Science of Sex: BMI And Birth Control Efficacy

March 30th, 2019

bmi and birth control efficacy

This month’s very late Science of Sex post was motivated by the new Hulu show Shrill, which reminded the world that emergency contraception may not be as effective for overweight people. Specifically, the brand Plan B (also known as the morning after pill) EC is rated up to 175 pounds, which is just over the average weight of an American woman.

The results of a large European study show that the popular form of EC, levonorgestrel 1.5 mg, (Plan B pill) loses its potency in women weighing about 165 pounds and does not work at all in women weighing 175 pounds or more.

There are several theories as to why.

  1. Having more fat makes pills break down more quickly. This makes the medication less effective.
  2. Overweight people have more blood, so more birth control is required to reach ideal blood concentration levels.

Researchers haven’t pinpointed which theory, if either, is correct. All we know is that EC might not be reliable for many people. This was something I learned last year thanks to Reddit, but it’s not something that many people have heard from doctors, pharmacists, or other professionals. Even the manufacturer denies this to be the case.

Fortunately, there is another option: Ella. According to the study, Ella is more effective than Plan B for overweight users, and you can take the pill up to five days later. In comparison, Plan B loses effectiveness after 72 hours. However, you may need a prescription for Ella.

Ella bested Plan B by half, with about 50% fewer pregnancies than those taking levonorgestrel.

Additionally, you may be able to double up on doses of Plan B to increase its effectiveness if you are overweight.

This increased risk of pregnancy doesn’t end with EC. Cochrane examined different studies and found mixed results. The effectiveness of birth control didn’t decrease universally as BMI increased, but the patch and some birth control pills were less effective for overweight and obese users. Shots, implants, and hormonal IUDs were not less effective.

Across the board, IUDs are touted as being the most effective birth control or EC regardless of BMI.

But any contraception is better than none. The European Medicines Association advises that using Plan B is better for overweight people than using no EC. You just need to be aware of the risks.

Further Reading

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March 2019 Media Recommendations

March 29th, 2019

Just when I thought things were finally returning to normal, they.. have not. This month threw me for a loop with my main client taking some time off and some unexpected chest pains. My kitty also has lost more weight than I anticipated since his health issues, and our most recent vet visit was frustrating. The good news? The pain is just a muscle strain… probably from masturbating. I’ve been able to pick up enough work to cover me, too; although, the different payment schedules has thrown me for a loop. And my cat is eating quite well and I think gaining some weight, slowly but surely.

While I am looking forward to April, I enjoyed some quality media in March. The prevailing theme seems to be sex work. I am still reading Revolting Prostitutes, which I hope to finish up soon, and I’ve stumbled across a few more pieces that I found interesting.

Listen

A recent episode of The Science of Sex introduced listeners to Christina Parreira, a graduate student who worked at a brothel to gain information about sex work in America. Looking at the business elements, the characteristics of sex workers, and how safety play into sex work in brothels is super interesting.

Tristan interviews Lora Haddock and Sarah Brown, the women behind Lora Dicarlo, the company that was the CES 2019 Innovation Awards Honoree in the Robotics category only to have the award revoked and be banned from the show in a recent episode of Sex Out Loud Radio. You’ve probably heard about this, and the interview allows the creators to discuss why, yes, their upcoming product actually is a robot and different from traditional vibrators, and why CES was in the wrong but got away with it because the victims were women (and female sexuality).

Sex Out Loud Radio, American Sex, and a few other podcasts are now part of the Pleasure Podcasts collective. I decided to check it out, and it introduced me to Sluts & Scholars podcast. I’ve only listened to a few episodes, but I’ll probably tune in for more. The episode featuring Shira Myrow focuses on emotional intelligence, attachment, and mindfulness while I also enjoyed their discussion with suprihmbé about sex work, people of color, and more. It’s always a good thing to check my white privilege.

Watch

Dr. Doe spent some time in a brothel for a recent episode of Sexplanations. She didn’t spend nearly as much time with the sex workers as Parreira did, so it’s not quite in depth, but it adds a visual to the information that can be helpful.

Journalist Sarah Barmak discusses female sexuality in this Ted Talk. It’s not quite as science-based as some talks, but her points about the orgasm gap, ignorance about anatomy, arousal models, and other often ignored or unknown factors of female sexuality. There’s not much that I considered new or contentious, but the comments show that this information is still controversial and outside the mainstream for many people. I love that she acknowledges asexuals in a way, too.

I’ll hopefully have a few reading recommendations next month after I finish my current book. I honestly need to catch up on what’s been published over the last 6 or so months, so I’ll take any recommendations in the comments! Of course, let me know about any media related to sexuality that’s worth a gander. Thanks!

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FOSTA/SESTA Hurts the Very People It’s Intended to Protect

March 11th, 2019

Today’s guest post is about a topic that I’ve discussed on Twitter and Facebook but not here on my blog. My sex educator peers and the sex workers who run in adjacent circles are well aware of the costs of SESTA/FOSTA and similar policies in other locales. However, not everyone is. The following explains a bit more.

Sex work is a controversial topic. Some have moral and religious objections to the practice, while others view it as a normal way to make a living. Due to the nature of the vocation, there is risk of exploitation. Pimps manipulate the young and vulnerable into the practice against their will. They are often separated from their families and placed in dangerous situations. There is a high risk of:

  • Emotional abuse
  • Violence
  • Drug use to control depression
  • Death

As a society, we need to put measures in place to detect and stop sex trafficking.

On the other hand, some people voluntarily ent er the sex industry. Contrary to popular belief, it isn’t because they are from broken homes, or addicted to drugs. Some enjoy the perceived freedom, flexibility and relatively high earnings per hour rate of sex work. As of writing, the UK minimum wage is £7.81 an hour. An independent sex worker can expect to make £100 an hour in most cities. Therefore, it can be a rational choice.

The United States designed the FOSTA-SESTA bills in order to stamp out sex trafficking. FOSTA stands for ‘Fight Online Sex Trafficking Act’. SESTA stands for ’Stop Enabling Sex Traffickers Act’. Interestingly, there is no evidence that sex workers were consulted while creating this bill. Essentially, the United States government had meetings and decided what they thought was the best way to eradicate sex trafficking. It is difficult to solve a problem if you don’t know the root cause and complexities. In the end, they decided that the internet was a driver of sex trafficking. As a result, social media sites will be criminally responsible for content deemed to be promoting sex trafficking.

Let’s cross back over the pond for a second. It is difficult to get data on sex work because there is no national body. However, we use certain data to extrapolate from. Between 2002 to date, the percentage of soliciting of prostitution offenses has sharply declined. Interestingly, there is a positive correlation between internet access and the decline of prostitution. Could it be that those who might have been vulnerable to sex trafficking are now working independently in safe and controlled environments?

Since 1996, social media site operators were protected under ‘Safe Harbor’ in the United States. It stated, “No provider or user of an interactive computer service shall be treated as the publisher or speaker of any information provided by another information content provider.” This meant that users were responsible for their activities. The FOSTA-SESTA bills make internet service providers and platforms responsible for what their users post. In response, top social media sites closed certain sections of their site. For example, Craiglist no longer has a personals section.

Interestingly, UK politicians were planning a version of FOSTA-SESTA. This is likely to have the opposite effect. Instead of protecting sex workers, it will drive it further underground. Ironically, instead of limiting sex trafficking, it will provide the environment for it to flourish. Hypothetically, the government will be able to use carefully chosen statistics to show that the incidences of prostitution has reduced. Would it have reduced or simply driven underground? Out of sight, out of mind.

The All-Party Parliamentary Group (APPG) on Prostitution and the Global Sex Trade, consisting of several members of Parliament, stood up in a House of Commons debate in July 2018 calling for a ban on “prostitution websites.”

They are also mulling the “Nordic Model,” in which selling sex is not illegal, but buying sex is. Ireland instituted this model in 2017, and immediately saw an uptick in violence against sex workers.

“People who are doing the worst of crimes are not deterred at all by this law,” says Kate McGrew, director of the Sex Workers Alliance of Ireland. “People see us as even more outside society, as vulnerable, as even less likely to call gardai or draw attention.”

Notably, the internet has increased the opportunities available for sex workers to operate in a safe environment. Some perform ‘cam work’ from home. They have no physical interaction with clients and are able to remain anonymous. Others sell video content and make passive income. Those who indulge in more ‘traditional’ prostitution, use social media to share information. For instance, they can notify their counterparts about violent clients or dangerous places.

The internet is an expression of freedom. It can’t be controlled, no matter how hard we try. Arguably, the FOSTA – SESTA bill is a form of political point scoring and a lazy way of trying to solve the big problem of sex trafficking. All it will do is increase the demand for underground sites which act as modern-day sex trafficking networks. The police should be trained on how to detect sex trafficking victims and establish rehabilitation programs to heal any emotional abuse or addiction.

Another issue is that the FOSTA – SESTA bill and any variations of it implemented around the world, is trying to limit a complex industry. For instance, some escort agencies, such as gentlemen4hire, strictly provide companionship. However, they are likely to be affected if such a bill was to be passed in the U.K.

There is a trend of governments trying to control the internet. In extreme cases, popular sites are banned. However, the internet is the exchange of information. People always find a way around it, Moreover, there are dark web sites which harbor all kinds of illegal activities. If governments truly care about stopping sex trafficking, they should train their police departments on how to detect and rehabilitate victims. They should also educate people on the tactics used by pimps and the effects it can have on one’s life. The FOSTA – SESTA bills are an ineffective bandage on a complex societal injury.

In conclusion, the passing of such bills has wide-reaching implications. Could businesses lobby to have other internet bills passed in order to protect their interests? This could open the floodgates to a world of scrutiny, and control over our lives – and perhaps that is the end goal. So, we need to take a deeper look into the issue of sex trafficking. Moreover, sex trafficking victims need to be listened to as they are best informed about how it works. Instead of trying to place a ban on sex work, more needs to be done to protect the vulnerable.

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Tongue Tied: Untangling Communication in Sex, Kink, and Relationships

March 9th, 2019

I wasn’t intending to read Tongue Tied initially. I was previously unfamiliar with Stella Harris (who I now know is an experienced sex educator and coach as well as an erotica writer) and, perhaps more importantly, felt pretty familiar with communicating about sex. I’ve frequently read about the topic. I’ve argued that we need to talk more about sex and do it in a healthy way that isn’t inherently sex-negative. Hell, I’ve written about talking about sex and provided instructions for readers to do so. Tongue Tied, therefore, seemed a bit old hat.

But I heard Stella on American Sex, and she made a few points that resonated with me enough to change my mind. Soon after, I had a digital copy of the book, and it wasn’t much longer after that I had finished it. Unlike, say, BDSM: A Guide for Explorers of Extreme Eroticism, Tongue Tied isn’t a huge book, and it’s a pretty easy read. Of course, you can pick and choose what you read in Tongue Tied to save a little time and effort, but reading the whole thing gives you a better impression of not just how to communicate but what you need to do so.

Right from the introduction, Ms. Harris draws on her experience as a sex coach, explaining that her most frequently received questions about sex involved communication, even if the people asking those questions were unaware of that fact. A quick look at r/sex on Reddit shows that most people need to talk to their partners to resolve issues in the bedroom, so many people realize this. When our mouths are closed shut about sex, people learn the wrong — and sometimes dangerous — things from less-than-reputable sources. We need to talk about sex. However, like most things, it’s easier said than done.

Initially, I didn’t expect a book on communicating about sex to cover so much non-communication issues. But it’s true that one of the main inhibitors of talking about sex is the way people think about sex. From the very start, the author proposes that every person is responsible for themselves and the way they behave in relationships. She dedicates the entire first chapter to the goal of sexual communication (healthy relationships with boundaries and goals regardless of the specific arrangement of those relationships). In this chapter she addresses how it’s easier to talk about sex when you make a habit of it from the getgo but also how sometimes these discussions are uncomfortable, and that’s okay.

From here, she follows a chapter detailing the common mistakes when communication. Knowing what not to do when talking about sex is as important as knowing what to do. Ms. Harris writes about common mistakes include being selfish, not speaking up about what you want, assuming there’s such a thing as normal, and others. She also advises the reader to check their cultural biases and not to make assumptions or to lie about pleasure and orgasm (ie faking it).

The third chapter reveals how differently we can each define things as common as “sex”. This encourages clarity, specificity and positivity. The chapter ends with a quick anatomy lesson.

If you’re familiar with all these ideas, you might skip ahead to the next chapter, wherein Ms. Harris gets to the specifics of talking about sex, starting with when to do have conversations. I especially appreciated how she guides the reader through talking to friends as a form of support and when people should reach out for professional help to deal with their relationship and sex issues.

Readers who are struggling to define what they want would benefit from the chapter six in which Stella encourages readers to examine their future “perfect” sex lives and presents them with tools such as a Yes/No/Maybe list and a “Sensation Exercise.” It’s not the first time when she suggests tools that originated within the kink community for discussion “vanilla” sex nor the last. Throughout her book, Ms. Harris encourages explicit and practical communication in these ways.

The goal of these exercises is to encourage readers to explore their sexuality and find scenes that represent their desires and interests. This is the last chapter that focuses on setting the foundation for talking about sex.

The chapter that follows is one that provides examples of what to say to your sexual partners. Chapter 6 is where you’ll want to start if you have a good foundation for talking about sex but you just need to know what to say.

There’s some typical advice such as using “I” statements, and Stella suggests questions and exercises that reminded me a bit of sensate focus. The goal, at least, is the same: to learn more about your partner’s body and reactions. She stresses remaining positive, listening without judgment, and the word “No.” There are plenty of examples of exactly what to say that will benefit readers who just aren’t sure what words to use. Chapter 6 is the meat and potatoes of the book and perhaps the longest as well.

In the vein of sensate focus or practicing using a safe word, the next chapter details exercises to get readers used to communicating about sex including giving feedback, asking questions, and communicating without words. No book about communication would be complete without information about body language and nonverbal communication, so I was glad to see it included.

There are types of people who I would imagine find these activities silly, the type whom I suspect need more than a single book to fine tune their attitudes about sex, relationships, and communication. If readers don’t already agree with much of the author’s point of view, they’ll struggle to get much out of the book, I think. Arguably, most people reading a book about talking about sex are at least open to new points of view, but some people will struggle to learn from this book.

Others may find the exercises fun or sexy. But they’re useful if you go into them willing to experience and learn. I imagine readers might use these tools with new partners or over the long run to improve communication and understanding of themselves. Among the tools suggested are methods of tracking arousal, which is especially important to women, and using sex toys with partners. I’m so glad to see that included in these pages.

Incorporated into the book is a (short) chapter on talking about safer sex specifically, an important topic and one that may happen in the confines of a casual encounter with a stranger versus a longterm partner.

I appreciate that Ms. Harris walks us through apologizing and accepting an apology as part of her next chapter about difficult discussions, which also tackled fighting, mismatched desire, admitting a lie, and breaking up.

Chapter 11 had the potential to be one of the most useful in the book. The author lists examples of phrases to use in particular scenarios. However, she goes from examples to anecdotes involving past clients. From here, it seems that Stella becomes much less specific, illustrating fewer examples of how to speak about specific issues. This is especially noticeable when she talks about kink in the next chapter, and the section seems brusque. It’s not that phrases exemplified previously in the book can’t be used for these things. I just think a book that walks you through talking about sex benefits from specificity. Sometimes people know they need to talk about sex have all the right attitudes and goals but don’t know exactly what to say.

Communicating in a healthy manner can feel awkward and stilted to a person who hasn’t done a lot of explicit communication. The more examples, the better. Yet examples seemed sparse the further I got into Tongue Tied. It may not have been as noticeable if the author hadn’t done such a good job providing them in other parts of the book. But it was frustrating as I read on.

I am not sure if Ms. Harris was rushing to complete, felt that expanding on certain topics was too niche or would make the book too long, thought that specific examples weren’t necessary, or had another reason for her change. Unfortunately, this seeming lapse meant the end of the book was a bit of a letdown for me, and that the information on kink isn’t presented as usefully as information from previous chapters, especially chapter six. the final chapter — one self-care — made little impression on me because of my frustration.

This doesn’t mean there isn’t useful information in Tongue Tied, just that it didn’t quite reach its potential. This could be remedied in following editions or, less ideally, perhaps with a sort of companion workbook. But it’s a shame because Stella Harris writes in an approachable way, the book is easy to digest, and the topic is so important.

On a final note, Tongue Tied is gender neutral, a point that Ms. Stella makes on purpose and addresses early on. This should make it welcome to people regardless of the gender configuration of their sexual relationships.

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