I was on NPR yesterday. That’s it. That’s my note for this week. I was on NPR talking about the similarities between getting people to wear condoms and getting them to wear masks. I wrote an article about it last year (which is already a little outdated given that our knowledge of Covid-19 has changed so rapidly). And I talked with the Takeaway’s guest host, Melissa Harris-Perry, about it yesterday. Yay!
CDC Updates STD Guidelines; Suggests Opt-Out Testing for Gonorrhea and Chlamydia
The Centers for Disease Control and Prevention (CDC) just released updated guidelines for STD testing and treatment. The new guidelines continue to recommend routine annual chlamydia and gonorrhea screening for sexually active adolescents and young adults and now they suggest providers consider taking an opt-out approach to these tests.
We’ve talked about opt-out v. opt-in policies for sex education a number of times and I’ve explained that I like opt-out policies, under which students are automatically enrolled, much better than opt-in policies, under which no one is enrolled without a signed permission slip, for numerous reasons (not the least of which being my tendency as a parent to lose paperwork and forget to sign permission slips). It turns out the opt-out/opt-in debates happen in medicine too.
For the most part medical tests are opt-in: you go to your health care provider, discuss your symptoms or risk factors, they suggest a test, and you say “sure” and stick out your arm for a blood draw or go pee in a cup. This strategy, however, leaves gaps when it comes to sexual health for a number of reasons. We are reluctant to talk about our sex lives with health care providers and health care providers are reluctant to talk about our sex lives with us, and even more reluctant with younger patients. One study of teens found that when doctors did ask about sex (about 65% of the time) spent a total of 36 seconds discussing it. We also tend to underestimate our own risk of STIs and there is still stigma and shame attached to even needing a test, which means some patients won’t ask for it and may even dismiss the suggestion when made.
Universal testing or opt-out testing essentially says that anyone who is seen for care will be tested for certain infections unless they refuse. Under this kind of policy, a doctor’s office or hospital would tell patients—either verbally or in writing—what tests will be automatically performed and offer them the opportunity to decline. Consent is assumed under the general consent-to-treat agreement between the patient and the provider. Not only does this cast a far wider net, it eliminates some of the stigma and shame. No one needs to admit that they think they’re at risk for an STI, they can say nothing and still be tested.
The CDC has recommended opt-out testing for HIV since 2006 and research has found that it increases the number of people tested. In one study patients who came to the emergency room at an urban hospital were divided into three groups. Opt-in patients were told they could get tested if they liked active choice patients were specifically asked if they would like to get tested or not, and opt-out patients were tested unless they asked not to be. Opt-out testing reached the most people (66%) compared to 51% of active choice patients and just 38% of opt-in patients.
Adopting this kind of policy for chlamydia and gonorrhea makes sense given the high and rising rates of these two bacterial STIs, especially among young adults. In 2019, there were 4,110 cases of chlamydia per 100,000 females ages 20 to 24. And, rates of gonorrhea among women of all ages increased 43% between 2015 and 2019.
While both can be cured with antibiotics, a person needs to know they’re infected to be treated, and these infections are often asymptomatic. Without treatment both can lead to Pelvic Inflammatory Disease which in turn can lead to infertility. It is also becoming harder to treat gonorrhea as the bacterium that causes it continues to develop resistance to available antibiotics.
Now, the question is whether providers who remain reluctant to discuss sex with their adolescent and young adult patients will adopt this newly recommended policy.
Sex Toys in Space?
Last week we saw billionaire Jeff Bezos take a sex-toy shaped rocket into space (yes, it looked like a penis, but it also looked a lot like the Hitachi magic wand). Now, we learn that sex toy company, Tenga—known for its masturbation cups and vibrating eggs—is planning on launching a rocket filled with messages and swag into space sometime this summer.
According to the company, there will be three things on the rocket when it launches. A pod shaped like a classic Tenga cup that will include 1,000 messages of love collected from people across the globe; the brand’s mascots, Tenga Robo and Egg Dog, who are expected to fall back to earth and be retrieved by the company; and a special Tenga cup designed to gather data about space conditions that might help the company create better sex toys for space.
The company’s president Koichi Matsumoto told IFL Science that he sees this as a first step to space-product development: “…since the company was founded, I’ve firmly believed that there will eventually be a huge need for TENGA in space. Someday perhaps, we’ll be able to create something that the likes of NASA will want to incorporate into their endeavors in space.”
There is a dearth of information on sex in space and some questions about how it would all work in zero gravity—not just trying to stay coupled while floating, but trying to get turned on when all the blood is rushing away from your genitals. (I had a professor in graduate school who was totally obsessed with how sex would work in space.) Apparently, the Russians did try to make a masturbation aid for space and there has been a two-person space suit that was designed with sex in mind.
Still, I have a hard time seeing this as anything more than creative marketing and feel much the same way I felt about Bezos’s 10-minute glory ride—spend the money to solve some problems here on Earth (we have many, some of them sexual). Plus, I agree with the people behind EXO-MOAN Studio who pointed out that the company only sent a sex toy designed for men into space even though women are huge sex toy consumers.
Must we start our space-age sex endeavors with the same stereotypes we have here?
Stroking It Takes on New Meaning as Man Has Masturbation-Induced Stroke
A case study published in the Journal of Stroke and Cerebrovascular Diseases tells the story of a 51-year-old single man in Japan who said he liked to masturbate a few times a day. No, it’s not that kind of story.
One day, right after orgasming, he experienced a sudden intense headache on the left side of his head. Though the headache got better after about a minute, he started vomiting and wisely took himself to the hospital. Tests discovered a subarachnoid hemorrhage—a brain bleed—but it took days for doctors to figure out the precise cause of it. Ultimately, his physicians determined that he suffered from spontaneous cervicocephalic artery dissection (sCAD), a condition in which the lining of the arteries separate allowing blood to pool between layers. The man was treated and recovered
On the one hand, this event makes sense because physiological changes induced by masturbation—including increases in heart rate, blood pressure, and noradrenaline—are considered to contribute to the development of sCAD. On the other hand, few cases of masturbation-induced strokes have been documented in the medical literature (the case study points to just two).
The authors were excited by their finding because it is the first time that masturbation has been specifically identified as the cause of sCAD. The media was excited by this finding because writers all over the world got to make “unhappy ending” and “stroking it” jokes (myself, clearly, included).
Mostly, though, I’m going to take this opportunity to remind us all that masturbation is really a very safe activity that has many health benefits—from lowered heart rate, to better sleep, to relief of menstrual cramps. Do not let a couple of pun-happy headlines suggest otherwise.