Men’s sexual health: are the supplements safe?

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January 18th, 2016

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Over-the-counter dietary supplements and therapies sold to improve male sexual health may be ineffective and even unsafe, says a report published in the Journal of Sexual Medicine.

men-s-sexual-health

Around 40-70% of men experience sexual dysfunction at some time.

To avoid paying for prescription drugs, or the embarrassment of discussing such matters with their physicians, many turn to over-the-counter (OTC) products.

Sales of dietary supplements doubled in the US from 1999-2007, and around 50% of Americans use them for a variety of conditions.

The dazzling array of products, from horny goat weed to ginseng, costs from $0.83 to $5.77 per day. But lack of regulation on dosage, purity or ingredients, and limited information regarding health effects confuses patients and medical practitioners alike.

Researchers from Wake Forest Baptist Medical Center in Winston-Salem, NC, reviewed the scientific evidence for the effectiveness and safety of the most common ingredients in top-selling men’s health products.

They wanted to provide urologists with a guide for counseling patients who present with sexual health problems and who are taking such supplements.

Prescription ingredients sold OTC

There was no scientific evidence to support claims that many products positively impact erectile function, libido and sexual performance, and some were likely to be unsafe.

Some products advertised as “natural” contain traces of phosphodiesterase-5-inhibitors (PDE5Is), the same class of medication that includes prescription drugs such as Viagra, which is used to treat erectile dysfunction. PDE5Is cannot be legally sold over the counter in the US, because using them without a physician’s supervision could be risky.

Patients with advanced heart disease or who take nitrates, such as nitroglycerin, should not use PDE5Is, as it may cause an unsafe drop in blood pressure.

PDE5Is should also be avoided by men with severe liver impairment or end-stage kidney disease. Those with enlarged prostates who take medications such as Flomax (tamsulosin), terazosin or doxazosin should only take it with supervision, as interactions may cause dizziness, leading to falls and fractures.

In one study, 81% of OTC products purchased in the US and Asia contained PDE5Is.

Pros and cons of popular ingredients

The findings on some of the best-selling products can be summarized as follows:

  • DHEA is a hormone naturally made by the human body and produced in laboratories from chemicals found in wild yam and soy. While findings do not suggest a benefit, it appears to be relatively safe, as the impact on hormone levels is not significant
  • Fenugreek features in 1 in 3 top-selling men’s health supplements. It may improve sexual arousal and orgasm, muscle strength, energy and well-being. There was no evidence of adverse effects
  • Ginkgo biloba is taken for numerous conditions, but data does not support its use in erectile dysfunction. It can cause headache, seizures and significant bleeding, especially if taken alongside Coumadin
  • Ginseng is the most common ingredient in top-selling men’s health supplements; it can cause headache, upset stomach,constipation, rash and insomnia. It can also lower blood sugar, risky in cases of diabetes
  • Horny Goat Weed is generally safe with rare reports of toxicity leading to fast heart rate and hypomania; it has no apparent benefit for sexual function
  • L-arginine is the top amino acid in men’s health supplements, featuring in 1 in 3 best sellers. It may improve erectile function in some patients and seems relatively safe. It has been associated with a drop in blood pressure but without significantly changing the heart rate
  • Maca is the most common vegetable among top-selling men’s health supplements. Maca has been associated with increased sexual behavior in animals but not in humans. Rare cases of toxicity and a mild increase in liver enzymes and blood pressure have been reported.

Tribulus promises to treat a range of conditions, but evidence is lacking to prove its effectiveness; two young men suffered liver and kidney toxicity after taking high doses. Yohimbine is a well-established product that may improve male sexual function, but it can also cause hypertension, headache, agitation, insomnia and sweating. Zinc appears to be safe but not beneficial.

Let’s talk about sex

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January 18th, 2016

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A parent would rather feed their child the birds and bees story when it comes to discussing this issue. Gordon Ochieng, Youth Programme Manager at Family Health Option Kenya, explains why they do not mince words

Briefly tell us about Family Health Options Kenya (FHOK)?

FHOK is a local non-governmental organisation that provides Sexual and Reproductive Health Services through clinics and community projects that actively involve beneficiaries. It has a presence in 14 counties, with strong grassroots network.

What motivated the organisation to start youth centres?

We started youth centres after realising most young people don’t visit hospital for check-up because they fear their parents. With the ever increasing sexual and reproductive health problems such as sexually transmitted infections, HIV/Aids, unsafe abortions, high infant mortality rate, escalating adolescent problems and an increasing population, we realised that there is need for a place where youth can gather and learn about their sexual reproductive health in a youth-friendly setting. Our youth centres are located in Nairobi, Mombasa, Eldoret, Nakuru, Meru, Bondo and Kisumu.

If a young person visits the centre today, what kind of services would they get?

In our centres, we offer youth-friendly services such as clinic services, VCT and general counselling, vocational training, capacity building, library, knowledge, informational services and recreational activities.

How many people have benefited from your youth programme?

More than 500,000 youths have benefited from our projects. We hope to reach a bigger number in the next five years through our outreach activities.

What is the criteria for one to join your youth programme?

There is no criteria. Every youth is welcome to our centres and it’s free to access our services. Sex education is a thorny issue here in Kenya.

Why did you choose to go down this path?

The issue of sex education has become an exceptionally controversial one. Our curriculum teaches knowledge, behaviour, attitudes and skills that promote committed family relationships, healthy l relationships, good character and good reproductive health.

Sex education seeks to assist children in understanding a positive view of sexuality, provide them with the skills about taking care of their sexual health and help them to acquire skills to make decisions now and in the future.

One of your initiatives is the Youth Sexuality Education (YES) project. What is its impact?

There has been decrease of pregnancies in schools where this project has been implemented. Further, health service providers have indicated that young people were reporting fewer incidences of sexually transmitted infections.

 

Reorienting adolescent sexual and reproductive health research: reflections from an international conference.

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January 18th, 2016

Abstract

On December 4th 2014, the International Centre for Reproductive Health (ICRH) at Ghent University organized an international conference on adolescent sexual and reproductive health (ASRH) and well-being. This viewpoint highlights two key messages of the conference – 1) ASRH promotion is broadening on different levels and 2) this broadening has important implications for research and interventions – that can guide this research field into the next decade. Adolescent sexuality has long been equated with risk and danger. However, throughout the presentations, it became clear that ASRH and related promotion efforts are broadening on different levels: from risk to well-being, from targeted and individual to comprehensive and structural, from knowledge transfer to innovative tools. However, indicators to measure adolescent sexuality that should accompany this broadening trend, are lacking. While public health related indicators (HIV/STIs, pregnancies) and their behavioral proxies (e.g. condom use, number of partners) are well developed and documented, there is a lack of consensus on indicators for the broader construct of adolescent sexuality, including sexual well-being and aspects of positive sexuality. Furthermore, the debate during the conference clearly indicated that experimental designs may not be the only appropriate study design to measure effectiveness of comprehensive, context-specific and long-term ASRH programmes, and that alternatives need to be identified and applied. Presenters at the conference clearly expressed the need to develop validated tools to measure different sub-constructs of adolescent sexuality and environmental factors. There was a plea to combine (quasi-)experimental effectiveness studies with evaluations of the development and implementation of ASRH promotion initiatives.

Author information

  • 1International Centre for Reproductive Health, Ghent University, Ghent, Belgium. Kristien.Michielsen@UGent.be.
  • 2International Centre for Reproductive Health, Ghent University, Ghent, Belgium. SaraA.DeMeyer@UGent.be.
  • 3International Centre for Reproductive Health, Ghent University, Ghent, Belgium. Olena.ivanova@ugent.be.
  • 4Guttmacher Institute, New York, USA. randerson@guttmacher.org.
  • 5International Centre for Reproductive Health, Ghent University, Ghent, Belgium. Peter.Decat@UGent.be.
  • 6Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium. Peter.Decat@UGent.be.
  • 7Butterfly Works, Amsterdam, The Netherlands. celine@butterflyworks.org.
  • 8African Population and Health Research Center, Nairobi, Kenya. ckabiru@aphrc.org.
  • 9Radboud University, Nijmegen, The Netherlands. e.ketting@tip.nl.
  • 10University of the Western Cape, Cape Town, South Africa. jlees@uwc.ac.za.
  • 11Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. cmoreau2@jhu.edu.
  • 12Hunter College and The Graduate Center, CUNY, New York, USA. deborah.tolman@gmail.com.
  • 13Rutgers & Utrecht University, Utrecht, The Netherlands. i.vanwesenbeeck@rutgers.nl.
  • 14University of Cuenca, Cuenca, Ecuador. bernardo.vegac@ucuenca.edu.ec.
  • 15Sensoa, Antwerp, Belgium. Lies.Verhetsel@sensoa.be.
  • 16Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. chandramouliv@who.int.

Do we need more than two genders?

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January 14th, 2016

A growing number of people refuse to be put into male or female categories, either because they do not identify as male or female, or because they are going through transition to the opposite gender.

Germany, Australia, Nepal and Pakistan now offer a third gender option on official forms with other countries set to follow suit. And scientists are finding more evidence to suggest that even biological sex is a spectrum.

Do we need to re-imagine our binary world and rethink one of the most basic parts of our identity?

Four experts talk to the BBC World Service Inquiry programme.


Brin Bixby: Gender is a cultural construction

Brin Bixby was brought up as a boy, and went on to get married and father children before coming out as bigender. She set up Bigender.net, which reflects the view that gender is a spectrum.

“In college I wore a dress on Halloween, and it was supposed to be a joke, and the people helping me thought it was going to be hyper-real, exaggerated. [But] I didn’t want to be a drag queen, I wanted to be a woman, and I think it took people by surprise.

“It was the first time I looked in the mirror and saw myself. People interacted with me as a woman: they saw me the way I wanted them to.

“I would be most comfortable if I didn’t have to think about my gender, but unfortunately that’s not how it works for me and a lot of other non-binary people.

“We have a cultural understanding of what gender is and looks like, and in the west we have a very binary view of it. My sense of gender as a part of my identity shifts.

“I present as a woman everywhere I go, except for at work and at my children’s school, because it gets very exhausting to have to explain gender fluidity to everyone I meet.

“Ideally we would not make gender such a huge focus of our culture, which would give people the freedom to inhabit their gender in ways that feels most comfortable to them.

“What we’re seeing now is a relaxation of the sense of binary amongst younger people and internet-savvy people who are inhabiting much more fluid spaces.”


Mark Gevisser: Accept the gender continuum

Writer Mark Gevisser explores gender identities across different cultures.

“We know there’s a gender continuum, because there have always been effeminate boys and masculine girls. Transgender is certainly not a western phenomenon. In many cultures all over the world there are traditionally third gender or gender-fluid identities.

Telangana Hijra Intersex Transgender Samiti (THITS) activists in Hyderabad

“There are the Hijras in India, what are known as two-spirited people in Native American culture, Muxe in Mexico, and the Bakla in the Philippines. The space these people have occupied has receded with the spread of the Judeo-Christian ethic and western culture, but they’re still very much there.

“There’s a tendency in the west to idealise these. But the truth is that if you’re Bakla or two-spirited, there are only certain things in your culture you can do. In India, the Hijras are basically cast out of society, only good for begging and sex work. So it’s not necessarily a great life.

“I was talking to a remarkable gender therapist named Diane [Erinsaft] and I suddenly started worrying that if she’d been around when I was a little boy, I might have been turned into a little girl. She laughed and said ‘No, you’re definitely a guy’.

“But we started talking about the potential risk of the transgender movement establishing new binaries where, if you have a girly boy, and you’re worried about how effeminate this child is, you could very easily solve the problem by taking the child to the doctor and the doctor can wave a wand and say ‘Your girly boy is now a princess’.

“Wouldn’t it be better if we had a society that just raised children so that it was okay to be a tomboyish girl, or a girly boy, and to explore that?

“Diane speaks about ‘gender smoothies’; she got this from one of her patients who said ‘I’m not a girl or a boy, I’m a gender smoothie, I mix it all up together’.”


Dr Imran Mushtaq: Doctors increasingly recognise complexity of defining sex

Dr Imran Mushtaq is a consultant paediatric urologist who works with children with differences in sex development (DDS) at Great Ormond Street Hospital in London. Around 1 in 1500 babies are born with DDS but up to 1 in 100 people have less obvious differences.

“Absolutely sex is a spectrum. It’s not binary in any way and we are slowly coming to understand this.

“As a specialist working in this area for the last 12 years, I’ve seen us transitioning so much in the way we think about sex and the way we treat children in whom the sex is not clear, and we are increasingly becoming aware how complex the issue is.

“How do you define what sex a child is? Is it the physical characteristics, the genitalia – do they have testicles, do they have ovaries or do they have both? Is it their chromosomes, is it their hormones?

“You can have a child whose chromosomes are XX, typical of what you’d associate with being female, yet their genitalia looks like a boy.

“Ten or 20 years ago when children were born with these kind of problems, there was very little discussion about not doing surgery. It was almost a given that the child would need surgery to make it a boy or a girl.

“As a doctor and surgeon, I’m increasingly uncomfortable about undertaking what is irreversible surgery.

“We know that the outcomes of surgeries that were undertaken 10, 20 years ago are not necessarily as good as we would like them to be. Now is the next stage: in 10 or 20 years’ time we will find out the outcome of not doing the surgery or maintaining these children in a certain sex, whereas previously they would have been changed to a different sex.

“I don’t think we should have gender categories. I don’t think that sex should be on birth certificates, I don’t think sex should be on driving licences and I don’t think sex should be on passports.

“We are just what we are. We have a name, we have a date of birth, give us a number.”http://www.bbc.com/news/health-35242180

 

Bisexuality on the rise, says new U.S. survey

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January 14th, 2016

By Carina Storrs, Special to CNN

A growing number of women and men say they are bisexual, according to the latest national survey by the Centers for Disease Control and Prevention.

As awareness about bisexuality has grown over the years, it could be getting easier for people to label themselves as bisexual, said Debby Herbenick, associate professor at Indiana University and author of the book “Sex Made Easy,” who was not involved in the study.

Researchers asked more than 9,000 people in the United States age 18 to 44 about the types of sexual experiences they have had, whether they are attracted to the same or opposite sex and whether they identify as being straight, gay/lesbian or bisexual. Interviews were conducted between 2011 and 2013 as part of the CDC’s National Survey of Family Growth.

Many of the findings about sexual behavior, attraction and orientation were similar between the current survey and the previous (2006-2010) family growth survey. Similar to previous surveys the group conducted, 1.3% of women and 1.9% of men said they were homosexual.

However a few trends stood out. More women reported having had sexual contact with other women: 17.4% in the current survey compared with 14.2% in the 2006-2010 survey. And higher numbers of both women and men identified as bisexual, 5.5% of women and 2% of men, compared with 3.9% and 1.2% respectively in the last survey.

“It’s certainly not a new idea that women and men may be attracted to more than gender,” Herbenick said. “But that doesn’t mean it’s an easy orientation to adopt. Women and men who self-identify as bisexual experience stigma not just from heterosexuals but also homosexuals,” she said.

The finding that women were more likely than men to say they were bisexual is consistent with what previous studies have found, said Casey E. Copen, demographer at the CDC National Center for Health Statistics and lead author of the study, which was published on Thursday.

Women were also more likely than men to report having same-sex sexual contact. Compared with 17.4% of women, only 6.2% of men said they had ever had this activity.

However, as Copen noted, the survey could have given women more opportunity than men to report same-sex sexual contact. For example, women were asked if they have engaged in oral sex or any other sexual experience with another woman, whereas men were asked specifically whether they have engaged in oral or anal sex with another man.

The wording of questions in the survey could also be part of the reason for the low number of men who said they were gay, Copen said. Other surveys have found that closer to 4% to 6% say they are gay, a higher proportion than the 1.9% in the current survey.

Among women who reported being lesbian, the rate of 1.3% is consistent with other surveys. Over the last several decades, fewer women have been saying they are lesbian and more report being bisexual, similar to what the current study found, Herbenick said.

There is high correspondence between how survey participants identified themselves — whether straight, gay/lesbian or bisexual — and the sexual attractions and behaviors they reported, Copen said. For example, among those who labeled themselves heterosexual, 12.6% of women and 2.8% of men had had sexual contact with the same sex.

“You do expect some differences, because for some people … they may or may not have had the experiences they’re contemplating, [especially] if they’re younger,” Copen said.

The survey found some differences between women of different racial groups. Only 11.2% of Hispanic women have engaged in same-sex sexual contact compared with 19.6% of white women and 19.4% of black women.

The next survey, covering 2014 and 2015, will be coming out this fall, Copen said. These surveys are important to allow researchers “to separate out and study these categories, like lesbian and bisexual women and gay and bisexual men, because they all have different health outcomes and different levels of access to health care,” she said.

Understanding trends in sexual behavior and orientation can help health groups and programs reach at-risk populations, Herbenick said. For example, putting information about sexually transmitted infections in a gay bar may only reach men who identify as being gay, and miss men who have sex with men but do not identify as being gay.

“There are real effects when you find out what people are doing sexually that can translate into safer sex, sex education, (and) informing doctors and nurses (about) what people are doing so they can talk with them in more informed and compassionate ways,” Herbenick said.