Saturday, November 28, 2020

Health experts discuss maintaining a healthy relationship with sex

November 20, 2020
Exploring the stigmas around sex and how they impact health and wellness. (Illustration by Hope Ann Flores.)
Exploring the stigmas around sex and how they impact health and wellness. (Illustration by Hope Ann Flores.) —

College students are having a lot of sex. That shouldn't come as a surprise, nor should the results of The 2018 National College Health Assessment, finding that 66% of students had sex in the past 12 months. But, for as much sex as college students are having, they don't talk nearly enough about it in healthy, safe places.

About one-third of adolescent patient-doctor interactions don't include talk at all about sexuality. This includes sexual activity, dating and sexual orientation.

The stigmas surrounding sex exist today for endless reasons, whether it be concerns surrounding body images, the way it's portrayed, or the feeling of embarrassment when the topic comes up; Classroom conversations about sex growing up shift to conversations in the dark and as this transition happens, important knowledge about sex is lost in translation. So, let’s talk about sex. 

Sex, health and wellness

Having a healthy sex life is beneficial for you both emotionally and physically.

Dr. Stacey Missmer, a professor in the OBGYN College of Human Medicine in the Grand Rapids campus and half appointment in epidemiology and biostatistics, said many people don't discuss sex because there’s this embarrassment around sexual things, but discussing sex and your body can lead to a healthier lifestyle.

Because we don’t talk about sex in general, people don’t really have any sense of what is normal and what isn’t. People feel fear around the potential embarrassment of not being normal but also not understanding when things should be a concern.

One of the areas that Missmer specializes in is pelvic pain. Sometimes that pain is associated with menstruation, other times it’s outside the menstruation cycle. A large portion of women also report having pain during and immediately after sex.

“A key thing is normalizing the discussion so that we can have a better sense of when something is happening that is a concern but also focusing on health and wellness in general not just focusing on impactful symptoms,” Missmer said.

According to her, "sexual and reproductive health in general and sexual health specifically is part of a healthy and well-rounded life. It's definitely a part of adult relationships and adult functioning in the world."

Failing to discuss these things creates all barriers around maximizing health and well-being, Missmer said. It also creates a level of shame, which can center around non-consensual sex acts including sexual violence, child sexual abuse and adult sexual assault. 

“When we’re not even willing to discuss happy, healthy sexual relationships, that pushes those violent circumstances even farther into the shadows and also aren’t discussed,” Missmer said.

Sexual violence is a lot more common than one may think, especially in college. About 13% of all students experience rape or sexual assault through physical force, violence, or incapacitation. Among undergraduate students, that statistic is higher, 26.4% of females and 6.8% of males experience rape or sexual assault. Male college-aged students (18-24) are 78% more likely than non-students of the same age to be a victim of rape or sexual assault.

Sexual dysfunction is also something that is very prevalent yet many are afraid to talk about it. A bad night can become a disorder when these things occur regularly and significantly affect your sexual life:

- Desire disorder, when you have little or no interest in sexual relations on an ongoing basis.

- Arousal disorder, you're emotionally in the mood, but your body isn't into it.

- Orgasm disorder, you're emotionally in the mood, but you have an inability to climax which leads you to be frustrated.

- Pain disorder, having pain during intercourse.

According to Cleveland Clinic, sexual dysfunction is a problem that can happen during any phase of the sexual response cycle. It stops you from experiencing satisfaction from sexual activity. Sexual dysfunction can occur at any age but is more common in those over 40 since it is related to a decline in health associated with aging.

Because sexual dysfunction is generally associated with older age, it can be a difficult thing to talk about when that isn't the case.

“Anything brought into the light is easier to tackle and remedy even, then things kept secret and stigmatized,” Missmer said.

Missmer said that there are an array of resources, such as talking with teachers, a Boston Children’s Hospital website on young women’s health, books and online resources that can help educate about sexual health. Menstrual and reproductive health apps are also beneficial for keeping track of your period and monthly changes which can aid in family planning, pregnancy prevention, and general health.

Even though Missmer believes that apps for menstrual and reproductive health are helpful for tracking symptoms and issues, it doesn’t beat local one-on-one sit down discussions.

Oftentimes she doesn’t understand how teens or young women are not afraid to share pain about a body part such as the elbow or chronic migraines, with friends and medical practitioners. Yet, when it comes to things related to reproductive and sexual health there is this extra barrier of discomfort of sharing.  

“Again, the important thing is that everyone deserves health and well-being in this area and unfortunately girls and women and young men sometimes need to really be their own advocates,” Missmer said.

She said "there is no downside to having more opportunities for discussion and more opportunities for education" on the topic.

Missmer puts into practice what she preaches about sex-related conversations with the basis of improving well-being through the WORK Study, which is a Michigan based, MSU led study. WORK is an acronym for Women’s Outcomes Research and Knowledge. The study is focused on exploring women’s experiences with pelvic pain and the medical care they receive.  

“It’s really a great way for girls and women across our state to have their journeys understood,” Missmer said. “And hopefully the goal is to use that information to affect change and to highlight where some of these resources are more needed, how prevalent these issues are and what the barriers are for girls and young women achieving reproductive and sexual health and well-being.”

Body image and sex

Body image is how you see yourself when you look in the mirror or when you picture yourself in your mind. It can include what you believe about your appearance (memories, assumptions and generalizations), how you feel about your body (height, shape and weight) and how you sense and control your body as you move (how you physically experience or feel in your body).

"The reason people are afraid to talk about our bodies is ... we have been somewhat socialized to not even look at our bodies and talk about our bodies ... even as little children we are told ... those are things that we just don’t do," Dr. Lisa Lowery, an assistant dean for diversity and cultural initiative at Michigan State University and section chief of adolescent and young adult medicine at Helen DeVos Children's Hospital, said.

Lowery thinks that the first step in becoming more open about our bodies is by starting more conversations about them, getting rid of these specific ideals we place onto each other.

“As a society, we still have this what an ideal body should look like," Lowery said. "It should look one way and be flawless and have this type of skin type, so we know those ideals sell. I think for us to be comfortable in our body we have to educate ourselves and be proud and comfortable in our bodies.” 

"Everybody has a body, ... there's more similarities than there are differences, and the more people talk about their bodies in a positive way it gives other people permission to do the same, which can have a big, cumulative, positive impact on society," Dr. Megan Maas, an assistant professor in human development and family studies, said.

She believes that sex should be normalized as it is one of the few behaviors that almost everyone experiences in life and it’s completely natural.

In her human sexuality class, they talk about masturbation and "even looking at yourself in different angles in the mirror so you can see different angles of your body parts, and that can sort of help you get some of the 'heebie-jeebies' out of being naked and that can help to sort of increase your comfort with your own body," Maas said.

Since she researches adolescent sexuality and sexuality during emerging adulthood, Maas focuses on media influences on our ideas of what sex should look like. 

"A lot of my research is focused on pornography because it's one of the few places that we actually see other people having sex," she said. "And my goal is really to make sure that people can develop healthy, satisfying sexual relationships and experiences that are free of coercion and free of violence."

“My perspective is that it takes more than violence prevention education to do that,” Maas said. “It’s not enough to say that no means no or yes means yes, we need to talk about all of the things that influence our ideas about sexuality and gender, and so my lab really looks at a bunch of different factors that contribute to that.”

"My lab really looks at a bunch of different factors that contribute to that, so we look at self-objectification, and women’s and college students' experiences on Instagram and how that might impact their attitudes about sex, and we are looking at how sexual misconduct policies can influence behavior and experiences of high school students in terms of sexual harassment and online sexual experiences," Maas said.

Maas is "also studying how ACEs or Adverse Childhood Experiences can sort of differentially impact girls and women as they have their first sort of sexual experiences in their teens and twenties."

Even though the research is pretty limited on social media as it is new and always changing, Maas does know that "people tend to do something called an upward social comparison. Meaning that they look at people who they think are skinnier than them, or prettier than them or have better lives than them," and that leads people to feel worse about themselves.

“We also know that for girls and women who edit their selfies that they post or edit pictures with photo editing software, they’re more likely to experience eating disorders and anxiety and are higher in depression,” Maas said.

According to her, "for the most part social media doesn’t seem to be helping people sex-wise, but that doesn’t mean that it doesn’t have the potential to, we just don’t know what that looks like yet."

She suggests taking a break from social media "at least one day a week and really focusing on other aspects of yourself that have nothing to do with how other people evaluate you or perceive you."

"It’s really about just connecting to who you are and doing things that you enjoy and that are fun for you and give you pleasure," she said. "So, that can sort of help you become more cognizant of how social media might be influencing your attitudes about yourself and your own sexuality."

As for what a healthy relationship might look like, for Maas that means a relationship where "you’re free to be yourself, so you're not trying to change yourself to make your partner happy."

"Healthy relationships don’t include a partner texting you a million times a day wanting to know who you’re with and what you’re doing, that’s coercion," she said.

Maas has noticed that "a lot of times, especially when you’re ... in teens and twenties ... is that people, particularly heterosexual girls and women feel like they need to change themselves in order to be a good partner or to make their partner happy or to make their partner like them more, think that they're sexier."

“And so spending time single and not focusing on relationships can be a great way to sort of figure out who you are and what you’re going to contribute to your relationships so that you don’t find yourself in a pattern of trying to adapt to whatever you think your partner wants you to be,” Maas said.

Often she finds that there is a lot of discussion surrounding "what sexual empowerment looks like for women. There is a lot of discourse around striptease classes, and tanning and waxing looking hot and hooking up as empowering." She believes that it can be empowering, "but a lot of times, depending on how someone is experiencing that, it can also be degrading."

“It’s important to ask yourself are you having orgasms, are you experiencing pleasure in your sexual experiences and if not, why are you engaging in those sexual experiences if they’re not pleasurable to you,” Maas said.

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