Sex Reassignment Surgery at 74: Medicare Win Opens Door for Transgender Seniors

Originally posted on *NBC News
Written by Miranda Leitsinger

CHICAGO — Denee Mallon marveled at the view of Lake Michigan from her hospital bed in the Windy City, where she had just made history: the then 74-year-old transgender woman underwent a milestone sex reassignment surgery she’d sought for decades. “Here I am, finally, after all these years,” she said. “It happened.”

Her operation will be one of the first paid for by Medicare after she won a challenge in May to end the government insurance program’s ban on covering such procedures for transgender individuals. Mallon’s victory opened the door for other seniors to access this care and may influence whether more insurers – private and public – will cover them. LGBT advocates also hailed her case as another step forward to securing equal rights for transgender people.

“I feel congruent, like I’m finally one complete human being where my body matches my innermost feelings, my psyche,” said Mallon, of Albuquerque, New Mexico, two days after undergoing sex reassignment surgery in mid-October. “I feel complete.”

The Medicare ban was imposed in 1989, stemming from earlier information years before that found there was a “lack of well controlled, long-term studies of the safety and effectiveness of the surgical procedures and attendant therapies.” It deemed such treatment “experimental” and noted a “high rate of serious complications.”

But since then, research has found that sex reassignment surgery is a proven therapy for some individuals suffering from gender dysphoria, with decades-long studies and clinical case reports showing positive results, experts say. There is “agreement among professionals in the field that this is effective treatment,” said Jamison Green, president of the World Professional Association for Transgender Health.

The American Medical Association, the American Psychiatric Association and the American Psychological Association are among the professional medical groups that have in the last decade endorsed sex reassignment surgery, which can include a number of procedures such as a complete hysterectomy, bilateral mastectomy and genital reconstruction.

Yet no one challenged the Medicare prohibition until Mallon did.

Jim Seida / NBC News
Denee Mallon pumps gas into her Ford Mustang in Albuquerque, New Mexico. “They say until you have the surgery you don’t realize what effect it has on your psyche and on your whole being something almost magical occurs. I think, ‘Yeah something goes on.’ I’m going to find out really soon,” says Mallon.

Long road home

Mallon said she first became aware of her gender identity when she was a child in the 1940s. “People would ask, ‘How is your little girl today,’ and that was me,” she said. “Well, it’s taken me all these years and detours, potholes and whatnot to finally be where I am right now.”

For Mallon, life – work, five kids and three marriages – had gotten in the way of having sex reassignment surgery. When she could afford it in the late 1970s and early 1980s, she couldn’t get her doctors to approve it. They balked, she said, because she was having sex with women – which they felt was inconsistent with her needing the operation. By the time she got the okay in the late 1980s, she could no longer afford it.

“I’ve tried to be the kind of man that society wanted and my feminine self just kept creeping up.”

“I lived what transsexuals call the stealth life, didn’t disclose the fact that I was originally male,” said Mallon, who prior to surgery had taken hormones as part of her transition. “And in 2012, I came out of stealth mode and started being more of an activist.”

Her decision to take on Medicare came after she was denied sex reassignment surgery by her secondary private insurer and then the government insurance program. Male-to-female transitions can run about $25,000; for female-to-male transitions it’s around $100,000. Such costs are prohibitively expensive for many on Medicare. Mallon, for example, lives on $650 a month in Social Security income and shares a trailer with another transgender woman.

Mallon’s challenge of what is known as Medicare’s national coverage determination took about 18 months. Medicare never defended its policy before a U.S. health and human services (HHS) board tasked with hearing the challenge, nor did it question the new evidence, which included medical studies, provided by several experts in this field as part of the review.

The HHS board, in its decision, said it was comfortable with that evidence and thus didn’t feel it was necessary to independently consult with scientific or clinical experts on it.

“The new evidence indicates that transsexual surgery is an effective treatment option in appropriate cases,” the board said.

Medicare didn’t respond to NBC’s questions about why it didn’t defend the former policy. Data for reimbursement requests for sex reassignment surgery since the change wasn’t yet available, Medicare said, but a spokesman noted that the decision on whether to cover the procedures was now up to the program’s contractors. (The HHS board said its determination doesn’t bar Medicare or its contractors from denying individual claims for payment for others reasons allowed by the law.)

‘There’s no escaping it’

Transgender people and the issues they face are being discussed and embraced more openly than at any other time in history, with television shows featuring transgender characters — like “Transparent” and “Orange is the New Black” — helping to bring more awareness.

But seniors, like Mallon, grew up during a time when transgender issues were invisible at best. Mallon had grappled for decades with her gender identity: She had tried, as she said, to “man up” by joining the high school football team, the Army and then a police force. She lost marriages and family ties as she haltingly made her transition. She struggled and lacked confidence in jobs where she presented herself as a man.

“I have a difficult time relating to somebody what it feels like to be me. One of the obvious things people will say is, ‘It’s a lifestyle choice. You’ve made this choice.’ Well, it’s far deeper than that. It’s so a part of my basic psyche, there’s no escaping it,” she said. “I’ve tried to be the kind of man that society wanted and my feminine self just kept creeping up.”

Mallon, now 75, began living full time as a woman when she turned 40, taking fashion merchandising courses with 20-somethings at a vocational school in Albuquerque to learn how to walk and talk like the woman she knew herself to be. She’d known since she was about 12 that she needed to have sex reassignment surgery after news broke in 1952 that Christine Jorgensen, a transgender New Yorker, had done it in Europe.

“I was delivering the morning paper at the time and eagerly anticipated each article. That’s when I knew that I could actually have the surgery and become a woman,” Mallon said. “She’d get on TV shows and people would just eagerly watch the show to catch a glimpse of her because that was so novel back then. He was this Army veteran, now a woman, and looking quite good.”

gtws_trans2 Jim Seida / NBC News
Denee Mallon holds a photo of herself from 1957, when she was known as Dennis Mallon, a U.S. Army private in basic training is at Fort Leonard Wood, Missouri.

Of Mallon’s five children, she said, her eldest fully accepts her gender identity and is proud of her for leading the Medicare fight.

“I’m so sad it took so long,” Kelly Mallon-Salter said of Denee’s surgery, getting emotional. “But I’m so happy that she’s helping others to have it.”

Coverage expands in private sector

The Medicare decision comes as the number of private insurance companies offering transition-related coverage has surged in recent years. Human Rights Campaign, which advocates for LGBT equality, said about 34 percent of the Fortune 500 companies today — up from 10 percent in 2009 — offer transgender-inclusive health care benefits, including surgical. Many employers have started to address coverage for transgender individuals, and most have experienced little to no premium increases as a result, HRC said in its annual Corporate Equality Index.

Five states’ Medicaid programs — California, Massachusetts, Vermont, the District of Columbia and Oregon — cover transgender health services, including sex reassignment surgery, in their plans for lower-income and disabled people. Ten states have banned health insurance discrimination against transgender people (the five listed above plus Colorado, Connecticut, Illinois, Washington, and most recently, New York).

The hope, transgender advocates say, is that the Medicare decision will encourage more Medicaid programs and private insurers to offer coverage.

“That’s going to have a ripple effect, we believe, across other third-party payers,” said Dr. Loren Schechter, a plastic surgeon who performed Mallon’s surgery at Weiss Memorial Hospital in Chicago. “And the important recognition is that this surgery is not cosmetic, it’s not an individual’s lifestyle choice.”

“It was extreme anxiety that there was something totally wrong and I wasn’t able to fix it. And if I’m doomed to live this horrible life with these feelings, then it’s not worth living.”

Having sex-reassignment surgery for some individuals suffering from gender dysphoria is medically necessary, said Green of WPATH. Being unable to access such care can create stress, depression, anxiety, heart conditions, disorders or worse. Data is limited on suicide among transgender individuals, though 41 percent of respondents to the National Transgender Discrimination Survey in 2011 said they’d attempted to take their life. “There is nothing more meaningful than to be able to be at home in your body,” Green said.

Veronica Shema, a 65-year-old transgender woman living in Tucson, Arizona, said she has attempted suicide and has been on suicide watch four times. She began to transition 10 years ago.

“I could not take it anymore,” she said. “It was extreme anxiety that there was something totally wrong and I wasn’t able to fix it. And if I’m doomed to live this horrible life with these feelings, then it’s not worth living.”

Shema met with Schechter in November to plan her sex reassignment surgery. She said she’d been turned down by private insurance and was waiting on Medicare, calling it her “last hope.”

“I’m hitting an end-of-life crisis,” she said. “I can’t continue living like this another 10, 15 years. Once I get the gender marker (changed) on my birth certificate, I will feel like I would have accomplished my task. And I’m not there. It’s hard to live with.”

Obstacles remain

Despite the Medicare win, there are still many obstacles ahead: the surgery’s expense combined with typically low Medicare reimbursement rates (for any procedure) may discourage the few surgeons working in this area to accept patients with government insurance.

Dr. Marci Bowers, a pelvic and gynecologic surgeon who has performed more than 3,000 sex reassignment-related surgeries, said she has been getting “scores” of inquiries every week from Medicare patients since the decision. Although she has operated on some of them, she doesn’t think she’ll be able to accept more patients through the government insurer. The costs of this specialty are high, she said, and doctors must accept whatever the insurer reimburses as payment in full. They can’t seek additional payment from patients.

“It’s actually having an unintended harmful effect on patients’ access to care,” she said. “There are an overwhelming number of patients out there. And potentially, if they were all to come in, they would overwhelm our ability to care for them,” she added. “If the reimbursement is paltry, as we are fearful it will be, it’s going to be very difficult to continue to take any kind of Medicare payments. The surgery is just too difficult, too risky, too complicated.”

But the Medicare change could encourage university medical programs to add this surgical expertise to their curriculum, which may increase the number of qualified surgeons, in turn leading to more competition and better access to care, said Bowers. There is currently no approved training program for sex reassignment surgeons in the U.S. Universities also can afford to sometimes take lower payments on treatments — such as from Medicare — with the tradeoff being that surgeries happen at teaching hospitals, she added.

Despite the ongoing challenges, Mallon said now that the door has opened, other transgender seniors who need sex reassignment surgery shouldn’t hesitate. As she savored her new beginning, Mallon mused about all the fun things she looked forward to: swimming comfortably in a pool and going on some dates.

“I’m just a normal everyday woman who is bound to get into trouble,” she said. “I’m so flirtatious, it’s ridiculous.”

The 250-mile-high club: A look at sex in outer space

Originally posted on *AV Club
Written by Mike Vago

With more than 4.6 million articles, Wikipedia is an invaluable resource, whether you’re throwing a term paper together at the last minute or re-editing Pluto’s page because it is so a planet! But follow enough links, and you get sucked into some seriously strange places. We explore some of Wikipedia’s oddities in our 4,683,612-week series, Wiki Wormhole.


This week’s entry: Sex in space

What it’s about: Since the earliest humans gazed up at the heavens, humankind has shared a dream that our species would break the shackles of this earthly realm and that one day, we would be up there, among the stars, doin’ it. Yes, as long as we’ve been traveling into space, we’ve been thinking about having sex in space. Officially, no one has ever been sent into orbit while actually in orbit. And unofficially, while rumors persist, it’s actually fairly unlikely anyone’s ever boldly come where no one has gone before. But humanity will still gaze heavenward and dream a sexy, sexy dream.

Strangest fact: The biggest obstacle to outer space intercourse was first spelled out in 1687. Newton’s Third Law Of Motion states that every force exerted is met by an equal and opposite force. In practical terms, this means that without gravity pulling both partners towards a reassuringly firm mattress, every caress and thrust can send a copulating couple spinning off in unpredictable directions—a serious issue given our current spacecrafts’ close quarters and tendency to cover every available surface with sensitive equipment.

Biggest controversy: While most earthly laws have no jurisdiction in the exosphere, Rule 34 still applies. While there’s no definitive proof that anyone has had sex in space, there is, perhaps unsurprisingly, zero-gravity porn. The Uranus Experiment: Part Two claims to include real-life weightless copulation. The effect was achieved via the “vomit comet” method—flying a plane to high altitude then doing a steep dive, providing temporary weightlessness to the plane’s occupants. Because of the difficult logistics and the film’s low budget, weightless sex was only achieved for about 20 seconds, and viewers of the film say those seconds are hard to pick out among other scenes of very clearly faked zero-G.

Thing we were happiest to learn: NASA’s working on it. While the agency has never acknowledged any human astronauts getting down to business, our space program has performed experiments involving rodents’ reproductive cycles. It seems that mice can get pregnant in space, although their fertility rate was lower than it would be on Earth. And baby rats have been raised in zero gravity, although they had no sense of up or down upon returning to Earth. Science has yet to study an entire cycle of conception, pregnancy, and birth in space, but knowing such a thing is possible may be essential to long-term interplanetary missions.

Thing we were unhappiest to learn: According to the experts, mankind’s future among the stars may never come to pass because of a very sexy problem: weightless boobs. No less an authority than Apollo 11 astronaut Michael Collins (the one who stayed behind on the ship, apparently with some time on his hands to let his imagination run wild) wrote in his autobiography of female space travelers’ “breasts bobbing beautifully and quivering delightfully in response to every weightless movement… and I am the commander of the craft, and it is Saturday morning and time for inspection.”

Science fiction has also weighed in on the subject. Arthur C. Clarke’s 1973 novel Rendezvous With Rama agreed with Collins that, “Some women… should not be allowed aboard ship; weightlessness did things to their breasts that were too damn distracting.” Isaac Asimov was at least able to take a more mature tack, writing an essay the same year called “Sex In A Spaceship,” analyzing more physics-oriented problems—nothing, he concluded, that couldn’t be overcome with a few restraints and padded walls.

Also noteworthy: Many of the rumors around sex having taken place in orbit involve STS-47. The 50th mission in the Space Shuttle program, was notable for carrying the first black woman into space, the first Japanese shuttle astronaut, and the first married astronauts. The presence of Jan Davis and Mark Lee has prompted much speculation that the couple engaged in marital relations while on board the shuttle. Given the shuttle’s close quarters and seven-member crew, this seems unlikely.

Best link to elsewhere on Wikipedia: The fashion world is at least ready for sex in space. The 2suit allows two people to attach to each other to facilitate intimate contact, and attach to a wall or other surface to insure stability. The suit was created by Vanna Bonta, after she experienced weightlessness during a parabolic flight in 2004. Bonta, who died last year, led a fascinating life. Born in the U.S. but raised in Italy and Thailand, she was a poet, actress, novelist, and inventor. She acted in The Beastmaster, and did voice work in Beauty And The Beast, and auditioned for the role of Diane Chambers on Cheers. Her postmodern sci-fi novel Flight prompted Gene Roddenberry to hire her to write for Star Trek: The Next Generation (she wrote an episode, “Somewhen,” which never aired.) A poem she wrote was sent to Mars aboard the MAVEN spacecraft. Besides the 2suit, Bonta also invented shoes that convert from heels to flats, and a device that reduces the risk of rocket engines from exploding during ignition.

Further down the wormhole: Studying the possibility of, and possible effects of, sex in space falls under the broader category of space medicine. That field mainly involves studying the medical consequences of long-term exposure to weightlessness, cosmic radiation, and other effects of space travel. The term “space medicine” was coined by Hubertus Strughold, former Nazi scientist and rival candy maker to Willy Wonka, who was brought into the U.S. space program under the auspices of Operation Paperclip. That secret program brought German scientists and engineers to America after World War II. We’ll look at the Nazis behind America’s space program (among other things) next week.

Mobile dating apps blamed for soaring sex infections

Originally posted on *

The increasing popularity of dating apps on mobile phones has fuelled a surge in cases of sexually transmitted diseases, say doctors.

Tinder and other match-making firms have proved explosively popular, especially among those in their 20s and 30s, providing users with lists of potential sexual partners nearby.

But sexual health experts say ‘hook-up’ apps are leading to rises in sexually transmitted infections (STIs).


Gonorrhoea cases in England jumped 15 per cent between 2012 and 2013, according to official figures, from 25,577 to 29,291. Syphilis cases went up nine per cent, from 2,981 to 3,249.

Peter Greenhouse, of the British Association for Sexual Health and HIV, said: ‘You don’t have to be a genius to work out that these sorts of apps make having casual sex a damn sight easier.

‘You can find, down to a metre or two, the nearest available person who is interested. This is something that just hasn’t been available before.’

Millions now use Tinder, which lets users connect via their phones if they ‘like’ each other’s picture. Advocates say it works because it is spontaneous and discreet, but critics believe it is making casual sex more normal. An app called Grindr is equally popular among gay men. Mr Greenhouse said: ‘Thanks to Grindr or Tinder, you can acquire chlamydia in five minutes.’

Chlamydia can cause infertility in women, though most clear it naturally. Gonorrhoea can cause infertility but needs antibiotics to clear it. Doctors are worried by a rise in antibiotic-resistant gonorrhoea.

Syphilis can lead to blindness, brain damage and even death if left untreated.

Experts at Public Health England found such apps had a role in six outbreaks of syphilis across Britain since 2012. They were enabling ‘hyper-efficient transmission’ of infections, Dr Ian Simms of Public Health England told New Scientist magazine.

Outbreaks that would once have been confined to one area were spreading to other towns and cities, he said.

The companies behind these apps argue no firm evidence yet exists to link them to rises in STIs. But a spokesman for Public Health England said: ‘The only way to get protection from STIs is to practise safer sex.’

Watch the video by clicking *here*

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Truancy, failing tests linked to more sex, less condom use in teenage girls

Originally published on *Medical News Today

What do skipping school, failing tests and engaging in risky sexual behavior have in common? Lots, according to Indiana University researchers who combed through 80,000 diary entries written by 14- to 17-year-old girls.

Although the findings are intuitive, this is the first study to examine the day-to-day relationship between teenage girls’ reports about school-related events, how they felt and the sexual behaviors they participated in. Published in the Journal of Adolescent Health, the findings are based on a 10-year study of the development of 387 teenage girls’ romantic/sexual relationships and sexual behavior. During the study, the teens contributed daily reports of their activities and mood.

“This study demonstrates that young women’s weekday reports of skipping school and failing a test were significantly linked to more frequent vaginal sex, less frequent condom use and different sexual emotions, on that same day,” said lead author Devon J. Hensel, Ph.D., said.

Prior studies have shown that academic success is linked to lower sexual risk, but researchers have relied on retrospective information, she said.

“The strength of using multiple daily reports is that allows us a more ecologically valid, or ‘real world,’ look at how young women’s academic and romantic behaviors are linked from one day to the next. Rather than relying on reports about what happened in the past, we have a unique view of events as they unfold,” said Dr. Hensel, who is an assistant research professor of pediatrics in the Section of Adolescent Medicine at the IU School of Medicine, and an assistant professor of sociology at Indiana University-Purdue University Indianapolis.

“Romantic relationships become a primary social focus during adolescence, and school provides a venue where young women meet and interact with their partners,” Dr. Hensel said. “Many of the same skills underlying academic outcomes — such as communication, emotional awareness and behavior regulation — are also linked to what happens in young women’s relationships. Using this idea, we hypothesized that what happened academically during a given school day would impact how an adolescent felt about her romantic partner, and the behaviors she engaged in with that partner.”

Academic behaviors included skipping school and failing a test; sexual behaviors were vaginal sex and condom use; and emotions involved positive mood, negative mood, feeling in love, sexual interest, partner support and partner negativity.

What she and co-author Brandon H. Sorge, M.S., found is that vaginal sex was more frequent (13.5 percent vs. 5.4 percent) and condom use was less frequent (13.8 percent vs. 33.1 percent) on weekdays when school was skipped as compared to weekdays when school was attended. However, incidents of vaginal sex did not vary if the diary author failed or did not fail a test (6.4 percent vs. 5.8 percent); but when sex did occur, condom use was less frequent when she failed a test (6.9 percent) compared to when she did not (27.1 percent).

Emotionally, young women reported significantly higher levels of negative mood, sexual interest and feeling in love, and lower levels of positive mood, on weekdays when they skipped school or failed a test, as compared to weekdays when neither of these events occurred. Moreover, skipping school was associated with significantly higher levels of partner support.

“Our findings raise the possibility that the emotional and behavioral experiences in young women’s romantic and sexual relationships may impact her reaction to academic events, particularly if an event is more salient to her or to her partner. For example, condom use might be lower after failing a test if a young woman feels supported and loved by her partner. Conversely, if a boyfriend pressures a young woman to skip school, that same pressure could influence her to eschew condom use when sex occurs,” Dr. Hensel summarized. “Our data reflect the importance of considering how the close links between different areas in an adolescent’s life can impact her overall health and well-being.”

Teen sex and LGBT issues: It’s what doctors say and how they say it

Originally posted on *Medical News Today

When doctors speak to teens about sex and LGBT issues, only about 3 percent of them are doing so in a way that encourages LGBT teens to discuss their sexuality, and Purdue University researchers say other doctors can learn from these conversations.


“Physicians are making their best efforts, but they are missing opportunities to create safe environments for teenagers to discuss sexuality and their health,” said lead investigator Stewart C. Alexander, an associate professor of consumer science who focuses on health communication. What the doctor asks or brings up about sexuality sets the tone, and gay and lesbian youth are very good about reading adults to determine who is safe to confide in. They ask themselves, ‘Can I disclose this information to this adult?'”

Physicians are encouraged to discus teenage sexuality during wellness visits per the American Academy of Pediatrics recommendations. But the researchers said these conversations are more than a simple phrase and they need to consider the whole conversation – thus physicians can undo any good they do if they don’t remain inclusive.

“Open, inclusive conversations can help youths realize there is no threat, and this can be a great start for building trust with the physician who is someone they are likely to see year after year,” said Cleveland Shields, an associate professor of human development and family studies and co-investigator. “These adolescents, especially the younger ones, may not have established a sexual identity, their sexuality is in flux, or they may be romantically involved with someone of the same gender but not identify themselves as gay or lesbian.”

The researchers looked at patterns in physicians’ conversations about sex when speaking to patients ages 12-17. The findings are published in LGBT Health. The research was funded by the National Heart, Lung, and Blood Institute, and the data was collected at 11 clinics in the Raleigh/Durham, North Carolina, area as part of the Duke Teen CHAT project. The analysis is based on recorded conversations between 49 physicians and 293 adolescents during annual wellness checks. Of all the visits that contained sexuality talk, physicians were able to maintain open and inclusive talk only 3 percent of the time.

“The physicians I know want to do a good job, so we’re trying to identify best practices, and hopefully these examples will provide them additional context for strengthening these conversations,” said Shields, who used to train family doctors in communication methods.

These conversation methods have not been tested clinically, but here are examples of inclusive conversation tactics from the study:

  • To start an inclusive conversation, focus on attraction: “I know some teenagers who are attracted to girls. I know some teenagers who are attracted to boys, and I know some who are attracted to both. Have you started to think about these things?” or “Usually girls your age start to become interested in boys or other girls or both, have you started to become interested in others?”
  • To start an inclusive conversation, ask about friends: “Have any of your friends started dating? Any boyfriends or girlfriends or both?” or “Do you know if your friends started to have sex yet?” Physicians used this approach to then turn to the teenager’s dating and sexual behavior by always suggesting gender-neutral terms such as “anybody,” “someone” or “partners.”

The researchers say that maintaining an inclusive conversation can be challenging at first, but when done inclusively doctors can reinforce the notion of multiple attractions and identities and emphasize non-judgment. For example, “People like different people” or “I see teens of all types and I tell them the same thing ‘be yourself.'” One physician stated, “I want you to know that I am here for you and regardless of who you are or become interested in, I want to be sure I can provide you the proper care.”

Another technique to maintain inclusive conversations is leaving the door open for future conversations, such as, “If things change, or if along the way you decide something else is right for you, I want you to let me know.”

“The idea of setting the tone for the years to come is very important,” Alexander said. “This may not be the big conversation for the 12-year-olds – that may take place in four years – but the tone needs to be set at age 12 so that when the time comes the child is comfortable and knows the doctor is a safe contact. This approach also reinforces the adolescent as an emerging adult. We want to provide them with autonomy so they can be a consumer of their own health.”

Shields and Alexander collaborated with J. Dennis Fortenberry from the Indiana University School of Medicine and Kathryn I. Pollak and Truls Ostbye from Duke University and Terrill Bravender from University of Michigan.

8 Signs It’s Just a Hook Up

Originally posted on *College Candy

Guys act like girls are so hard to read, but it’s not just us. Trying to figure out a guy’s intentions is like trying to read Chinese. While every situation is different, these signs are pretty clear indicators that a guy is only interested short-term.


1. You Only Talk When You’re Trying to Meet Up

Does he take an hour to respond to a text where you ask how his weekend was, but when you ask what he’s up to that night, he responds quickly? While you might think it’s a good sign that he wants to see you, it’s a red flag if you never talk just to talk. Also not a good sign if his texts usually come at 2 AM on weekends.

2. Alcohol Is Usually Involved

Maybe you hang out sober sometimes, but hooking up tends to occur after you’ve both had a few drinks. It could be that you meet up at a party or hit a happy hour together, but if he can’t make a move without help from his friend Jose, you should throw him away anyway.

3. You’ve Never Gone on a Date

Watching a movie at his place is fine and dandy, but if he’s genuinely interested in getting to know you, he’ll want to get to know you outside the bedroom. Dates don’t have to be stuffy or expensive. Chances are he doesn’t want people asking questions.

4. He Dashes in the Morning

After a sleepover, he’s not trying to cuddle, chat, or even grab a coffee with you. He just wants to get dressed and get out of there.

5. You Know Little About Him

If most of the information you know about him comes from stalking his social media, you might need to reevaluate this relationship. A guy who only sees you as a hook up doesn’t introduce you to his friends, talk about his family, or let you know about what he’s into…and also doesn’t really care about your interests.

6. Seeing Each Other Unplanned is Awkward

When you run into someone you know at the library or dining hall, you should be able to say hi. He’s not only not excited to see you, he tends to avoid you or rub you off with a simple “Hey.”

7. His Social Media Activity is Non-Existent or Over the Top

A player will go with one of two extremes. A: He likes all your Instagram photos, Facebook statuses, and favorites all your Tweets…but he also does this with several other girls. B: He leaves absolutely no trace so none of his hook ups know whose profiles he’s checking out. If he’s interested in you long-term, he’ll try to show interest while still playing it cool.

8. He Avoids a DTR Talk

If you’ve been hooking up for a couple months and he’s never brought up a talk about exclusivity, it’s probably because he doesn’t want it. When you bring up the topic, he’ll try to change the topic or make excuses. Finding out where you stand shouldn’t be like pulling teeth. Say adios to the loser.

Most patients don’t get counseling about sex after heart attack

Originally posted on *Medical News Today

Most patients don’t receive counseling about resuming sexual activity after having a heart attack, according to new research in the American Heart Association journal Circulation.

Researchers interviewed 3,501 heart attack patients in 127 hospitals and one month later by telephone in August 2008-January 2012 in the United States and Spain. The patients’ median age was 48 years and two-thirds were female.

One month after their heart attacks, only 12 percent of women and 19 percent of men reported they received sexual counseling from their healthcare provider – though most reported they were sexually active within the year before their heart attack.

“Even with life-threatening illness, people value their sexual function and believe it is appropriate for healthcare providers to raise the issue of resuming sexual activity,” said Stacy Tessler Lindau, M.D., M.A.P.P., study lead author, associate professor of obstetrics and gynecology and geriatric medicine and director of the Program in Integrative Sexual Medicine at the University of Chicago Medical Center.

In rare instances when healthcare providers counseled about sexual activity, they often recommended restrictions more conservative than medical guidelines. For example, those patients given restrictions more most often told to limit sex (35 percent), take a more passive role (26 percent), and/or keep their heart rate down (23 percent).

“Healthcare providers should let their patients know that for most it is OK to resume physical activity, including sexual activity, and to return to work,” Lindau said. “They can tell their patients to stop the activity and notify them if they experience chest pain, shortness of breath or other concerning symptoms. If the healthcare provider doesn’t raise the issues, I encourage patients to ask outright: ‘Is it OK for me to resume sexual activity? When? Is there anything I should look out for?'”

In the United States and worldwide, heart disease is the leading cause of death. About 720,000 people have a heart attack in the United States each year and about 20 percent are 18-55 years old.

In 2013, the American Heart Association published a scientific statement about counseling patients with cardiovascular disease about sexual activity. The statement concluded that sexual counseling should be tailored to the individual needs and concerns of cardiovascular patients and their partners/spouses

“When the topic of sexual function is left out of counseling, patients perceive that it’s not relevant to their medical condition, or that they are alone in the problems they have resuming normal sexual activity,” Lindau said.

I Forgot to Take My Birth Control; What Should I Do?

Originally posted on *PopSugar
Written by Tara Block

One of the complaints we hear from women about the birth control pill is that they have a hard time remembering to take it every day. So what happens if you forget? Being even 12 hours late taking your birth control pill could increase your chances of getting pregnant. If you miss any of the first 21 pills in your pack, you need to use a backup method of birth control (condoms) until you have taken seven consecutive days of pills.


  • If you miss one pill: Take it as soon as you remember. Take your next pill at the regular time.
  • If you realize when taking your pill that you skipped one: Take the pill you skipped and the new one together. It’s OK to take two pills at once.
  • If you miss two pills: Take two pills each day for the next two days, and then go back to one pill each day at your usual time. You could get pregnant if you have unprotected sex for the next seven days, so make sure to use a backup method.
  • If you forget to take one pill during the third week of your pill pack: Finish the pills for that week, skip the last week (inactive pills), and begin a new pack. Understand that you probably won’t have another period until the fourth week of this new pill pack. Use a backup method of birth control until you have taken seven consecutive days of pills.
  • If you forget three or more pills: Call your doctor for advice. She may suggest to take one pill daily until Sunday and then start a new pack, or to discard the rest of the pill pack and start over with a new pack that same day. Be sure to use a backup method of birth control each time you have sex because you are no longer protected against pregnancy. After you’ve had seven days of pills, then you are protected against pregnancy.

Advice: It’s always a good idea to talk to your doctor if you have any questions. If you think there could be a chance that you are pregnant (and you don’t want to be), emergency contraception (Plan B) is always an option. And as of last week, the morning-after pill is now available over the counter without a prescription for all ages.

HPV vaccination not linked with risky sexual behavior among teenage girls

Originally posted on *Medical News Today
Written by

Opposing concerns over increased promiscuity following HPV vaccination, a new large study published in CMAJ finds that the introduction of the routine HPV vaccination has not affected the sexual behavior of teenage girls.


More than 40 HPVs can be easily spread through direct skin-to-skin contact during vaginal, anal and oral sex.

Human papillomavirus (HPV) is a common virus that is spread through sexual contact. Often, HPV is not symptomatic, and people are unaware that they have contracted the virus.

There are approximately 40 types of genital HPV. Some types can cause cervical cancer in women and can also cause other types of cancer in both men and women. Other strains can cause genital warts in both sexes. The HPV vaccine works by preventing the most common types of HPV that cause cervical cancer and genital warts. It is given as a three-dose vaccine.

In 2006, 49 countries licensed Gardasil, a quadrivalent HPV vaccine designed to protect against four types of HPV (6, 11, 16, 18) that cause 70% of cases of cervical cancer and most cases of anogenital warts. By 2012, the vaccine had been approved in almost 100 countries, many of which also implemented nationwide HPV vaccination programs aimed at immunizing young girls before the onset of sexual activity.

The large-scale immunization programs have been met with approval and controversy regarding the unanswered questions about the real-world effects of the vaccine.

A major topic of public debate has been the possibility that HPV vaccination might give women and girls a false sense of protection against all sexually transmitted infections and that this false sense of protection might lead them to engage in more risky sexual behaviors. Increases in risky behaviors, such as heightened promiscuity and neglecting condom use, could have important clinical consequences, including increased risk of pregnancy and sexually transmitted infections.

This population-based retrospective cohort study aimed to assess the effect of HPV vaccination on clinical indicators of sexual behavior among adolescent girls based in Ontario, Canada.

The researchers identified a population of 128,712 girls eligible for Ontario’s grade 8 HPV vaccination program in the first 2 years it was offered – 2007/2008 and 2008/2009. These eligible girls were compared with girls in grade 8 from 2 years before the vaccination program began, who were ineligible for publicly funded, school-based HPV vaccination – 2005/2006 and 2006/2007.

The cohort members were followed for an average of 4.5 years, and data was collected on indicators of sexual behavior such as pregnancy and non-HPV-related sexually transmitted infections in grades 10-12.

Vaccination, program eligibility did not increase pregnancy or non-HPV-related STIs

The results of the study highlighted 6% of cohort members with indicators of sexual behavior between September 1st of grade 10 and March 31st of grade 12:

  • 10,187 pregnancies
  • 6,259 with a non-HPV-related sexually transmitted infection.

Only 51% of eligible girls received all three doses of the HPV vaccine in grades 8 and 9. Girls born during the first quarter of each year, January-March, were consistently at a higher risk of outcomes than those born later in the year.

The authors observed no statistically significant increase in the risk of indicators of sexual behavior in relation to HPV vaccination.

Dr. Leah Smith, from the Department of Epidemiology, Biostatistics and Occupational Health at McGill University in Montréal, Canada, and Dr. Linda Lévesque, from the Department of Public Health Sciences at Queen’s University in Ontario, say the “findings suggest that fears of increased risky sexual behavior following HPV vaccination are unwarranted and should not be a barrier to vaccinating at a young age.” They continue:

“Neither HPV vaccination nor program eligibility increased the risk of pregnancy and non-HPV-related sexually transmitted infections among females aged 14-17 years.”

Alleged to be the largest study on the association between HPV vaccination and proxies of sexual behavior, this study reports similar results to a US study on the topic involving 1,398 teenage girls.

“The results of this study can be used by physicians, public health providers and policy-makers to address public and parental concerns about HPV vaccination and promiscuity,” the authors conclude.

Medical News Today reported in July that vaccine coverage among US adolescents remains “unacceptably low.” It was estimated that in 2013, only 57% of girls and 35% of boys aged 13-17 years received one or more doses of the HPV vaccine.