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Posts Tagged ‘sexual health’

So over on Tumblr (yes, that’s still a thing that’s happening), ozymandias271 explained what “condoms are 98% effective” actually means in a recent post and it’s kinda made my brain explode.

I’ve been hearing that statistic (or other similar ones) for ages, and never concerned myself with it too closely. Given how little casual (or any kind of) sex I’ve generally been having, it wasn’t of much personal importance, and while I advocate strongly for comprehensive sex and relationships education, it should definitely be someone better-informed than me doing it. But I knew enough to know that condoms are good, and knowing how they work is also good, and if I needed more detailed data than that I’d surely be able to do the research.

But 98% always seemed oddly low. I wasn’t sure how much it was affected by issues like compliance or user error – is that remaining 2% at least partly explained by people just applying them wrong? – but taken on its face that’s actually quite a high-sounding failure rate. Do you really only have to have fifty sexual encounters involving a condom before you’ve statistically had one for which it might as well not have been there and you’re facing all the risks of unprotected sex? Given how much sex straight people on TV seem to be having, this makes it sound like unplanned pregnancies due to contraceptive ineffectiveness would be cropping up pretty regularly, and just something to be accepted as par for the course.

Anyway it turns out that’s totally not what “98% effective” means. Taking the outcome of unplanned pregnancy specifically, here’s how one website describes the effectiveness of condoms:

In one year, only two of every 100 couples who use condoms consistently and correctly will experience an unintended pregnancy—two pregnancies arising from an estimated 8,300 acts of sexual intercourse, for a 0.02 percent per-condom pregnancy rate.

98% effective doesn’t mean a condom is only doing its job in 98% of sexual encounters. It means that 98% of people using condoms for a year will avoid unplanned pregnancies in that year.

Or, assuming you’re using them correctly and having sex about as often as these statisticians imagine, the length of time the average person would have to keep having regular safe sex before encountering a condom failure isn’t fifty sexual encounters, but fifty years.

I have been massively misunderstanding this for YEARS because of what seems like REALLY UNCLEAR COMMUNICATION AND UNHELPFULLY OBSCURE PHRASING, GUYS. Seriously, I can’t be the only one who finds that a totally counter-intuitive interpretation of the “98% effective” line. Did everybody but me already have this figured out? I mean, it’s less important that I understand this than almost anyone else, but still.

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Remember how some awful people protested against vaccinating young people against HPV, not simply on the grounds of any anti-vaccine quackery, but because they thought it would turn teenage girls into shameless sluts?

Well, you knew they were full of shit, and now it’s official. Routinely protecting children from a dangerous infectious disease does not turn them invariably toward any kind of flagrant immorality, like daring to enjoy sex, any more than usual.

Just a quickie from me today, but it’s worth mentioning.

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One important aspect that seems to have been largely left out of the debate on forced and unnecessarily penetrative medical procedures for women, which is becoming legally mandated in a number of states of the USA, is the role of the doctors performing these procedures. In particular, those who morally disagree with the mandate just as much as the lay folk who’ve been protesting it.

It’s not like medical professionals don’t have their own strong opinions about patient care, after all. Most of them wouldn’t be happy to simply carry blithely on with an invasive medical procedure that they thought was traumatising and unnecessary. Aren’t some of them outraged as well? Aren’t some of them standing up against this?

Yep.

An anonymous medical acquaintance of John Scalzi’s has guest-posted on his blog, calling for what they call “a little old-fashioned civil disobedience”. After several points of advice as to how physicians who “should” be performing these procedures can respond ethically, here’s the conclusion:

It comes down to this: When the community has failed a patient by voting an ideologue into office… When the ideologue has failed the patient by writing legislation in his own interest instead of in the patient’s… When the legislative system has failed the patient by allowing the legislation to be considered… When the government has failed the patient by allowing something like this to be signed into law… We as physicians cannot and must not fail our patients by ducking our heads and meekly doing as we’re told.

Because we are their last line of defense.

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Dentist went well. Just one more round to go. Still planning to be a bit quiet, but have some links.

– If reproductive services are going to be covered by health insurance in the US, Rush Limbaugh’s demanded visual evidence of what women need all those pills for. Here you go. (NSFW)

– Some Republicans want all their party members to be “pure“. Hilarity will no doubt ensue.

Ann Romney doesn’t consider herself wealthy, thus demonstrating one of the most serious problems with extremely wealthy people.

The most astounding fact about the Universe. With pictures. And music. And Neil deGrasse Tyson. Wonderful.

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Don’t you miss the good old days, back when abortions in the USA happened about as often as they do nowadays, but thousands of women died every year?

No? Well, Rick Santorum does.

This is just another example of the dangers of letting religious ideology motivate your moral principles. Some Christians say atheists can’t be moral because we have no overruling guiding force to tell us what’s right and wrong. I say we have a much better shot than some Christians, who willingly submit to an overruling force that entirely shuts down their capacity to think for their damn selves.

Seriously, I’m willing to take Rick Santorum at his word on this. He thinks our approach to women’s health was better in the days when “people who did abortions were, you know, in the shadows”. Which was because many of these medical procedures – perhaps as many as 1.2 million a year – couldn’t be performed by qualified professionals in appropriate hospital settings, and hundreds of women a year were dying as a result, well into the 1960s (on top of numerous others suffering complications).

So the country Rick Santorum wants to run is one in which thousands of women die needlessly, and millions of eggs continue to be fertilised and reach the early stages of development before being terminated, but in which his conscience is clear because he can claim to have followed his own interpretation of his religious ideology to the letter. The fact that abortion is less common in countries where it’s legal? Not important. It’s the principle of the thing, and if that means the unnecessary deaths of people who won’t do what they’re told, so be it.

It’s either that or he doesn’t know what the fuck he’s talking about.

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Ah, America. Sweet land of liberty. Home to so many rights and freedoms. Speech, religion, suffrage, ownership of property, dressing your pets up in people clothes and making them dance. Those USAnians have it all.

Of course, it’s not always been such a bastion of equality and fairness. It took a while before the above rights were extended to women or the insufficiently pale, after all. And there’s still a long way to go.

Today we’re saddened by the prevalence of racism in generations past. But how will our children’s children view our own callous refusal to grant all basic human rights to all human or potentially human beings, from the very moment of conception? For the love of God, won’t somebody please think of the just-fertilised eggs??

Yes, this was a real bill, really being considered by lawmakers in Oklahoma recently. But don’t worry: Sarcasm to the rescue!

However, any action in which a man ejaculates or otherwise deposits semen anywhere but in a woman’s vagina shall be interpreted and construed as an action against an unborn child.

That was an amendment put forward by a State Senator rather effectively trying to make fun of the bill’s content. It was withdrawn fairly swiftly after making its intended point, and before making any significant impact. (No, that’s not what she said. Stop that. This is serious political news.)

Anyway, I’m in something of a quandary over this.

Am I glad that there are lawmakers out there with a sense of humour, who have the nerve to take a comical stand against the kind of ridiculous ideological nonsense that some of their colleagues are trying to push through?

Or am I even more depressed that this is what constitutes a constructive work-day for the people who run the world and decide what rules are imposed on the rest of us?

In even less cheery news, Typhonblue points out another aspect of how messed up a lot of the laws about parental obligation already are, and how liable they are to seriously screw over men as well as women. Whether it’s technically legally true that men are always “strictly liable for where their sperm ends up”, I don’t know, but it doesn’t look like there are many cases around where it goes their way, even when they allege rape or simply theft.

Here’s a worrying-sounding sentence from one case in New York (emphasis mine):

But respondent’s constitutional entitlement to avoid procreation does not encompass a right to avoid a child support obligation simply because another private person has not fully respected his desires in this regard. However unfairly respondent may have been treated by petitioner’s failure to allow him an equal voice in the decision to conceive a child, such a wrong does not rise to the level of a constitutional violation.

Which seems to indicate that your sperm are your own liability, even if you don’t consent to or cooperate with their use in any given way. If you’re the father of a child, it doesn’t matter whether you had careless or deliberate unprotected sex, or you were kidnapped and milked for your precious bodily fluids. Once it’s biologically your kid, it’s your financial burden whatever your level of involvement.

The whole thing’s screwy in too many ways to count.

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I’ve not written about this at length before, but not kept my views exactly secret either. Basically, what Marsh said.

Having said that, I think much of the anti-circumcision camp can sometimes get bogged down with slightly weaker arguments that they really don’t need to worry about. In particular, when they counter claims about the perils of foreskin ownership with ways in which this particular area of skin can be beneficial.

It doesn’t need to be useful, or to actively promote good health, or to have anything particularly wonderful going for it. All you have to do is point out that the default course of action is not to cut bits off other people.

In religious arguments, the burden of proof with regard to God is on the person making the positive claims about him. And in arguments where one side is saying “I think surgically removing a bit of this newborn child is a good thing to do”, it’s very much up to them to justify that.

For instance, don’t respond to studies saying that sex is better without a foreskin, by pointing to other studies which indicate the opposite. Well, if you have good reason to think that your studies really are the only sound ones, I guess you could do that. But you should primarily be asking why such a ridiculous argument is being made for slicing a chunk off your baby’s genitalia in the first place.

The implication is that a significant number of uncircumcised men aren’t enjoying their sex life as much as they could be, and are seething with frustration at this damnable yoke of a foreskin they’ve been cursed to carry around with them. And that this is such a huge problem for these poor men, that it’s worth taking a knife to every new-born boy’s junk pre-emptively so that it can be avoided.

This is a serious mishandling of priorities. Most of these men’s sexual experiences would benefit far more from an open and honest conversation with their partner, a little creativity and research, and maybe a shopping spree at Lovehoney, than from having had their foreskin removed years ago. And in those cases where the foreskin really is the problem, there are various medical or surgical interventions which can be employed down the line, once there’s actually a problem that requires it, and once they’re in a position to understand and consent to the proposed fate of their dangliest of bits.

Other arguments intended to justify and support this mass emasculation, in brief:

Tradition

Fuck off.

Seriously. If the best you can say for it is “We’ve been doing it for years”, isn’t it maybe time you stopped and asked why you’ve been doing it for years?

Lots of things are traditional. Some are good, some are bad. If it’s a good idea, it should stand up on its own merits. The sole fact that it’s an idea with tenacity has no predictive power either way.

As it happens, if circumcision wasn’t already a long-standing cultural tradition, and was a new thing that people were just starting to do now, my guess is that most people would be appalled by it, and far less impressed by the usual justifications offered.

Aesthetics

Fuck RIGHT off, you insensitive, superficial, thoughtless lacerater of children.

Religion

To quote a wise and handsome man:

Saying “because it’s my religion”, as a legal justification for something, or in any similar circumstances, should carry exactly equivalent weight to saying “because I really, really want to”.

In other words, nobody’s obliged to care if you consider something a religious obligation if it’s a flat-out terrible thing to do.

You’re welcome to exercise your own freedoms to the full extent of your capabilities, up to the point where they adversely affect other people. They can be religious, or not. Doesn’t matter. Knock yourself out. But beyond that point, you don’t get to snip off the tip of someone’s dick for the same reasons you don’t get to poke out their eye or hack off their clitoris, regardless of what you think God wants.

It’s superfluous

There is plenty of my body that’s technically superfluous. I’m not convinced my middle toe on either foot has ever done anything for me. Its neighbours on either side have the balance thing taken care of. But they’re not exactly in the way, and I’m rather glad they were left there when they weren’t causing any trouble, and I was allowed to decide what to do with them myself.

Health benefits

Here the evidence is murky at best. But however much the data might inch things onto the pro-circ side here, it’s not enough to merit such an intrusive and widespread intervention as some people suggest.

At least, not in the developed world it’s not. In Africa, where a good deal of research has been done, it does seem that HIV infections are being prevented by circumcisions, and that there is a significant percentage reduction in other infections.

In Uganda, for instance, circumcision might be an understandable route to take, and is certainly some way removed from being a monstrous act of barbarism. But the developed world has certain advantages we take for granted which Ugandans don’t have, such as widely available contraception and sexual health information.

There might be worthwhile benefits to circumcising 1.2 million American babies a year, if it was a given that they would all be having unsafe hetero intercourse and not looking after their sexual health in any other ways. This might be a fine opportunity for another jab at abstinence-only education, but I’ll hold back on that for once. Americans aren’t like that.

The health benefits of cleaving millions of babies’ penises are easily surpassed by those of educating them in basic cleanliness and sexual health later in life. It’s just not necessary.

Seriously, there should be a much higher bar than many people seem willing to set, before we start cavalierly perforating our children’s manhoods. Think of it this way: What percentage reduction in HIV transmission, in penile-vaginal sex, would justify female circumcision? How much infection would it have to prevent before you supported cutting off every clitoris at birth as a preventative measure?

Which I suppose I should touch on at least briefly before closing. This process involving the excision of the clitoris in young girls, which is alarmingly prevalent in parts of Africa, is utterly terrible. It is more deserving of the name “genital mutilation” than male circumcision (though I’m not getting into that semantic argument here), and is certainly more likely to cause problems and be resented by the victims later in life than removal of the foreskin. On an individual level, it seems safe to say that girls have it worse.

But it’s not a competition, and it doesn’t just have to be considered on an individual level. What concerns people about male circumcision is how widespread it is in developed countries like the United States, where it goes on all the time as if it were perfectly okay.

They’re both serious issues worth addressing. But only one is the primary subject of this particular blog post, and only one is something that many of your neighbours and work colleagues might boast proudly about doing to their own children.

The title of this post might seem a bit laboured, but I’m sure the spoonerism is as dear as clay.

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