Health & Science

I've been reading the sexuality-related proposed revisions to the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Assocation and I'm troubled. In the move from DSM-IV to DSM-V It seems that larger and larger realms of sexual expression are falling under the rubric of psychiatric disorder. This is the wrong approach to the difficulties people have with sex.

My reading started with the newly proposed diagnosis "Hypersexual Disorder" because a reader asked me if I intended to post about it. The new diagnosis is a response to the increasing use of the loosly defined and largely bogus label "sex addict." The American Psychiatric Association subcommittee that put this new diagnosis together says, in its rationale statement:

There is a significant clinical need, even a “demand” from mental health consumers, for mental health providers to recognize and diagnose a distinct group of men and women who have been seeking and are already receiving mental health care such as individual psychotherapy, 12-step group support, pharmacotherapy, and specialized residential treatments. These men and women are presenting to clinicians because of recurrent, “out of control” sexual behaviors that are not inherently socially deviant (i.e., normophilic, not paraphilic). Persons afflicted with these conditions are currently diagnosed as Sexual Disorder Not Otherwise Specified, a diagnostic wastebasket that the DSM-V editors would like to see diminished in scope. Clinical and research-based interest in this set of problematic nonparaphilic sexual behaviors is sufficiently established to have birthed a peer-reviewed journal published since 1990 dedicated exclusively to research and treatment of “sexual addiction/ compulsivity.”

This, on its own, is troubling. The diagnostic criteria are even more troubling. Direct from the DSM-V Revision site, here are the criteria:

"Don't let fear of letting someone stick something in your butt get in the way of cancer prevention."

Those were not his exact words, but close. The speaker was a survivor of stage 4 colon cancer - one of the rare ones - and his message was all about the importance of colonoscopies. But what was striking to me was that he so bluntly identified one barrier men face when it comes to getting them: fear of anal penetration. He talked about how relieved he was when, after his girlfriend had suggested he request a screening his doctor said "You're only 40, you don't have to worry about that for another 10 years." Two years later, an investigation of ongoing dizziness and anemia, he was diagnosed with advanced colon cancer. He regretted not advocating for himself and insisting on the screening, but explained that at the time when the doctor told him not to worry about the screening he was very relieved that he'd be able to put off a procedure that made him feel so squeamish. In trying to convince other men to choose differently he said things like "Guys, nobody will ever know you had one" and "You know how stigmatizing it is if you're a masculine guy to admit that someone put something up your butt, but it's so important to get screened."

He never used the word "homophobia" but that is essentially what he was talking about. Why else would he emphasize "Guys, nobody will ever know you had one" and what other stigma around "putting something up your butt" could he have meant other than the stigma of male homosexuality?

So it made me think. We know that homophobia is hazardous to the health of gay men, and any man who incoroporates stereotypically feminine interests or characteristics into his personality unless they are balanced out by a sufficient number of stereotypically masculine ones. But this is a clear example of how homophobia is hazardous to the health of straight men. And that got me thinking that one subtle way to reduce homophobia is to convince straight men of the merits of sticking things in their butts.

So why not start big, with a long flexible tube and a fiber optic camera!

In the past few months I've received numerous calls and emails about the revisions to the bible of the psychiatric world - the Diagnostic and Statistical Manual of Mental Disorders, or DSM for short.  The diagnosis in this manual are critically important because they determine who gets diagnosed as mentally ill, who should get powerful psychotropic drugs, and whether and how much insurance companies will pay for care.

The Washington Post quoted Alan Schatzberg, the president of the American Psychiatric Association, "It not only determines how mental disorders are diagnosed, it can impact how people see themselves and how we see each other.  It influences how research is conducted as well as what is researched. . . . It affects legal matters, industry and government programs."
 

The proposals will be debated in an intense process over the next two years, with potentially billions of dollars at stake for pharmaceutical companies, insurance companies, government health plans, doctors, researchers and patient advocacy groups.

But perhaps more important, the outcome will help shape which emotions, behaviors, thoughts and personality traits society considers part of the natural spectrum of the human persona and which are considered pathological, requiring treatment and possibly even criminal punishment.

From Megan Andelloux, founder of the Center for Sexual Pleasure and Health, now officially open in Pawtucket Rhode Island:

The Center for Sexual Pleasure and Health (CSPH), the first non-profit sexuality resource and information center on the East Coast, has won the right to open its door and provide sex education for adults.

The Center for Sexual Pleasure and Health will provide one on one coaching services, group classes, drop-in hours, teaching resources, access to sexuality journals and in the fall, start an internship program and conduct sexual health studies. Megan Andelloux, a board certified Sexologist and Sexuality Educator is the founder and director of the non-profit Center for Sexual Pleasure and Health.

Megan Andelloux and the Center for Sexual Pleasure and Health have not given up in their efforts to provide medically accurate information about sexuality to the residents of Pawtucket, RI and surrounding communities.

The CSPH, if allowed to open, will make an invaluable contribution to improve the quality of life in Pawtucket and surrounding areas. Specifically, its mission is to educate adults about sexuality so that they can enjoy sexual pleasure in ways that also protect (and even improve) their own health and the health of their partners. By extension such an organization protects the health of families and communities.

I sincerely hope that the zoning board will approve CSPH's application for a special-use permit that will allow it to do educational work in a space zoned for commercial use. The fact that CSPH is not going to be a commercial enterprise should not be held against it!

What follows below is the press release that Megan sent a few days ago. Please read it, retweet or repost it, and if you can show her your support please do!

A new advancement in barrier protection.

Today’s conference call was a report on the development of the new version, FC2. They’ve taken the feedback from users and agencies into account and have definitely improved the product. FC2 is made from nitrile, so it doesn’t have the seam or the plastic bag sound. It’s also at least 30% less expensive than the first version (the cost per unit decreases with higher volume), and it’s still latex-free.

http://magazine.goodvibes.com/2009/12/03/report-on-the-new-version-of-th...

I love Scarleteen. I am proud to be a monthly contributor. Why?

Scarleteen is one of the most reliable sources of independent sex education available to teens. By "independent" I mean that they receive no federal, state, or local funds and are also noncommercial.

Scarleteen is designed specifically for teens and presents sexual health information in a clear and nonjudgmental way. It is maintained by people who care deeply about making sure that teens have access to accurate information with which to make decisions about their bodies and their relationships.

 From Heather Corinna, the indomitable force behind Scarleteen, I learned just how much use the site gets:

25,000 unique users daily, with an average of 3.5 page loads apiece.

43,000 registered users on their always-moderated message boards. Scarleteen's staff and voluteers have answered every one of teh 63,000 topis teens have posted, providing honest, accurate and nonjudgmental answers.

900 "Sexpert Advice" columns. "Sexpert Advice" is also syndicated on RH Reality Check (another fabulous information resource).

In addition to blog posts and active forms, Scarleteen runs a text message service where teens can text questions to 66746 (keyword "ASKST") and receive answers directly on their phones.

They do all this with very little money and the unbelievable energy of people like Heather Corinna. And because she is Heather Corinna, she has big plans for the future, provided the money is there. In Scarleteen's plans for 2010?

A: When it is a selective reduction

I don't imagine this post is going to make me popular.

Today's New York Times has an article about the very painful choices faced by prospective parents who make use of fertility treatments, find that they are pregnant with multiples, and then are faced with the risk of those pregnancies - both to the hopeful mom and the soon to be children. Successful fertility treatments often produce multiples because hormones are used to stimulate egg production or because multiple embryos are implanted. But because being pregnant wtih twins or triplets or even more developing fetuses is risky, and because children born from those pregancies are more likely to be born very premature and are thus at risk for greater and more serious health problems than babies born from singleton pregnancies, doctors sometimes counsel prospective parents to consider "selective reduction" where some fetuses are eliminated.

I am not going to write about the painful choice this must be. I am not going to write about whether or not such fertility treatments are ethical given their potential for resulting in pregnancies risky enough to warrent advising abortion. Nor am I going to address the fact that in vitro treatments require the creation of more embroys than anyone intends to implant. I am not even going to write about whether we should be spending so much health care money on helping people to reproduce and then paying for the complications that occur as a result of those treatments. Not today anyway.

Today all I am going to write about is the use of the term "selective reduction" itself.

Next weekend, on September 26th, I'll be speaking at the grand opening of the Center for Sexual Pleasure and Health, a nonprofit resource center run by certified sex educator Megan Andelloux. I'll be on a panel with some of my role models in the world of sex education and research: Carol Queen, Becky Chalker, Barbara Carellas, Gina Ogden and Bill Taverner. I'm also very excited about the screenings of Tara Hurley's Happy Endings? and At Your Cervix by Amy Jo Goddard and Julie Carlson.

I admire Megan's work a great deal and was thrilled to be invited to participate in the grand opening of her center. Several times I've been struck by the courage she's shown in the simple act of including the word "Pleasure" in the name of her center. It shouldn't require courage to pair pleasure and health in talking about sex, doing sex education work, or naming sexuality resource centers, and yet it does. Sexual pleasure is a lightening rod in this culture. Pairing pleasure and health takes special courage because while we are willing - sometimes, grudgingly - as a society to spend money on sexual health education we are most unwilling as a society to spend money on sexual pleasure. Publicly recognizing that sexual health and pleasure go together could seem very threatening not only to those whose conservatism requires the public denial of most sexual pleasure in the first place, but also for those who depend on the health discourse to legitimize their sex-related work in the eyes of funders. Megan's insistance that sexual pleasure is an integral part of sexual health is admirable for its honesty in the face of tremendous pressure to disguise or hide the connection.

Anyway, I mention all of this because Megan recently published a piece on Carnal Nation (where Chris Hall, co-founder of Sex In The Public Square lives these days) that reflects on the challenges she's faced in getting her center born. I asked her if I could reprint it here, she said yes, and so here it is, below the fold.

RU-486, or mifepristone, was approved for use in 2000 in the US, for medical abortions.

Shortly there after, something weird started happening. A handful of women who used RU-486 were dying from sepsis, caused by a really rare bacteria, Clostridium sordellii. Like, these women didnt have AIDS. They werent meth addicts or recovering from cancer. They were previously completely healthy 18, 22 year-old women dropping dead.

To pro-lifers, the message was clear: Abortion kills women.

Planned Parenthood's recommendation to use the abortion-causing drug Misoprostol vaginally rather than orally has led to fatal infections according to a research study released by the University of Michigan.
...
"This study shows Planned Parenthood not only disregards the lives of babies in the womb, but the lives of their mothers as well," said American Life League's Jim Sedlak. "This is scandalous, if not criminal. It's time people stopped viewing Planned Parenthood as a responsible healthcare organization and saw it for what it is -- a money-making, social engineering group that plies its trade of sex and abortion without regard to human life, born or preborn."

To rational people and scientists, there is a different puzzle afoot.