How the next generation of doctors is learning to treat transgender people

Alex Izaguirre/FUSION

Anna thought she had finally found an endocrinologist who could treat her.

“It went great initially the first day,” the 27-year-old transgender woman told me. “I got in, got a prescription that day because I had a therapist’s letter, and it was going really well.”

Anna felt lucky at first. Endocrinologists typically treat hormonal problems like diabetes or thyroid diseases—not all are willing to prescribe sex hormones like estrogen or testosterone to help transgender patients transition, or develop secondary sex characteristics that correspond to their gender identity.

But Anna’s luck quickly ran out. Her doctor prescribed her an unusually low dose of estrogen and over time, she says, it became clear that he had never treated a transgender patient before. So she took matters into her own hands.

“I wound up having to do research on my own figuring out what my levels should actually be, print it out, bring it in, and basically educate him on it,” Anna told me.

The endocrinologist eventually adjusted Anna’s dose, but she later moved from California to Portland, Oregon, where she was fortunate to find a doctor who was well-versed in transgender hormone therapy. Making an appointment with a new endocrinologist, Anna told me, “just seems like this huge shot in the dark.”

She’s right. A recent study suggests that a transgender person walking into an endocrinologist’s office to begin medical transition has less than a two-thirds chance of receiving that treatment. That study, published in Endocrine Practice, found that only 63% of endocrinology providers at a 2015 conference were willing to provide hormone therapy for transgender patients. Half hadn’t even read the Endocrine Society’s 2009 readily available guidelines for that treatment.

But there was a silver lining: 70% of providers under age 40 had read the guidelines. If that’s indicative a broader trend, the next generation of endocrinologists could change the map for transgender health care. Someday in the not-too-distant future, as pioneering young doctors reshape the medical world, transgender patients may be able to access state-of-the-art hormone therapy as easily as diabetics receive insulin prescriptions.

My own experience could not have been more different from Anna’s. When I started hormones while working toward my doctorate at Emory University, I was referred to Vin Tangpricha, the director of the school’s endocrinology fellowship program and the president-elect of the World Professional Association of Transgender Health.

As one of the modern-day experts in transgender health, Tangpricha is excited by the shift he has seen among his students in the past few years.

“It’s refreshing that there are a lot of young doctors who want to educate themselves,” Tangpricha told me. “They’re very open-minded and they don’t think anything of it. That was different from when I went through training.”

When Tangpricha was younger—he started medical school in 1992—his professors were wary of his interest in transgender hormone therapy. But he “felt like no one was doing anything,” so he persisted. After publishing an article on the subject in 2003, he was asked to help develop the Endocrine Society’s 2009 guidelines for transgender hormone therapy—the ones too many of his colleagues still haven’t read.

Even though those guidelines exist, making sure that endocrinologists actually learn them has been a challenge. The World Professional Association of Transgender Health has been conducting trainings around the country—reaching about 1,000 doctors so far by Tangpricha’s estimation—but that’s still not enough.

“You would think that doctors would want to educate themselves, but until you force them to do stuff, they don’t,” Tangpricha told me.

But even if all practicing endocrinologists learned the guidelines, most medical schools still aren’t teaching transgender hormone therapy to a rising generation of young physicians.

Joshua Safer, the director of Boston University’s endocrinology fellowship program and a spokesperson for the Endocrine Society, has been trying to change that. “Transgender medical care is not a part of conventional medical education and has not been a part of conventional medicine ever,” he told me.

It’s not that prescribing hormones for transgender patients is challenging—the process is “not that complicated,” Safer assured me—but that medical schools are “very conservative.” A 2011 Stanford study found that only about 30% of 176 U.S. and Canadian medical schools cover transitioning in their required curriculum, even though the American Medical Association has supported transition-related health care since 2008.

Safer has observed some recent progress in medical students being taught how to be culturally competent in their interactions with transgender patients—knowing the right pronouns, using the proper language, et cetera—but he wants to see more of them trained in the actual medical treatment itself.

“Transgender individuals who want medical intervention—and that’s a sizable number of people who are transgender who are showing up to doctors—are not looking for the doctors to simply be respectful,” he told me. “They’re looking for doctors to actually know what to do, and that’s still missing.”

Learning about transgender hormone therapy is not even a guarantee for medical school graduates who choose to pursue an endocrinology residency or fellowship —despite the fact that these training programs are meant to offer doctors an in-depth, immersive education in the field. Out of the 104 fellowship program directors who were surveyed for a recent Endocrine Society presentation, only 52% responded and less than three-quarters of those respondents said their programs teach transgender hormone therapy.

But much like Anna did with her own treatment, some young endocrinologists are taking transgender health care disparities into their own hands.

Farah Naz Khan first became aware of hormone therapy during a high school debate competition when she was assigned to argue a case about health care for incarcerated transgender people. She didn’t learn about it in medical school nor did she see any transgender patients during residency. But now, thanks to Vin Tangpricha’s fellowship program at Emory, she is revisiting the subject at long last.

“The fact that I look back and my initial exposure to this was in high school and I haven’t dealt with it again until years later in endocrine training—that’s terrible, in my opinion, and that shouldn’t be happening,” she told me.

Khan currently sees transgender patients at a weekly continuity clinic at Grady Memorial Hospital in Atlanta and she is eager to become more involved.

There’s strong evidence, too, that today’s medical students share Khan’s willingness to treat transgender patients. In a 2016 study co-authored by Safer, thousands of Canadian medical students across 14 schools answered a survey about transgender topics on their curricula. Almost all—95%—believed that transgender issues “should be addressed by physicians” but fewer than 10% said they were “sufficiently knowledgeable to do so.”

That matches Khan’s experience working with doctors who are uncomfortable with transgender health care “not because of any sort of stigma” but because they never got the right training.

“If you have an interest in it or if you are aware of it, you need to seek it out,” she explained. “It’s not something that’s readily available.”

In the meantime, Sonya Haw, who just joined the Emory endocrinology faculty in 2014, doesn’t want Atlanta’s large transgender population to have to wait for more doctors to get trained. Along with a working group of medical residents, most of whom are in their mid-to-late twenties, Haw has applied for a grant to set up a multi-discipline “one-stop shop” for transgender health care at Grady.

Transgender people could visit the clinic for hormone therapy, yes, but they could also see a psychiatrist or an OB/GYN. Haw envisions it as an “entryway into the health care system” that can help transgender people now, rather than later.

“We don’t see this as a place that trans patients come back to for ten, twenty, thirty years like they would do for a family practice clinic,” she told me, imagining a future in which transgender health is integrated into general health care. “But right now, there’s such a need for more formal and informal medical education for not only residents, medical students, and trainees but also senior physicians.”

And like many younger physicians, Haw is completely unfazed by the cultural controversies around transgender issues. To her, this is a medical issue—and a fairly straightforward one at that.

“Caring for transgender patients has a lot of societal, political baggage that comes with it,” she told me. “But if we can just think of trans care as caring for any other patient that we have, addressing their medical and physical needs, it’s not that difficult or convoluted.”

All of the people I interviewed were optimistic about the future of transgender health care.

Tangpricha and Safer believe they will have an easier case to make with medical schools as a more accurate picture of the size of the transgender population comes into focus. The Williams Institute, a UCLA-based think tank that conducts independent research on gender and sexual identity, estimates that there are 1.4 million transgender adults in the U.S. alone—a much higher prevalence, Tangpricha says, than some of the rare endocrine conditions that medical students “learn so much about” in school.

And both Tangpricha and Safer pointed out that as New York’s Mt. Sinai Health System and other prestigious hospitals open their own transgender health care centers, other medical schools and hospitals are likely to get envious.

“Once you start getting that competition, all the other hospitals will follow suit,” Tangpricha suggested.

“Institutions are beginning to step up and put this together,” Safer added. “If you’re talking about looking forward to a brighter future, that’s happening.”

But change will have to come from the bottom up, too, and that means training new students. Studies that Safer has co-authored have shown that even “simple” changes in instruction can significantly boost medical students’ and residents’ willingness to treat transgender patients. And if curricula can become more inclusive, Haw predicts that it is only a matter of time before we see a massive shift in accessibility for transgender health care.

“As we are able to train residents and medical students and continue their exposure—and as they move on to be attending physicians themselves—I think we will see a change in the landscape of how easy it is to care for trans patients from an access standpoint and a quality standpoint, too,” she said.

Today’s physicians may be able to address the gaps in transgender health care access, but tomorrow’s physicians will close them.

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How the next generation of doctors is learning to treat transgender people

What happens after you’re sexually assaulted on a plane? Not much.

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Airline travel is stressful under even the best circumstances. But for too many passengers, it’s the source of something more traumatic than long lines and a lack of legroom. This year, the Federal Bureau of Investigation has opened 58 investigations into in-flight sexual assault allegations on commercial aircraft. But these investigations still don’t address the problematic reality that no centralized system exists for reporting sexual assaults on flights, or even collecting and publishing data tied to these events.

That’s why, on Monday, Senators Patty Murray (D-WA) and Bob Casey (D-PA) sent a letter to the Department of Justice and Federal Aviation Administration to address the urgent need for standards, training, and protocol when it comes to addressing, reporting, and preventing sexual assault on flights. Twenty-one other Senate Democrats also lent their signatures to the letter.

Over the past month, many Americans were forced to think about the dynamics of sexual assault mid-flight for the first time, after a 74-year-old woman named Jessica Leeds told The New York Times that Republican presidential nominee Donald Trump grabbed her breasts and attempted to put his hand up her skirt when the two were seated next to one another on a flight in the early 1980s.

But stories like Leeds’ aren’t a relic from the past—they’re a troubling reality facing airline passengers today, and one made more challenging by the fact that airline employees are not adequately trained to identify, assist with, or report inflight sexual assaults, according to Murray and Casey. This summer, three such stories made headlines and The New York Times reported earlier this month that Federal Bureau of Investigation investigations into in-flight sexual assaults have increased by 45 percent this past year alone. This increase does not account for the overwhelming number of sexual assaults that, historically, remain unreported, regardless of location or circumstance.

Meanwhile, when these incidents do occur, passengers receive scant formal support. Not only is there no centralized system for collecting reports of sexual assaults on flights, but there is no government agency responsible for tracking this data or creating regulations for how to best handle it. There is no body that administers any kind of specialized training to flight attendants, pilots, and other crewmembers for how best to respond to sexual assaults they witness or have reported to them. Presently, all reporting is essentially left up to the discretion of the crew; if a passenger notifies a flight attendant of an assault mid-flight, the crew have the option of asking police to meet a flight once it’s landed on the ground, reporting allegations of assault to the Federal Aviation Administration—or doing nothing at all.

Even when assaults are reported to the Federal Aviation Administration, they are simply classified as mid-flight disturbances, without any special categorization given to cases involving sexual violence.

This lack of any kind of formalized system has real effects on passengers who have survived in-flight assaults—like one of Senator Murray’s constituents, who contacted the lawmaker’s office to report having experienced such an ordeal. The letter to the Federal Aviation Administration and Department of Justice details this woman’s story, explaining that after she reported being sexually assaulted on a long-distance flight, this woman was “provided a new seat for several hours, [before] she was ultimately asked by the flight attendants to return to her original seat next to her attacker for landing. When she refused, they seated another male passenger next to him, offering airline miles for his inconvenience.”

The letter continues, “Like many Americans, this passenger is often on long distance flights for work. Concerned with the response to her sexual assault, and under the impression that a report had been filed with the relevant authorities, she followed up with the airline. She was shocked to learn no report was filed.”

Which is where the letter sent by Senators Murray, Casey, and their Democratic colleagues comes into play.

Though Rep. Eleanor Holmes Norton (D-Washington, D.C.) tried to pass passenger protection legislation back in 2014, her bill—which sought to ensure that the Federal Aviation Administration be required to collect and publish data on sexual assault—failed to make it out of committee for a vote, despite having garnered bipartisan support.

In the letter sent Monday, Murray, Casey and their colleagues request that the Federal Aviation Administration and the Department of Justice work across the federal government and industry to convene stakeholders and establish a working group with the relevant federal agencies (including airline employee unions, the airlines themselves, law enforcement, and sexual assault advocacy organizations); collect data to understand the prevalence of sexual assault aboard commercial aircraft; and identify, collect and develop federal rules, guidelines, and best practices for responding to sexual assault aboard commercial aircraft, including guidance on timely reporting.

The letter notes that current federal laws clearly illustrate that any attack that would be classified as criminal sexual abuse on the ground should be likewise classified “when committed in the special aircraft jurisdiction of the United States.” And, the letter adds, “the Federal Aviation Administration … is tasked with carrying out duties related to aviation safety, including sexual assault.” The Senators write that they find the lack of training for flight attendants and crewmembers on how to handle sexual assault “troubling and unacceptable.”

“All passengers should be able to travel without the worry of being sexually assaulted,” the letter reads. “We must support those with authority, like flight attendants, crewmembers, and pilots, to ensure that an incident of sexual assault is halted, prevent a repeated attack, support and help the survivor, and ensure the event is documented and reported to the proper authorities.”

Airline workers agree. “This is a unique crime and needs to be reported differently than an unruly passenger. Once we recognize the problem, we can work to stop or prevent these crimes from occurring onboard,” says Taylor Garland, a spokesperson for the Association of Flight Attendants-CWA, a labor union that represents 50,000 flight attendants at 18 airlines.

Garland added that the union supports establishing the type of cross-agency working group Murray and Casey propose “to identify the issues and gaps, and develop solutions to support survivors of sexual assault.”

With the bill that grants the Federal Aviation Administration its legal authority set to expire in September 2017, discussions on how to reform it are anticipated to happen over the next year—a perfect opportunity to consider legislation that would better manage sexual assault in the skies.

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What happens after you’re sexually assaulted on a plane? Not much.

Someday, these bloody period emoji will be real

Annelies Hofmeyr

Canadian conceptual artist Annelies Hofmeyr is on a bloody mission.

In early 2015, Hofmeyr posted an eight-second video on Instagram in which she danced around in leopard print leggings that were artfully styled to recreate what we’ll call, for the sake of brevity, an external free bleed. Instagram, however, said the video was in violation of its Community Guidelines—because #thepatriarchy.

'Period Pants' was only ever supposed to be a one-off social media project but since Instagram removed my 'Period Pants In Action' video I've decided to make it a monthly project and I'm calling it #theperiodproject. I'll be posting a 'Period Piece' of adornment every month, mid-cycle. Read about the motivation and purpose here: bit.ly/1cThb1r

A photo posted by Annelies Hofmeyr (@wit_myt) on May 13, 2015 at 8:47am PDT

So Hofmeyr decided to hit back with “The Period Project,” through which she now shares a period-related piece of some kind every month on her social media accounts. Highlights of #ThePeriodProject include everything from My Little Ponies made from tampons to a necklace featuring a uterus constructed out of nails.

Uterus necklace made from tampon cotton and nails, sterling silver chain for #ThePeriodProject. Read about the project at bit.ly/1cThb1r

A photo posted by Annelies Hofmeyr (@wit_myt) on Feb 13, 2016 at 9:32am PST

But my personal favorite? Her proposed period emoji, which seek to clearly and directly show your flow like it is: Included in the suggested emoji set are pads ranging from fresh-out-of-the-package to spotted to dripping with menses, as well as a tampon, a menstrual cup, and an anatomically correct uterus and ovaries.

https://www.instagram.com/p/BCVUGDvHH0t/?taken-by=wit_myt

I’d love to see Hofmeyr’s emoji brought to life, since they seem to be nothing short of revolutionary, especially after the sorta controversial attempt at #femoji from the U.K.-based menstrual product company Bodyform earlier this year. One major problem with the Bodyform #femoji? The way they perpetuated weird gender stereotypes and went full-out in implying that women are pretty crazy looking when they’re on their periods.

Bodyform

Which is why Hofmeyr’s emoji are such a breath of fresh air, creating a clear-cut visual shorthand that show exactly what periods are and entail, without the subjective projections of emotion or retro gender norms suggesting periods make women crazy. Periods, Hofmeyr’s emoji show, are simply a biological function, and how you choose to physically manage your own period blood is up to you: Pads, tampons, cups, free-bleeding—it’s all good.

Gearing up for that glorious time of the month where my body pretty much spells out my uterus situation #ThePeriodProject

A photo posted by Annelies Hofmeyr (@wit_myt) on Mar 8, 2016 at 6:13am PST

Hofmeyr recently channeled her period activism into a second, newly launched campaign called Trophy Wife Barbie. The Instagram-based project has already gained more than 14,000 followers, as Hofmeyr depicts this plastic symbol of conventional femininity snarling her way through urinary tract infections, wearing dresses made from panty liners alongside her friends (‘cause, duh, their cycles are synched), and taking selfies with euphemisms for menstruation. (Oh, and she also breastfeeds, has feathery pink pubic and armpit hair, and has to deal the injustice of unsolicited dick pics, too.)

This is what having a UTI feels like Can I get an amen? #UrinaryTractInfection #TrophyWifeBarbie #shitjustgotreal

A photo posted by Trophy Wife Barbie (@trophywifebarbie) on Oct 12, 2016 at 9:34am PDT

When your period is synced with your friends #TrophyWifeBarbie #McClintockEffect

A photo posted by Trophy Wife Barbie (@trophywifebarbie) on Sep 25, 2016 at 7:06am PDT

Getting ready to surf the Crimson Wave #TrophyWifeBarbie #PeriodEuphemism #

A photo posted by Trophy Wife Barbie (@trophywifebarbie) on Jul 30, 2016 at 7:36am PDT

So please, Annelies Hofmeyr, if you can hear me: Keep making your art, keep talking about periods, and keep showing that women’s bodies can exist in the absence of heteronormative male sexuality—and please bring your emoji to our digital universe. Because we’re here, we bleed, get over it.

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Someday, these bloody period emoji will be real

Here are some of the weirdest menstrual myths from around the world

Whether it’s being told they can’t be sushi chefs or blaming their periods for bread not rising, women all over the globe have to deal with some pretty strange misconceptions about their menstrual cycles.

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Here are some of the weirdest menstrual myths from around the world

Meredith ‘I’m a Bitch’ Brooks wants you to know she loathes Hillary Clinton

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Where were you the first time you heard the song “Bitch” by Meredith Brooks? Maybe you were in the car or at the mall or heard it on TRL from your MASH crush Carson Daly. Wherever you were, you were probably at least a little stunned to hear the b-word on top forty radio. I’m a bitch, I’m a lover / I’m a child, I’m a mother / I’m a sinner, I’m a saint / I do not feel ashamed, Brooks defiantly proclaims. The song was a paean to outspokenness and unapologetically being oneself in the face of a world that saw you as “just a girl.” And it became an instant anthem for unconventional women who refused to keep it to themselves.

So imagine my surprise when I recently came across Brooks’ Twitter feed and discovered the following incredibly un-bitch friendly message:

No I don't like him but I really #hate #HilaryClinton #Remember #Bengazi https://t.co/hl3kP9hZA5

— MeredithBrooks (@MeredithBrooks) October 20, 2016

No, the now 58-year-old feminist icon is not a fan of OG bitch Hillary Clinton—the woman who has had to withstand and reclaim the label again and again and again throughout her political career.

Are you for real, Meredith?

Unlike many of us, Brooks hasn’t been an avid tweeter throughout this political year. Save for one tweet in June—in which she wrote, “As a free woman it’s hard to support #HilaryClinton who takes millions from a country demonstrating horrific treatment of women #SaudiArabia”—she stayed silent on politics, instead devoting her feed to animal rights activism and protecting dogs from breeder hoarders.

As a free woman it's hard to support #HilaryClinton who takes millions from a country demonstrating horrific treatment of women #SaudiArabia

— MeredithBrooks (@MeredithBrooks) June 16, 2016

But on October 17th, two days before the third and final presidential debate, Brooks retweeted Paul Joseph Watson, editor-at-large of the extreme right wing website InfoWars, who shared a salacious link about Clinton supposedly calling a black “servant” the “n-word.” This retweet was a harbinger of things to come.

The next day, Brooks retweeted Watson again, and the following day—debate day—she issued multiple tweets and retweets revealing her distaste for Clinton, her lack of respect for Democrats, and some conservative views on abortion. Perhaps most shocking was her assertion that Clinton “emasculates Trump every time she opens her mouth.” Sort of like a bitch would do?

#Hilary emasculates #trump every time she opens her mouth #rude #nasty little #digs you think she acts better than #Trump? #hypocrite

— MeredithBrooks (@MeredithBrooks) October 20, 2016

While Brooks assures her followers she’s not a Trump supporter, she’s fervent about her hatred for Clinton. Despite the fact that accusations of sexual assault by Trump continue to roll in from her fellow women, the Oregon-native has remained silent on the issue, instead attacking the way Clinton smiles. (Bish.)

Maybe #Trump should smile #smuggly #weirdly #arrogantly #entitled #rude every time #Hilary lies He would never have a straight face

— MeredithBrooks (@MeredithBrooks) October 20, 2016

Could this really be the same woman who declared, 19 years ago, I’m your hell, I’m your dream, I’m nothing in between? Why the lack of support for a fellow “nasty woman”? I reached out to Brooks in hopes of learning more, but I had not heard back at the time of publication.

Brooks came of age musically during the punk rock feminist Riot grrrl movement of the late ‘80s/early ‘90s. While she herself was not a punk musician, she embodied that same spirit of being brazenly female, coming up around the same time as greats like Alanis Morissette, Paula Cole, Liz Phair, and the other performers in the early days of the woman-focused Lilith Fair music festival (which just so happened to be my first concert.) It was what Allison Yarrow, journalist and author of the upcoming book 90s B*tch, called the “commoditization of feminism.” Sort of like a proto-Beyonce.

Yarrow also pointed out that just as these strong women were topping the charts, women like Janet Reno, Marcia Clark, Anita Hill, and yes, Hillary Clinton, were front and center in the zeitgeist. They were the poster women for intelligence and strength, while at the same time, as Yarrow put it, being “bitchified” by the media. In other words, there was a bitch double standard. We loved them in crop tops on MTV, but we hated them in a pantsuit.

“Bitch” felt like a decidedly feminist song: It explored the complexity of women. It wasn’t exactly in opposition to the myth of the crazy emotional woman, but worked as a nice supplement. The song explained in simple, relatable terms how, yes, sometimes a woman may be a bitch—but it should not define her. Yarrow explained in a phone conversation how the word bitch, since its inception, was meant to “derogate, deride, and malign women on the basis of sex.” And how this song was a chance to reclaim it.

In a 1997 interview with MTV News, Brooks explained the song’s origin:

[My friend and co-writer] called me up one morning. She was in her car and she said, ‘Oh, God! I’ve just been such a bitch this morning and can’t believe my boyfriend didn’t kick me out of the house.’ And I was like, you know, this is what I had just been going through in my life saying that’s a part of us that we all have to accept.

From Yarrow’s perspective, the song “speaks to the challenges women face of having to be diverse identities. At the time, it was tapping into something real.”

The interesting part is that, according to her tweets, Brooks still sees herself as a feminist. After Trump issues his famous “nasty woman” jab during one of Clinton’s third debate responses, Brooks issued this curious tweet:

Because she is !!! I am a woman a feminist and want a woman in the White House BUT NOT #HilaryClinton https://t.co/S35CcRiMUM

— MeredithBrooks (@MeredithBrooks) October 20, 2016

Unfortunately, she has not responded to the many voters who have dubbed Clinton a “bitch.”

Perhaps the real truth is that “Bitch” was never the feminist anthem we made it out to be. In an A.V. Club post from 2010 entitled “A soundproofed room of one’s own: 17 well-intended yet misguided feminist anthems,” the authors wrote of Brooks’ song, “Brooks attempts to lay out the many aspects of her (and, by extension, women’s) identity, only to make herself sound like a totally self-involved flake: “Rest assured that when I start to make you nervous and I’m going to extremes / Tomorrow I will change, and today won’t mean a thing.” A dismissive fratboy couldn’t have put it better himself if he’d just said, “Someone’s on the rag!”

Nearly two decades later, the song still feels somewhat electric. And there’s definitely something empowering about screaming “BITCH!!!” at the top of your lungs, letting a sliver of your inner-rage seep out. While it’s impossible to know exactly why Brooks would “#hate” Clinton without speaking to the singer, or understand her ill-informed views on abortion, perhaps Brooks’ tweets are just an extension of the “Bitch” message of being loud, proud, and unapologetic about your views—no matter how contradictory they may be. We know we wouldn’t love her any other way. (Except for if she loved Hillary.)

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Meredith ‘I’m a Bitch’ Brooks wants you to know she loathes Hillary Clinton

Is sex ed in schools obsolete?

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Thea Eigo is the exact kind of teen who could have benefited from comprehensive, evidence-based sex education at her Phoenix high school. In the months leading up to the class, the 16-year-old was questioning her sexuality. She was curious about hooking up with both girls and boys. And she was desperate for information. But when she finally found herself sitting in a sex ed classroom, the teacher not only failed to accurately educate her about her sexual health—she made her feel ashamed for being interested in sex at all.

“The teacher used scare tactics and showed us the worst possible case scenarios for STIs, and then didn’t tell us how to prevent any of them. The young people in my class felt like we didn’t get the education we deserved,” said Eigo, who now identifies as bisexual. Worse, “it wasn’t LGBT inclusive whatsoever. One person asked, ‘If two girls are having sex, how do they protect themselves?’ And [the teacher] said, ‘Oh, I can’t answer that,’ and moved on.”

Unfortunately, Eigo’s experience is common in this country. Twenty years after public schools first started receiving federal funding for abstinence-only instruction, sex ed tends to be a hit or miss experience. In the right state, in right school, with the right teacher, it can be transformative, providing young people with the tools they need to make healthy decisions about sex and relationships. But in many cases, the experience falls short. Too often, sex ed curricula are fear-based, they fail to provide contraception instruction, and they’re largely heteronormative—not to mention void of any mention of sexual pleasure.

Against this backdrop, a growing number of online sex ed resources have popped up, providing frank, accurate information and going places most school-based sex ed classes wouldn’t touch with a ten-inch dildo. The latest and perhaps most inventive yet is AMAZE, an online library of short, funny sex education videos geared toward teaching middle schoolers about puberty, gender identity, sexual orientation, and healthy relationships. Launched last month, AMAZE is produced in partnership with the advocacy and educational groups Youth + Tech + Health, Advocates for Youth, and Answer. The site strives to be engaging, non-judgmental, and supportive of young people of all gender identities and sexual orientations.

Scrolling through the videos, which touch on topics from breast development to erections to the complexities of gender identity, it’s immediately clear that AMAZE is something incredibly different from most school-based sex education classes. And it’s tempting to argue that what AMAZE offers young people is vastly superior to the dated VHS videos about puberty screened by many sex ed teachers as they awkwardly mumble through a lecture on nocturnal emissions.

As I attended a launch party for AMAZE, where an enthusiastic audience watched screenings of the videos and listened to a panel of educators discuss the challenges of providing smart sex ed in a school environment, I couldn’t help but wonder: Are online platforms like this one the future of sex education in this country? And if so, will they one day replace school-based sex education altogether?

To many people, the idea of learning about sex on the internet means one thing, and one thing only: porn. Yet thoughtful, honest sex education has lived online for about as long as raunchy sex entertainment has—in some cases even forming a symbiotic relationship with its naughtier counterpart.

In the early 1990s, Youth + Tech + Health founder Deb Levine was working at Alice!, Columbia University’s student health education program. Feeling unsatisfied with the attendance at the workshops she was leading, she started to wonder if there might be a better way to connect with students and get them the answers they needed to the questions they were afraid to ask. And so, with a little assistance from the Columbia IT department, Go Ask Alice!—a pioneering site where students could anonymously submit questions about any manner of health topics—was born. Initially only available to the Columbia community, Go Ask Alice! made its way onto the internet in 1994, becoming the first major health Q&A website in the process. Though the site’s always covered a variety of health topics—including nutrition, stress reduction, drugs and alcohol, and other topics related to wellness—much of its popularity has stemmed from its frank approach to questions about sex (an attitude that greatly impacted me when I worked at Alice! as a work-study student at the turn of the century, inspiring me to pursue a career in sex education).

http://www.goaskalice.columbia.edu/

Columbia University's Go Ask Alice! was the first major online sex ed resource.

A few years after Go Ask Alice! hit the world wide web, kindergarten teacher Heather Corinna launched Scarlet Letters, an adult-oriented erotica project that wound up attracting a number of sex advice questions from teens. Unsure where to send young people for thoughtful answers, Corinna started tackling the questions herself, eventually launching Scarleteen, a respected sex education site that’s still going strong several decades later, with Corinna running the project full-time (which has enabled her to expand Scarleteen to Twitter, Tumblr, Facebook, and even offline in book form). Fittingly for a sex education site borne from an erotica project, Scarleteen derived much of its early traffic from porn sites: In the days when every adult site had a splash page requiring users to confirm they were 18+ before entering, Scarleteen was the site many XXX sites directed minors to if they didn’t make the cut.

http://www.scarleteen.com/

Scarleteen paved the way for sites like AMAZE.

Over the decades, a number of other projects have joined the ranks of Go Ask Alice! and Scarleteen: There’s Sex, Etc, a by-teens-for-teens magazine and website put out by Rutgers, and Answer, a 35-year-old New Jersey-based organization dedicated to providing sex education resources to young people (and one of the founders of AMAZE). Planned Parenthood has built out its website to include an extensive educational section. Apps like Sex Positive and JuiceBox promise fun, bite-sized sex education for the swipe left generation. And, of course, there’s AMAZE, which is primarily distinguished by its focus on middle school age students, a group largely ignored by online sex education resources.

http://sexetc.org/

Sex, Etc. is created by teens, for teens.

Online sex education comes with a number of obvious benefits. For starters, sex education websites are able to take on any topics they choose, a freedom rarely afforded to school-based sex education, which are often hampered by restrictions placed by school boards, PTAs, and public funding. During the latter half of the 1990s, and through the Bush years, many programs were required to promote abstinence-only education, presenting young people with a limited view of sexuality that stressed dangers and risks, shamed anyone engaging in sexual activity, and refused to discuss methods of harm reduction outside of not having any sex at all.

http://answer.rutgers.edu/

Answer is one of the founders of AMAZE.

Even as the Obama Administration has made a push toward comprehensive sex education, and cut funding for abstinence-only education, the taboos around talking about sex still affect what information gets shared in schools. “Controversial” topics like queer sexuality, trans and non-binary identities, and even something as basic as the pleasurable aspects of sex are often left out of school sex education; what information gets shared, and how, exactly, it’s communicated, is entirely up to whatever teacher happens to have been assigned to sex education that year.

Because online sex education can reach millions of young people with just one dedicated core team, there’s no need to worry that its curriculum might get warped or changed by educators who aren’t quite comfortable with some of the included messages.

Deb Hauser, who spent seven years working as a sex educator in the Atlantic City public school system—helping New Jersey middle and high school students navigate the transition to adulthood and learn the basics of healthy, respectful relationships—now serves as president of Advocates For Youth, one of the founders of AMAZE. In a recent phone conversation she told me about Rights, Respect, and Responsibility, a K-12 sex education curriculum produced by the organization that meets national standards for sex education, is fully inclusive of LGBT youth, and, best of all, is free for schools to download and use. Yet even with this free curriculum, Hauser notes that “there will still be places where they will drop the condom demonstration, or they will decide not to talk about gender equity, or role model gender equity, because they think it’s either not important or too controversial, or they just don’t have time”—or, potentially, because the teachers assigned to the curriculum just aren’t particularly comfortable engaging their students in honest, open conversations about sex.

At the launch for AMAZE, the team proudly screened its video on gender identity, which discussed terms like cisgender, transgender, and gender non-conforming and encouraged viewers to embrace whatever identity feels most comfortable; a similar video on sexual orientation is currently live on the site. Other upcoming videos declare that masturbation is perfectly normal and tackle the topic of deciding when to have sex, messages that are all the more impressive when you remember that the target audience for AMAZE is 9-to-14 year-olds.

Scarleteen, which targets an older age group, is able to take things even further. The site’s pleasure-focused guide to sexual anatomy includes the anus and prostate gland as well as the genitals—and the site does not shy away from tricky topics like abuse and assault, abortion, or even (gasp!) orgasm. Teens coming to Scarleteen never get told they’re too young to ask a question, or that they’re not ready for an answer to a question about sex: If there’s something a teenager wants to know about sex, Scarleteen is there to offer a shame-free, thoughtful answer—and to provide ongoing community and support through message boards, live chat, and even text messaging.

But for all benefits of online sex education, in some important ways, it falls short. Most notably, there’s the issue of access: While school-based sex education literally meets kids where they are, online sex education requires young people to actively seek it out—and to be able to differentiate trustworthy sources from the vast swath of questionable information that also exists online.

Pointing to a 2011 report on youth sexual health and digital behavior released by Youth + Tech + Health, Levine notes that “The vast majority of [respondents] did not know about all of the internet sex ed sites… We love Scarleteen, it is the banner of online sex education, and these kids did not know about it. They thought Planned Parenthood online was a place where you went when you were going to be a baby daddy. They did not know where to turn when they had one of those really difficult questions.”

While Corinna maintains that Scarleteen’s reach is impressive, citing five million visitors annually (and that’s with limited funding and no advertising), she agrees that access is a huge stumbling block for online sex ed. Even young people who know about sites like Scarleteen and AMAZE aren’t necessarily able to get to them: Online sex education requires internet access, and if you don’t have a computer or a smartphone, you’re pretty much out of luck. (And sometimes you’re out of luck even with a computer or smartphone: Corinna notes that, likely due to its willingness to acknowledge pleasure, Scarleteen is blocked by a number of porn filtering platforms, making it that much harder for teens relying on free, public internet to get access to the site.)

And that may be why none of the experts I spoke with seemed quite ready to throw in the towel on school-based sex education, advocating instead for a combination of online and school-based efforts. “Sometimes you need somebody to look you in the face and say, ‘That’s completely normal, you’re really fine,’” says Hauser. “I would hate to give up that personal interaction” that’s often only accessible through in school sex education.

In Hauser’s view, online and school-based sex education programs can work in concert, with schools providing “positive, supportive messages that say sex and sexuality are not something outside yourself, they’re actually something inside of you—and they’re natural, normal, and healthy.” Even if schools don’t get into the nitty gritty of what tabs go into which slots and how to achieve the best possible orgasm, they can still play an important role in teaching young people to love their bodies, accept themselves as normal, and show respect for the desires, safety, and well being of everyone around them—messaging that puts people on the path toward having healthy, happy, and fulfilling sex lives.

But Hauser recognizes that getting to that point is going to take continued effort, not just from schools and online resources, but from everyone. “What we’re asking the schools to do is not going to work unless we also concurrently are shifting the culture,” she says, noting that many schools shy away from positive, honest messaging around sexuality out of a fear of creating controversy or backlash. “In my ideal world we would have a culture that embraces sex and sexuality as normal and healthy, and helps young people to learn the information and skills that they need … prior to hitting these sexual development milestones, so that they’re prepared and they feel comfortable and that they can embrace sense of sexuality in a way that brings them pleasure and happiness as opposed to fear, shame, and denial.”

Hauser’s vision of the future of sex education isn’t that different from what Corinna would like to see. “I want [sex ed] everywhere,” she tells me, describing a world where, instead of separate sex education classes, sexuality is holistically integrated into other school subjects: reproduction and contraception in science class, discussion of healthy relationships mediated through talks about literature, historical views of sexuality included in the social studies curriculum. It’s a compelling view of an alternative take on sex ed in schools—and if we ever achieve it, we’ll likely have the pioneers of online sex education to thank.

link to source

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Is sex ed in schools obsolete?

How I learned to orgasm after sex reassignment surgery

Elena Scotti/FUSION

My vagina came with an instruction manual.

At least that’s what I called the papers my surgeon gave me before I was discharged from the hospital. Those documents told me how to care for the scars next to my labia so that they would fade over time. They told me when to see a gynecologist and how often to get a pap smear. They even specified how long I would have to wait to use a hot tub again—12 weeks, if you’re wondering.

But one thing they didn’t teach me was how to have an orgasm. I had to figure that out on my own.

After my sex reassignment surgery two-and-a-half years ago, my doctor ensured I could locate the essentials: clitoris, urethra, and vagina. Beyond that, though, her main advice for sexual gratification was to “be inventive and open-minded,” as if I were about to finger paint or go on a study abroad trip. I wanted details. You don’t give a novice baker a pantry full of ingredients and tell them to be creative; you say precisely how much flour and butter to use.

But there’s no one recipe for orgasm. And learning how to climax after your genitals have been reconfigured is a lot more complicated than baking a cake.

People who are transphobic spread three major myths about transgender women who have had sex reassignment surgery. The first is that our bodies have been “mutilated.” The second is that we regret what we did. The third is that we can’t come.

All of them are false. Scientific research proves it and so does my personal experience.

For a long time, I didn’t want to tell my own story. But it’s difficult to debunk those transphobic fictions without veering into personal and potentially uncomfortable territory. As Vogue columnist Karley Sciortino recently observed, there is a “lack of conversation around sex for women who have had sex reassignment surgery,” partly because those of us in the transgender community usually have to “steer the focus away from ‘the surgery’” when interviewers get fixated on our genitals.

“Is it time for a nuanced discussion about sex and pleasure for trans women?” Sciortino asked.

That conversation is already happening away from prying eyes. But even though transgender people are not obligated to clear up public misconceptions about their private parts, I volunteer as tribute. Those three myths have been around too long.

Before I can continue my story I have to bust the first one: Sex reassignment surgery is not “mutilation.” The American Medical Association wouldn’t support it if it were.

Instead of “mutilation,” picture the surgery I underwent as time travel for my genitals. My surgeon, sex reassignment pioneer Dr. Marci Bowers, puts it this way: “As everyone has female genitalia early in gestation, the goal of the procedure is to reverse the current anatomy to its earlier configuration.”

Contrary to popular belief, there is not some vast unbridgeable gulf between the sexes. As a committee of the National Academy of Medicine explained in a 2001 volume, we all “begin development from the same starting point,” regardless of chromosomes. In fact, until our eighth week in the womb, our external genitalia “have the capacity to differentiate in either direction.” The clitoris and the penis come from the same tissue, as do the labia and the scrotum. The vaginal orifice that everyone has in the womb can become a full-on vagina or it can close.

What that means is there’s plenty of genital tissue and space between our legs for everyone to have a vagina if they want one. And thanks to my gender dysphoria—a persistent feeling of distress at the mismatch between my gender and some parts of my body—I didn’t just want one. I needed one.

I will spare you the nitty-gritty of how Dr. Bowers met that need but the short version is that she constructed my clitoris out of the most sensitive tissue I had, using the remaining skin to form my labia and vagina. Once you understand the science, the process makes sense.

It was not grotesque for my body to be rearranged in a way that could have developed on its own. It was not butchery for my clitoris to be made out of something that was going to be a clitoris in the first place. It was a logical way to fix a long-ago mistake.

My first attempts at orgasming after surgery were like the black-and-white scenes in an infomercial—comically clumsy and ultimately unsuccessful attempts to get the job done.

I would start touching myself but then I’d have to pee. I would fumble around for a few minutes before being interrupted by thoughts of work or memories of mortifying things that happened to me in high school and I would lose the thread entirely. Sex felt great but it was even harder to concentrate on an end goal with another person in the room.

“I have to have the focus of an Olympic hopeful on a balance beam,” Amy Schumer once joked about her own attempts to hit the Big O. “And I get distracted.”

For me, life itself became the chief distraction. I got lost in the daily rhythms of my demanding journalism job, only making time to visit my nether regions every few weeks, then every few months. The more time passed, the more certain I became that I would never come again, even though Dr. Bowers says that “orgasm should be an expectation of each and every patient.”’ To be fair, she also warns her patients that it could take “up to one year” to learn the ropes. And what devilishly complicated ropes they are!

Orgasming before surgery—and especially before I started taking estrogen, which changes how your genitals function—was not a challenge. To put it bluntly, if you can polish a candlestick, you’re all set. Having to navigate a vagina was like being plucked out of preschool and placed in a quantum physics course overnight. Add in an unhealthy dose of anxious thoughts, and finishing seemed next to impossible.

I was out of my depth. I got discouraged. And I gave up.

I could have easily blamed my surgery for my inability to orgasm. But statistically speaking, chances were my vagina was not the problem—it was my head that was getting in the way.

One 2005 study of 55 Dutch transgender people who had undergone sex reassignment surgery between 1986 and 2001 found that all of the transgender men and 85% of the transgender women were able to orgasm through some form of sexual activity. Another larger study found that 82.4% of transgender women could climax after surgery. Surgical techniques are only improving and other studies have reported higher rates of orgasm.

Given my situation, too, I should have been able to come: Like the transgender women in the Dutch study, I had “excellent sensitivity.” But stimulation alone was not enough.

That’s when I discovered a reassuring word: anorgasmia, or the inability to orgasm. At my most pessimistic, that term made me feel less alone. The percentage of cisgender women who experience some form of anorgasmia is not that much lower than the percentage of transgender women who have reported being anorgasmic after surgery across several studies.

Back in the 1950s, famed sex researcher Alfred Kinsey reported that 10% of women said they had never orgasmed, a stat Ball State sociologist Justin Lehmiller notes on his Sex and Psychology blog. More recent data paint a similar if slightly less discouraging picture. One 1997 British study found that just 7% of a small sample of women was “completely anorgasmic,” but 20% had “situational anorgasmia,” meaning that they could only orgasm under specific circumstances.

Frankly, it’s a miracle those numbers aren’t higher given how many obstacles women face on the way to the big finish. As sex researchers Ellen Laan and Alessandra Rellini observed in a 2011 journal article on anorgasmia, “a number of psychosocial factors” can “interfere with women’s capacity for orgasm”—including sexual inexperience, childhood trauma, inadequate stimulation, and “fear of losing control.”

But the good news, as Laan and Rellini note, is that many forms of anorgasmia can be treated with therapy, “directed masturbation,” and good old-fashioned vibrator use. For most women, not being able to come is a problem that can be overcome—even if you’re pretty new at the whole “having a vagina” thing.

I was stunned when it happened. It had been two years since the surgery.

At home alone one day during my lunch hour, an old fantasy crossed my mind and practically tugged me into the bedroom. Out came the vibrator along with some erotica. I had no goal in mind. I didn’t expect to reach climax. I was simply following a stray impulse wherever it led, like a dog chasing a car or a Seeker following the Snitch in a game of Quidditch.

Not thinking about orgasming actually made it easier to get close. The same principle behind watched pots never boiling apparently applies to my vulva, too. Or as sex coach Xanet Pailet once told Cosmo, the “best way to have an orgasm is not to care about having an orgasm.”

In the end, that tactic worked for me. First, there was a tingling sensation in my head. Then, a familiar funny feeling behind my knees. My chest flushed. This. Is. Happening, I thought.

A long time ago—before my surgery—I was cast in a production of theVagina Monologues that included a trans-inclusive addition Eve Ensler wrote in 2004. “My vagina is so much friendlier,” I had said on stage, vagina-less at the time, but in character as a transgender woman who had already undergone surgery. “It brings me joy,” the monologue continued. “The orgasms come in waves.”

It felt hypothetical—aspirational even—to say those words back then. But on that afternoon two years after my surgery, I finally realized what Eve Ensler meant by “waves.”

The transgender women in that 2005 Dutch study reported that they had “more intense, smoother, and longer orgasm[s]” after surgery, while transgender men said theirs were “more powerful and shorter” after getting a penis.

I know now what both varieties feel like, and I prefer the first.

Before surgery, orgasming felt sudden, almost disturbingly so, like cliff-diving into the ocean. (“Jerky,” is how the Vagina Monologues puts it.) Now, an orgasm feels like a current that carries me away from the coast until my toes can no longer touch the bottom. Slowly, almost without noticing, I realize that I am floating in a warm sea.

Now, when I want to orgasm, I have a routine that borders on superstition.

I close all the doors and curtains in the house as if I can lock my anxious thoughts in another room. I set the thermostat to 75 degrees, and like Amy Schumer said, “If the temperature changes, I’m like, ‘I lost it. I lost it.’” And I always use the lucky vibrator my partner bought for me as a post-surgery present. (The toymaker, Je Joue, calls it “Mimi,” but we call it a “cookie egg” because it’s the same shape and color as an Easter egg candy.)

Using that method, I have been able to orgasm almost every time.

The most remarkable thing about my story is how unremarkable it is. Millions of women have trouble orgasming. I’m just one of them.

But as lawmakers in North Carolina and elsewhere attempt to turn bathrooms into borders between cisgender and transgender women, it has never been more vital to build bridges between our experiences. Womanhood is not defined by genitalia nor is orgasm its crowning achievement. But while not all transgender women have vaginas, those of us who do should be able to join feminist discourse around them, if only to say, “Me, too.”

More people should know that many transgender women, like many cisgender women, love their vaginas and think they are beautiful. In his most recent stand-up special, the comedian Patton Oswalt did a routine where he pretended to be an ignorant but good-hearted ally who thought transgender women’s vaginas looked like “a Boris Karloff horror movie.” It’s a common notion that surgically reconstructed genitalia are ugly, but nothing could be further from the truth. Only 3.2% of transgender women in a 2014 study said they were “dissatisfied” with the aesthetic results of their surgery.

(I think my vagina is beautiful, too—so beautiful that Dr. Bowers asked if she could put a picture of it on her results website. I declined. There’s enough of me on the internet already.)

More people should realize that both transgender and cisgender women can find orgasm challenging. Nearly 19% of transgender women in one sample said they can orgasm “rarely easily” after surgery. Compare that to the almost 21% of cisgender women in a 1993 study who said they also “had difficulty at least half of the time,” and it’s clear that women with vaginas face similar barriers to orgasm regardless of the gender they were assigned at birth.

Most importantly, though, people should acknowledge that transgender women—with or without vaginas—are having sex and getting off, just like cisgender women. That completely mundane fact should not be buried beneath mountains of stereotypes. Movies and television shows, as GLAAD notes, tend to depict transgender women as either sexual predators or as taboo sex objects for male characters. Anti-LGBT politicians and pundits paint us as perverts. They all refuse to accept the reality that transgender women can and do have happy sex lives. We do things with our genitals, after all, besides go to the bathroom.

So if you came to this story expecting a sensational tale defined by my difference, I hope you didn’t find it. My experience is not unique. But that’s precisely why I wanted to share it.

Even if I had been anorgasmic for life, I still would not have regretted my decision to have surgery. Many women like me appear to feel the same way. A 2003 study of 232 transgender women with vaginas found that 97% felt sex reassignment surgery had “improved the quality of their lives.” Better still: “No participants regretted SRS outright, and only 6% were even occasionally regretful.”

Orgasm is not the be-all and end-all of bedroom activities. I had a satisfying sex life without it. And the tragic truth is that the pain of gender dysphoria often cuts far deeper than the pleasure of orgasm can reach. If I had to to give up orgasming to get rid of dysphoria, I would make that choice every time.

As it turns out, I didn’t have to take that deal. I baked my cake and ate it too. What I needed was not an instruction manual but the same things so many other women require: time and healing.

That’s how I got to my happy ending—literally.

link to source

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How I learned to orgasm after sex reassignment surgery