risk while still having unprotected PV sex. However, in the United States, where condom-use is mostly encouraged and there is better access to sexual health education materials, neonatal circumcision is unnecessary. Also it is extremely interesting to compare Western views regarding male and female circumcision, also known as Female Genital Mutilation, (I’ll make a post about this at some point in the near future). Nearly everyone in the US will agree that FSM is wrong. Most people will say it’s a nonconsensual act that causes physical and psychological scarring to innocent young girls. However, these same people will argue that male circumcision is perfectly normal and safe ‘in the right hands’. So what’s the difference? At the end of the day, a child is still getting parts of their genitals chopped off without their consent. Is it just because it has become a tradition in Western society? And are parents being properly informed of the extent of the benefits and risks of circumcision? Doctors should inform them of current research and give them the information needed to make educated decisions. And parents should not take every single thing their doctor says as law. Do some research. Weigh the pros and cons and make an educated decision. An infant should not have to suffer just because of possible future STI transmission and shallow societal aesthetics.

A Quick Thought: The F-Up Agreement

So as I’m sure I’ve mentioned once or twice, I do psychology/sexuality research at an internship in NYC. In my internship, I work with and interview the participants in the studies. The other day, I called in one of my supervisors to do her part in the interview and, during her segment, she brought up something that I just have to share with you.

So the concept that my supervisor (let’s call her Sally) brought up is called, “The F-up Agreement”. This agreement applies to individuals in committed relationships who decide that they do not want to use protection (condoms, dental dams, etc) in their relationship anymore and want to become “fluid-bonded” (i.e. have sex without condoms, dental dams, etc). “The F-up Agreement” has two parts. Part one is the agreement that they won’t use protection in their relationship, but if and/or when they have sex with people outside of the relationship, they will use protection. Part two of the agreement states that if one partner “f’s up” and has sex outside of the relationship without protection, they can ask to use protection in the relationship with their primary partner(s) with no questions asked.

Now, I love this agreement. Sexuality researchers and therapists are realistic. As awesome as it would be for everyone to use protection all the time for the rest of their lives, we all know that’s not going to happen. And realistically, no one in a committed relationship wants to use protection for the rest of their lives. It’s understandable. I just want people to be as healthy and safe as possible and to understand/be aware of the risks. This theory is both realistic and risk-aware. One thing I’ve noticed over and over again in sexuality research is how hard it is for people to talk about safe sex and STIs in relationships, both committed and casual. Lots of assumptions are made, but, in many cases, no actual conversations are had. For instance, I know of one man who contracted HIV, but did not do intravenous drugs and was in one committed relationship for years. How did he get HIV? His partner had contracted HIV and never told him because the partner was afraid that he would leave him. It’s easy to judge the partner, but everyone who has been in sexual relationship knows how difficult and “unsexy” it is to bring up STIs. I think this agreement allows for sexual safety without the 'awkwardness' that everyone is afraid of. Now, I know “The F-up Agreement” involves a lot of trust and maturity. I’m sure the temptation to ask your partner exactly why they suddenly want to use protection would be very strong. However, you have to respect the fact that your partner cares enough about you that they would ask to use protection in the first place. And interrogating your partner would put a strain on the relationship and, if a “f-up” happens again in the future, the partner might not say anything anymore. This agreement is about the greater good of the relationship and the sexual health of everyone involved. It’s about trust and responsibility. And honestly, if you don’t trust someone enough to take care of their own sexual health and, indirectly, yours, then maybe you shouldn’t be in a relationship with them. Just a thought.

Sex Addiction Part 2

I recently had a mini-debate with someone in regards to whether or not the word “addiction” was an appropriate word to describe the phenomenon of “sex addiction”. In this section, I will discuss why I think “addiction” is not a suitable word, the other party’s counterargument and my following counterarguments. Please read "Sex Addiction Part 1” first. It explains what the phenomenon of “sex addiction” is, its relation to medicalization, how it reinforces sexual scripts and gender stereotypes, etc.

So I think a great way to start would be to define the word “addiction”. Now, when most people think of an addiction, they think about withdrawal symptoms and trying to quit and being unable to, but that’s not the whole story. Nick Heather, in his article, “A Conceptual Framework for Explaining Drug Addiction,” describes addiction in three parts: “(1) the level of neuroadaptation, (2) the level of desire for drugs and (3) the level of ‘akrasia’ or failures of resolve” (3). To clarify, an individual becomes addicted to a something when they resolve to stop, but fail many times, when they build up a tolerance and suffer from withdrawal symptoms upon trying to stop, and experience neuroadaption, which is when their brain changes permanently as a result of taking the drug. Common examples of permanent changes to the brain would be a decrease in dopamine production or a decrease in gray matter as a result of using the substance, that causes your body to need the substance in order to maintain a state of 'normal' (for lack of a better word at the moment) that non-substance users experience. My argument is that becoming “addicted” to sex is impossible because one cannot become addicted to behaviors. Behaviors do not cause neuroadaption and there has been no empirical evidence that the desire for lots of sex or having lots of sex causes physical changes in the brain. Two counterarguments I have seen for this were “Well, sex releases dopamine so can’t someone become addicted to that release?” and “I stopped having sex for a while and I suffered from withdrawal symptoms. I felt terrible.” To counter the first argument: Yes, sex results in a release in dopamine, many daily activities do. Dopamine is a neurotransmitter that is essential in learning and in making sure we continue to do things that are beneficial to our survival, like eating and having sex. Dopamine is related to feelings of pleasure and its release serves as a reward to the body for performing essential tasks so the individual will continue to do it in the future. However, the release of dopamine does not automatically result in addiction. The release of dopamine in the brain experienced through daily activities is a normal dosage that the body is naturally used to. However, the amount of dopamine released into the system when taking something like cocaine is well over and beyond the amount the body is used to. Cocaine inhibits the reuptake of dopamine, allowing the neurotransmitter to flood the brain. As a result of this unnatural flood of dopamine, the brain decides that it does not need to produce its own dopamine anymore. Now the brain is changed permanently and the user’s dopamine levels are below the norm without the drug. The individual no longer feels naturally rewarded without the drug. This is why many drug users say they need the drug to feel normal. In regards to the second argument, the difference between the experiences one might have after not having sex for awhile versus not taking a drug is that one can actually potentially die from the latter. In their article, “Myth of Sexual Compulsivity,” Martin P. Levine and Richard R. Trioden  agree with me stating: “First sex is not a form of addiction…Sex is an experience, not a substance. Although sexual experiences may be “mood altering,” abrupt withdrawal from sexual behavior does not lead to forms of physiological distress such as diarrhea, delirium, convulsions or death. Vomiting induced by fear of giving up a learned pattern for dealing with anxiety (such as having sex) is not the same thing as vomiting induced by physiological withdrawal from a physically addicting substance” (357). In light of these facts, the word “addiction” is not appropriate and the phenomenon does not fulfill all the necessary requirements to be referred to as such.

Moving away from the biological to more cultural/social perspectives, I want to discuss the main counterargument of the individual with whom I had the mini-debate with. His argument was that discounting the appropriateness of the disease model of addiction in regards to this phenomenon creates a stigma against those who suffer from it. He also specifically mentioned a moral stigma being directed to these individuals as well. My argument is that the term “sex addiction” and all of the connotations and meanings surrounding it create and reaffirm stigmas and stereotypes rather than erasing them. In “Sex Addiction Part 1,” I discussed how individuals who label themselves as ‘sex addicts’ tend to believe that medicalizing this phenomenon removes all the moral judgment and stigma that they otherwise might suffer as if medicine is somehow immune to social influences and morals. I further argued that this is not the case (see post for more). The diagnosis for “sex addiction” actually creates distinctions between “good” sexual behaviors/fantasies and “bad” sexual behaviors/fantasies. “Good” sexual behaviors/fantasies usually exist within the context of heterosexual sex in a heterosexual marriage or committed relationship. Anything else is usually labeled “bad”. Levine et al continues this train of thought, saying, “In addition, as conceptualized professionally, sexual addiction is currently the only type of ‘addiction’ in which the addict is not expected to give up [their] ‘drug’ of choice as a part of the ‘treatment’. As long as sex is ‘used’ in appropriate contexts (such as marriage, a committed relationship), the addict has been ‘cured’. Note that sexual expression is condoned when it occurs in the social contexts that affirm the traditional sexual order, but medicalized as an “addiction” when it falls outside existing norms” (357). Not only does “sex addiction” stigmatize certain sexual behaviors, but it also reaffirms gender stereotypes (see part 1). Another thing to think about is the connotations behind the word “addiction”. Calling this phenomenon/construction an addiction, even amongst lay people in daily life, is not beneficial to those who suffer from it. The word “addiction” is associated with drugs, especially hard drugs that have no real beneficial qualities, due in part to their addictive aspects. It can be implied from this comparison that sex is also inherently bad. We all know this isn’t the case. Sex is generally good. It’s just that when a person feels like that they HAVE to have sex all the time or find themselves constantly thinking about it and it causes them distress or inhibits other aspects of their life, sex becomes negative to them in that situation. In that specific case, the individual should go see a sex-positive therapist as I stated in Part 1. However, we should be careful of the words we use. Words are important. They hold ideas behind them and the words that become commonly used are extremely powerful and we should take care to use words that do not have serious negative effects on the issues we care so dearly about. The term “sex addiction” may be comforting to some on an individual level, but it strengthens societal anxieties about sex by painting different aspects of sexuality in a negative light.

A quick note (more of a P.S.): So I used to subscribe to the term “sexual compulsion” as a substitute for “sex addiction”. After doing the research for and thinking about this blog post, I realized that I was focusing too much on terminology without looking at the bigger picture. Although the term “sex compulsion” fixes the addiction definition issue, it is just as guilty for painting sex in a negative light. Now, I think that giving this phenomenon a special medical name individualizes it and ignores the social issues. I’d rather it not be named and believe that, in therapy, societal factors should be taken into account along with the person’s individual experiences.

Sex Addiction Part 1

This post is part one in a two-part post regarding sex addiction. This part will focus on the phenomenon of sex addiction, its presentation in men and women and how it influences/is influenced by societal norms. Part two will discuss terminology: whether or not the word “addiction” should be used to describe this phenomenon and discusses other terms that have been put forth by mental health professionals.

Ok so, what is sex addiction? According to Martin P. Levine and Richard R. Troiden, it is the phenomenon in which individuals “feel driven to engage frequently in nonnormative sex, often with destructive consequences for their intimate relationships (e.g. marriages) and occupational roles” (349). Diagnosed sex addicts report a sense of being unable to control their sexual behavior and fantasies and feel distress as a result. In my opinion, the phenomenon of sex addiction is another form of medicalization (See previous blog for an in-depth explanation of medicalization). Medicalization is the process in which various phenomena are perceived in the realm of the individual and as an appropriate area for medical and pharmaceutical intervention. In short, medicalization believes that any problem and solution is solely found within the individual person. I’m not a fan of medicalization because it tends give short-term (individual) solutions to long-term (societal) problems. Medicalization tends to believe that giving an individual a pill will solve all their problems without giving any consideration to the environment (societal and otherwise) the person lives in. According to Janice M. Irvine, in her article, “Reinventing Perversion: Sex Addiction and Cultural Anxieties,” many individuals label themselves as  “sex addicts” because “it has the alleged moral neutrality of disease; they feel relieved…to attribute their sexual problems to the disease of addiction” (433).  They believe the use of medical terms and medical intervention erases stigma and social judgment. However, medicine is not immune to cultural and social influences. For example, the first edition of The Diagnostic and Statistical Manual of Mental Disorders, published in 1952, “defined masturbation, fellatio, cunnilingus, homosexuality and sexual promiscuity as forms of mental illness” (Levine et al, 353). However, now, masturbation, oral sex and homosexuality are no longer seen as disorders. The boundaries of what is considered normal and abnormal changes within time and space. Levine agrees saying, “In any given society, sexual scripts provide the standards determining erotic control and normalcy. What one society regards as being sexually “out of control” or deviant, may or may not be viewed as such in another” (351). Medicine is just as susceptible to the changing whims of a given society as anything else. It is not immune and it is not objective, although it would love to be.

The socially constructed phenomenon of sex addiction is influenced by and strengthens sexual scripts and gender stereotypes as well as reinforces cultural anxieties about sex. Men who are diagnosed with sex addiction are said to “exhibit repetitive and extreme forms of behavior. Often they are prone to violence, or engage in fetishistic behavior” (Irvine, 446). These behaviors include “uncontrollable promiscuity, autoeroticism, transvestism, homosexuality, exhibitionism, voyeurism, fetishism, incest, child molestation and rape” (Levine et al, 349). In contrast, women who are diagnosed with sex addiction are said to engage in “frequent dangerous sexual encounters with strangers” (Levine et al, 350) in which they are either “risking victimization or using sex to feel vicariously powerful” (Irving, 446). Men are described as violent, yet powerful in a frenzied animalistic way as a result of uncontrollable lust. However, women are either helpless victims or as desperately trying to seize the power that only men have (Can anyone say Freud?). Irving declares “the concept of sex addiction is also antithetical to feminism in that it shapes ideas about ‘appropriate’ women’s sexuality into static imperatives” (449).  For something that is supposed to erase stigma, it affirms old ones: of men as animals and women as weak.

The concept of sex addiction also attacks sex as a behavior and as an identity/orientation. Many sex addiction self-help groups condemn “pornography, sex without love, and multiple partners” (Irving, 446). An individual is considered cured from their sex addiction when they are engaging in sexual behavior that is normative and condoned by mainstream society, i.e. heterosexual sex within the confines of heterosexual marriage or a committed relationship. Also individuals who participant in sexual behavior that is not considered normative (people who are polyamorous, not straight, and/or enjoy casual sex) are, by definition, labeled as disordered. It does make me wonder if the guilt and distress diagnosed sex addicts feel is, at least in part, linked to societal condemnation of their sexual behavior. Maybe if society were more accepting of non-normative sexual behaviors and fantasies, there be would be less guilt and distress?

Sex addiction is more than a term and much more than a “disease”. It is a powerful construction used to label people, to sway minds and to control the public. It individualizes societal issues and problems instead of solving them and reinforces gender stereotypes. That all being said, if someone feels that they are experiencing sexual urges that are causing them distress and impairs their daily functioning, then they should go see an open-minded, sex-positive therapist. Whether it results from negative societal views of sex or an individual issue or both can hopefully be determined with therapy.

HIV 101

Because of the research projects I am currently interning for, I have been thinking/reading about HIV-related topics for the past 5 months. I think it would be negligent of me to not make a HIV 101 post. Conducting and listening to interviews of study participants has made me cognizant of how little people still know about HIV, how it is transmitted, how they can protect themselves and what is available (in NYC) to those who become HIV positive. So I am going to start with a basic HIV 101 post and in the future, I will post more in-depth analyses of HIV-related topics.

Note: For this post, I am going to list the links I used at the end instead of sprinkling them throughout the post like I usually do. This is to ensure a more fluid post.

What is HIV and What Does It Do?

HIV stands for Human Immunodeficiency Virus. HIV attacks the CD4 cells aka T-cells in the immune system. These cells usually assist the body in fighting off infections and diseases and without them, the body is defenseless against opportunistic infections. An opportunistic infection is an infection that the body is usually able to fight without a problem, but because HIV has weakened the immune system, the infection seizes this opportunity and attacks the body. At this point, HIV turns into AIDS, which stands for Acquired Immunodeficiency Syndrome. With AIDS, the immune system is seriously damaged and the individual dies from opportunistic infections. For the record, HIV does not have to progress into AIDS. In this day and age, an individual can take medication and live a long and otherwise healthy life with HIV without it progressing into AIDS.

How can HIV Be Transmitted?

The fluids that have a high risk for transmitting HIV are blood, semen (cum), breast milk and vaginal fluid. Pre-seminal fluid (precum) that is released during sexual intercourse can also transmit HIV. To clear things up, HIV CANNOT be transmitting from the following: saliva, tears, sharing food, utensils, cups and bathrooms with a HIV-positive person, hugging, breathing, coughing and sneezing. HIV cannot be transmitted through the air and HIV cannot survive for long outside of the body. HIV is a virus and, like a parasite, desperately needs a living host in order to survive. The only way for HIV to be successfully transmitted is if the infected fluid comes directly in contact with wounds, tears and lesions.

Risky Behaviors

Unprotected Receptive Anal Sex (Bottoming) – The anus is not made for sexual intercourse the way the vagina is. The lining of the anus is very thin and prone to tearing and infected semen can get into the broken skin. Receptive Anal Sex is inherently riskier than insertive anal sex because the bottom is receiving the potentially infected semen from the top.

Unprotected Insertive Anal Sex (Topping) – Infected blood from tears in the bottom’s anus can get into the urethra and into any tears/open sores on the penis.

Unprotected Vaginal Sex – The vaginal wall can also tear and HIV can be absorbed through the mucous membranes of the vagina and cervix. And infected blood and vaginal fluid can get into the urethra and any tears/open sores on the penis.

Unprotected Oral Sex – This is the least common way to transmit HIV. Risk increases if the person has cuts in their mouth. It is recommended that a person does not brush their teeth or floss right before or after unprotected oral sex. Bleeding gums could ease the transmission of HIV.

Having another STI (sexually transmitted infection), like herpes, could increase the risk of HIV transmission because of the possibility of having open sores or the effect that the STI may have on the immune system.

Sharing needles and other injecting drug equipment – Residual blood left on drug paraphernalia can spread HIV.

Prevention

Obviously abstinence is the best prevention of HIV and other STIs, but let’s be realistic. Most people aren’t just going to stop having sex so here are other ways to prevent HIV transmission.

Contraception

Condoms stop the spread of fluids by creating a protective barrier. Dental dams, like condoms, provide a protective barrier when performing oral sex on a vulva and/or rimming (licking someone’s anus). Also latex gloves can be used if a person has cuts on their fingers or long nails and wants to finger another person’s vagina or anus. Lube decreases the likelihood of tears in the vagina and anus, reducing the likelihood of fluid transmission. Proper lube use is also important. DO NOT use oil-based lubes!!! Oil breaks down the latex in condoms and gloves, making them useless and ineffective. Examples of oil-based lubes are: lotion, cooking oils (i.e. Crisco), and baby oil. Again, DO NOT USE THESE!!! Water-based and silicone-based lubes are perfect for sex and do not break down latex. These lubes are usually sold as sex lubes and can be found at your nearest drugstore/pharmacy/sex shop. Two quick notes: If you are susceptible to yeast infections, avoid water-based lubes that contain glycerin. And do not use silicone-based lube with silicone sex toys, it will eat away at your toy, rendering your expensive sex toy useless. Speaking of sex toys, be sure to clean your sex toys after every use, especially if you use your toys on multiple people.

PrEP

PrEP stands for Pre-Exposure Prophylaxis. It is another form of HIV prevention in which HIV negative people, who are at high risk for contracting the virus, take a low dose of antiretroviral medication (A type of HIV medicine.) every day in order to try to decrease their chances of becoming infected. According to the CDC, PrEP has been shown to be effective with men who have sex with men (MSM) and heterosexual men and women.

Statistics From the Center for Disease Control  (Who Is Most At Risk?)

In future blog posts, I will go into why these populations are more susceptible than others, but this is a HIV 101 post so I want to give basic information.

MSM

“Gay, bisexual, and other men who have sex with men (MSM) represent approximately 2% of the US population, yet are the population most severely affected by HIV and are the only risk group in which new HIV infections have been increasing steadily since the early 1990s. In 2006, MSM accounted for more than half (53%) of all new HIV infections in the United States, and MSM with a history of injection drug use (MSM-IDU) accounted for an additional 4% of new infections. ”

Women

“In 2009, there were an estimated 11,200 new HIV infections among women in the United States. That year, women comprised 51% of the US population and 23% of those newly infected with HIV.”

“For women living with a diagnosis of HIV infection, the most common methods of transmission were high-risk heterosexual contact and injection drug use.”

“In 2009, the rate of new HIV infections among black women was 15 times that of white women, and over 3 times the rate among Hispanic/Latina women.”

African-Americans

“By race/ethnicity, African Americans face the most severe burden of HIV in the United States (US). At the end of 2007, blacks accounted for almost half (46%) of people living with a diagnosis of HIV infection in the 37 states”

Hispanics

“While Hispanics/ Latinos represented approximately 15% of the United States (US) population in 2006, they accounted for 17% of new HIV infections in the 50 states and the District of Columbia during that same year.”

Youth

“An estimated 8,300 young people aged 13–24 years in the 40 states reporting to CDC had HIV infection in 2009.”

“Nearly half of the 19 million new STDs each year are among young people aged 15–24 years.”

I Just Seroconverted. Now What?

To seroconvert is to become HIV positive. With the introduction of better HIV medications and a greater understanding of the virus, individuals who are HIV positive are now able to live full relatively healthy lives. There’s no cure for HIV, but there are treatments to decrease likelihood of transmission and to deal with complications resulting from opportunistic infections. There are public health services that cater to HIV positive individuals, like ADAP (AIDS drug assistance program that provides health insurance), psychological therapy, housing assistance, and substance abuse services. New York State, especially, is well known for its services. Two NYC centers that I have personally heard amazing things about are GMHC and Harlem United. Also check the Department of Health for more information. You are not alone.

Important Phone Numbers:

• NYS HIV/AIDS Hotline - 1-800-541-AIDS
• NYS TTY/TTD HIV/AIDS Information Hotline - 1-212-925-9560
• NYS HIV/AIDS Counseling Hotline - 1-800-872-2777
• NYCDOHMH HIV/AIDS Hotline - 1-800-TALK-HIV
• Confidentiality - 1-800-926-5065
• Legal Action Center - 1-212-243-1313; 1-800-223-4044
• NYS Division of Human Rights - 1-800-523-2437; 1-212-306-7500

Reference Links:

What is HIV? 

HIV Transmission 

Statistics for Women

Statistics for Youth

Statistics for MSM

Statistics for Hispanics

Statistics for African-Americans

The Medicalization of Sexuality

What is medicalization? It is both a process and a viewpoint. It is the idea that every aspect of the life should be observed and defined from a medical perspective. All negative or uncertain phenomena become labeled as diseases or disorders that fall under the jurisdiction of doctors and must be treated with medication. Medicalization falls under the Western biomedical view of health, which defines health as a lack of disease. Human phenomena falls under only two categories: health and illness. As you may know, I’m not a fan of binaries. Binaries oversimplify reality and leads to oppression as some groups are cast to the side because they do not fit in. The biomedical perspective also focuses only on individual health and how to solve an individual problem. My problems with the biomedical perspective and medicalization as a whole are the unwillingness to look beyond the individual into interpersonal and societal factors, disease-mongering in order to make a profit with short-term medications that do not fix long-term societal or psychological issues, the mislabeling of phenomena as disorders or problems and the downplaying of cognitive-behavioral therapy in favor of pills.

So what do I mean when I say “the medicalization of sexuality”? Sexuality has always been defined in terms of normal or abnormal, permissible or inexcusable. And sexuality has even been seen as something that can be cured, whether it was through prayer or electroshock therapy. However, something that is new and unique to the past few decades is the idea that aspects of sexuality and sexual phenomena can be studied and treated as if they were medical diseases and disorders. The idea that popping a pill or undergoing a medical procedure can solve all one’s sexual problems is a very new concept. The DSM-IV-TR, the Diagnostic and Statistical Manual, Edition Four, Text Revision, is the current edition of the book used by psychiatrists, psychologists and other health and mental health professionals to diagnosis psychological disorders. It is very controversial, yet it was created to standardize diagnostic methodologies to avoid a situation where two psychologists diagnose a patient with two completely different disorders. One of the reasons why the DSM is controversial is the section on sexual dysfunctions. In the DSM, certain sexual phenomena are listed and declared abnormal. This should make any critical thinker wonder: “What ideal is the phenomena being compared to? What is “normal”?” “Who decides what is normal and, in particular, what is sexually normal?” Society does. The social sciences in this society are well known for using college-aged Caucasian males as the subject of research studies. This small segment of society, that is in no way representative of this society, is set up as the standard for all other members of society. Obviously, that’s ridiculous.

Step two of medicalization: Now, that we have the disease, it’s time to treat it with medical miracles. I can’t watch TV for longer than five minutes before an advertisement for some pill pops up. Did you know those ads are illegal in most industrialized countries? Heather Hartley and Leonore Tiefer, in their article, “Taking a Biological Turn: The Push for a "Female Viagra" and the Medicalization of Women's Sexual Problems,” state, “Direct-to-consumer (DTC) advertising of prescription-only drugs, a phenomenon prohibited in most of the industrialized world, was newly permitted by the FDA in 1997 and plays an important role in the current trends (P. 43).” These commercials are funded by the drug companies who produce the drugs being advertised. They declare that these drugs can fix your current problem and even problems you didn’t even know you had while whispering very quickly all the nasty side effects. These side effects and complications can lead to the individual taking more and more drugs to make up for it, keeping the person trapped in a medicated web. Now, people, seduced by these commercials, run to their doctors and demand these drugs. Medicine is supposed to be about healing people, not about disease-mongering and scaring people for profit. Another thing to think about, that the commercials never tell you, is that studies have shown that, in many cases, medication alone is not nearly as effective as therapy or therapy along with short-term medication. Therapy is needed in order to learn how to live in the long-term without drugs (or with lower doses). One learns techniques to manage and/or solve their problems without the side effects. And therapy can include other people in the person’s life to provide support and to assuage any shame and stigma associated with the issue the person is facing. It is even more insidious and, in my opinion, disgusting when medicalization creeps into sexuality.

Two examples of the medicalization of sexuality that I will be focusing on are Viagra and Female Sexual Dysfunction (FSD). Everyone knows about Viagra. It blasted into mainstream culture and men pretty much paraded in the streets. However, I want to argue that the creation of Viagra has actually had negative effects and has perpetuated a negative and unrealistic standard that affects everyone. Female Sexual Dysfunction is an umbrella term used to describe difficulties in having/maintaining sexual desire (i.e. wanting to have sex), arousal (the vagina becoming lubricated) and orgasm. It is implied that FSD is a purely individual and medical problem that can be solved with a pill or a medical procedure. The trouble begins when one thinks about how a sexual phenomenon is labeled as a dysfunction (Think about what I said earlier: Who gets to determine what is normal?) and, because it is seen as a medical problem, societal and interpersonal factors are ignored.

The pharmaceutical industry, through the creation of Viagra and FSD, perpetuate ideals that continue to have a strong grip on individuals and on society. Barry A. Bass, in his article, “The Sexual Performance Perfection Industry and the Medicalization of Male Sexuality,” states, “The definition of sex, put forth by an industry in which sildenafil (Viagra) is held out to the world as nothing less than the miracle medical breakthrough of the century, represents a phallocentric, sexist, homophobic, and iatrogenic orientation to human sexuality” (P. 338). Ok so let’s unpack this in terms of both Viagra and FSD:

• Phallocentric – The great sex that Viagra promises to men is a kind of sex that focuses solely on the function of the genitals and nothing else. According to the pharmaceutical industry, all you need for sex is a hard penis. Your relationships or the lack of them are not important. Neither are any emotions you might feel or what your situation in life is like. Basically none of the things that might be the underlying causes of your problem matter. Just take this pill, get hard and give me your money. Viagra turns sex from an awesome interaction between two or more people into a performance. Since, according to their outlook, one cannot have sex until a hard penis is present, it puts a lot of pressure on the man to get hard immediately and every single time. As one gets older, this just is not possible and there’s nothing wrong with that. As situations change with age so should people and their sexual experiences/techniques. However, the pharmaceutical industry is promising an 18-year-old ideal to an older reality. This kind of sexual pressure takes the focus away from “intimacy and pleasure” (Bass P. 337) to “achievement and performance” (Bass P. 337). Bass declares, “In short, it is my assertion that whatever it is we mean by good sex is more likely to occur if it takes place in the context of a safe, noncompetitive, and non-performance-oriented setting” (Bass P. 337). However, the pharmaceutical industry does not want men to know this. They would rather men feel insecure and not worthy so that they can become dependent on the drugs and line the pockets of “Big Pharma”.

• Sexist – The focus on the genitals, more specifically the penis, implies that the only sexual act worth thinking about and performing is penile-vaginal intercourse. This excludes all other forms of sexual expression to the detriment of the average person’s sexual enjoyment. If the only normal sex act is penile-vaginal intercourse and a woman cannot orgasm from just that (and most can’t), then there must be something wrong with her. She must have an orgasm disorder. In February 1999, the Journal of the American Medical Association (JAMA) published a study with this statistic: "Sexual dysfunction is more prevalent for women (43%) than men (31%)." Hartley and Tiefer point out that this statistic has been used over and over again to prove that there is “a virtual epidemic of sexual problems among women” (P. 47). Women have been culturally trained to not be completely comfortable talking about their sexuality and are more likely to do less research and rely on the popular media and commercials for their sexual information. These are the same commercials that are funded by the drug companies. Oh and by the way, a not as widely publicized fact: the study this statistic originates from was written and funded by Pfizer, the drug company that manufactures Viagra. What a lovely coincidence, right? In this modern world, women are getting mixed signals, they are supposed to be sexual to attract men (because obviously wanting women in a romantic and/or sexual way that isn’t for the entertainment of heterosexual men is impossible), but not slutty so men will respect them. Women are now told they should have orgasms and as many as possible, but then they are told that only penile-vaginal intercourse counts as sex (everything else is foreplay and therefore is optional) and if they can’t have an orgasm just from this, they have a disorder.

• Homophobic – The focus on the “importance” of a hard penis and a wet vagina as completely necessary for optimal sex negates those who sexualities and sexual experiences do not fall in line, e.g.  Gay and Lesbian individuals. These individuals are treated as if they do not count and are systematically ignored.

• Iatrogenic – Meaning causing or worsening a problem that it claims to be fixing. As I stated before, medicalization individualizes sexual phenomena, meaning that if a man cannot get an erection, this is a physical problem lies within this individual man, which requires a pill to fix it. It ignores the existence of any other factors. For example, what if he cannot get an erection because he is having relationship problems, feels pressured during sex for some reason or is depressed. Popping a pill does not fix any of these issues. All it does is make his penis hard. Another example would be a woman who does not orgasm from sex with her male partner. The problem could be she can’t orgasm from sexual intercourse and needs to explore other sexual acts or maybe they are having relationship issues and she no longer feels comfortable in the relationship. None of this can be solved by popping a pill. To sum it up, sexual problems can occur because of general ignorance of various aspects of sexuality, sexual anxiety and a lack of open and honest communication among partners (Bass P. 338). These issues require communication among partners and/or therapy, not a quick fix pill. Also this perspective renders invisible other aspects related to having sex. Peggy J. Kleinplatz in her article, “New Directions in Sex Therapy: Innovations and Alternatives,” states “…the amount of time devoted to getting the penis hard and the vagina wet vastly outweighs the attention devoted to motives, scripts [i.e. gender/sexual scripts], pleasure, power, emotionality, sensuality, communication or connectedness” (P. 39). Most people would agree that these aspects are essential to good sex and without them, all that is left is an artificially hard penis and a wet vagina, which loses its appeal after awhile. So it is no surprise when the sex turns sour. The pharmaceutical industry wants people to think that something is wrong with them. According to Bass, “It is the message of fear and inadequacy. It tells us that we do not measure up and that we will never measure up unless we become regular customers of the industry’s products” (P. 338). It is unethical and disgusting, but it makes them a profit.

In conclusion, the medicalization of sexuality is a new method of social control that sets up ideals and standards that oversimplify the diversity and variety of human sexuality. It oppresses those who do not fit into its schema for the “perfect” sex and it brainwashes others into believing they are flawed in order to make a profit for drug companies. That being said, there are benefits to medicalization. Klienplatz states that medicalization has made it possible to “[Identify] difficulties with orgasm, erection, and arousal as appropriate sources of treatment specialization and mental health insurance reimbursement. This inclusion meant legitimacy for sex therapy clinics, organizations, conferences and some research” (P. 37). Without medicalization, sex research, therapy, treatment and outreach would be even harder to conduct. However, at least in my opinion, the negatives outweigh the positives. My moral for today: If you think you may have a sexual dysfunction, don’t just pop a pill. Talk openly with your partners and explore other options. Try to think about it critically from many perspectives: interpersonal, societal and otherwise. Go see a therapist who does not fall in line with the biomedical perspective. Take control of your sexuality. If you don’t, someone else will.