Sex and Meaning

This message was originally written by Dr. Eli Coleman.

Dear Donors to the Chair in Sexual Health,

Today is a day of reflection of where we are and where we need to go in our efforts to halt the spread of HIV and to provide comprehensive care for those infected with HIV.

Whether people are HIV negative or postive, we need to change our focus on the prevention and treatment of HIV/AIDS to helping people live sexually healthier lives. People are so tired of scare tactics and messages to live without sex. They are also complacent now that we have better treatments for those we have been infected.

Safer sex messages have been mired by a hesitation or fear that if we even promote condoms that we might promote more sexual behavior (particularly among youth). However, there are a myriad of other factors that are influencing sexual behaviors and practices. Condom promotion has only helped increase responsible sexual behavior rather than encourage greater sexual activity. Waning interest in safer sex combined with complacence about HIV and other STI risk makes it imperative that we find better and more effective safer sex promotion efforts. Sole emphasis on disease prevention is no longer working.

In an opinion paper in today’s Lancet, some researchers say that condoms need to be promoted as making sex more pleasurable – not just preventing disease. They point out that condom brands that emphasize ribbed or studded designed to increase pleasure have sold well in Uganda, where HIV/AIDS remains a problem. The authors say that adding pleasure into the conversation may boost condom use even further, thus reducing the spread of disease.

The authors accurately point out the obvious – that one of the main goals of having sex for humans is pleasure. Since there is a perception that condoms reduce pleasure and that condom manufacturers have been slow to develop more pleasurable type condoms, there remains many sexual acts that go unprotected. Fortunately condom manufactors are stepping up to the plate and addressing this problem in successful marketing strategies and development of new products that emphasize pleasure along with the assurance of disease prevention. Focusing on the pleasureable aspects of condoms and the pleasure of guilt-free and responsible sexual behavior will increase condom use and halt the spread of STIs and HIV. Condoms remain the most effective form of sexually transmitted disease prevention among those who are sexually active – but can also be a source of enhancing sexual pleasure. It is unfortunate that there is so much political effort to disparage the effectiveness of condoms. We need to tell the truth about condoms – based upon science not politics.

I am very concerned about our youth. Teens feel they are invincible. We need to understand what drives their sexual behavior. They are not focused on reproduction or worrried about getting old or sick. For those that are sexually active – and most of them are – they are looking for ways to enhance pleasure, develop relationships and enhance their self esteem. And unfortuantley, many women are not even motivated by pleasure but by desire to hold on to relationships or seeking or feeling loved. If they were allowed to seek pleasure and satisfaction rather than respond to pressure to please, they would be more likely to engage in responsible sexual and pleasurable sexual behavior. We need to address their needs and market safer sex recognizing their needs. Unfortunatley, many teens begin their sexual activity and don’t find their sexual activity pleasurable (especially women). This can influence their later sexual development and impair sexual and intimate relationships in adulthood. We need to help sexually active teens learn how to have safe and pleasurable sexual activities. Condoms that are pleasurable and are perceived as such can be a very effective tool in developing sexually healthy adolescent and ultimately adult development.

Furthermore, it is important that we recognize that sexual health is more than the absense of disease. According to the makers of Trojan condoms – Sexual health – it is the the experience of enjoying our sexuality — both emotionally and physically — throughout our lives. Being sexually healthy contributes to an overall healthy life and involves:

* understanding that we are sexual by nature
* taking care of our sexual and reproductive systems
* being able to experience sexual pleasure, satisfaction, and intimacy, when ready
* protecting and respecting ourselves and others

Sexual health is best realized through personal awareness, communication and access to accurate information and services.

This is an amazing departure from the messages of sexual health as being the absense of disease. This definition is also consistent with the new working definition of sexual health that has been defined by the World Health Organization (2002).

We need to take this approach in our prevention programming. And fortunately condom manufacturers are following what is seen as good sound public policy.

While parts of the world are facing a growing epidemic, we sometimes forget that there are parts of the U.S. that have problems as serious as faced in some Africian countries. We need strong new and bold approaches – that other countries have been able to do – but here in the richest and most educated and most well developed public health system in the world have failed to do so. We must stop being held hostage by a politically driven public policy on sexual health promotion. We need to promote a scientifically based approach based upon sound public health knowledge.

Eli Coleman, Ph.D.
Professor and Director
Program in Human Sexuality
Department of Family Medicine and Community Health
University of Minnesota Medical School

12.06.07
Update to previous post

By DAMIEN CAVE

New York City’s Board of Health unexpectedly withdrew a proposal yesterday
that would have allowed people to alter the sex on their birth
certificates without sex-change surgery.

The plan, if passed, would have put New York at the forefront of a
movement to eliminate anatomical considerations when defining gender. It
had been lauded by some mental health professionals and transgender
advocates who said it would reduce discrimination against men and women
who lived as members of the opposite sex.

But after the proposed change was widely publicized recently, board
members and officials with the Department of Health and Mental Hygiene
said that a surge of new concerns arose. Vital records experts said that
new federal rules regarding identification documents, due next year, could
have forced the policy to be scrapped.

Read more: www.nytimes.com
———————————————————————————————————————————–
Original Story:
New York City Plans to Allow Change of Gender

Separating anatomy from what it means to be a man or a woman, New York City is moving forward with a plan to let people alter the sex on their birth certificate even if they have not had sex-change surgery.

Under the rule being considered by the city’s Board of Health, which is likely to be adopted soon, people born in the city would be able to change the documented sex on their birth certificates by providing affidavits from a doctor and a mental health professional laying out why their patients should be considered members of the opposite sex, and asserting that their proposed change would be permanent.

Applicants would have to have changed their name and shown that they had lived in their adopted gender for at least two years, but there would be no explicit medical requirements.

“Surgery versus nonsurgery can be arbitrary,” said Dr. Thomas R. Frieden, the city’s health commissioner. “Somebody with a beard may have had breast-implant surgery. It’s the permanence of the transition that matters most.”

If approved, the new rule would put New York at the forefront of efforts to redefine gender. A handful of states do not require surgery for such birth certificate changes, but in some of those cases patients are still not allowed to make the change without showing a physiological shift to the opposite gender.

Read more: www.nytimes.com

“The fact that New York is taking this step toward a broader understanding of gender is important. Ones gender is far more than what genitalia we present visually. However, there will be legal ramifications as the federal government may challenge this rule. The government has specific needs in tracking gender status for research and demographics among other rational (can you say war on terrorism?). Potential resistance on the federal level won’t be surprising.

The United Kingdom instituted a similar law two years ago and has also had to address the occasional demand of someone who wants to “switch back”. Initial cases have been attributed to misdiagnoses as gender dysphoric. We have a long way to go in finding a practical way to define gender in our society. Luckily, we are at least finally raising the issue and discussing it’s impact on individuals struggling to find a place in a world that often does not want to acknowledge their existence .”