— How gender shapes the double standard

By Radhya Comar

Already-chewed gum, tape that has lost its stickiness and an unwrapped lollipop are not just random remnants of an office dustbin but a collection of metaphors. These metaphors compare women who have been sexually active before marriage to objects that have lost their purpose—essentially, trash. This striking comparison highlights the harsh reality of gender norms surrounding sexual activity. Such metaphors have often been used to discourage women from engaging in premarital sex to preserve their virginity.

Of course, not all figures of speech take such a reductive view of women’s bodies. In the opening scene of the acclaimed TV show Jane the Virgin, a young Jane holds a white rose. Her grandmother instructs her to crumple the flower and then try to restore it, using the wrinkled petals as a warning that she can “never go back” once her virginity is lost. Although roses generally symbolize beauty and femininity, this ritual still reduces women to mere objects and frames sex as inherently destructive.

This notion is one that many women carry into adulthood. Virginity is often seen as a valuable asset, while sex is perceived as something that diminishes that value. This belief can prevent women from exploring their sexuality and can limit access to comprehensive sexual education. Topics such as consent, STDs and contraception are less likely to be discussed when sex is regarded as inherently taboo. When a woman’s sexual status is considered integral to her worth, there may also be pressure to prove one’s virginity—an impossible task given that, biologically, virginity does not exist.

Many mistakenly believe that virginity is linked to the hymen, a thin tissue at the opening of the vagina. This misconception stems from the widespread idea that a woman’s first experience of penetration results in the hymen breaking and bleeding, serving as a sort of “virginity test.” However, for many, the hymen can break without any noticeable symptoms. A 2004 study of sexually active young women concluded that there were “no identifiable changes to the hymenal tissue” in 52 per cent of participants. Despite this, the myth persists, and women around the world may feel pressured to prove their so-called purity.

Although men face no equivalent virginity test, purity culture still influences their sexual identity. It is not only women who grow up with the idea that sex affects their value as human beings. When men internalize such beliefs, they may find themselves reducing both their own and others’ worth to sexual history. This attitude can affect even those who do not engage in sexual activities; numerous men admit to feeling shame and anxiety over not having had sex.

Even though virginity is now widely recognized as a social construct, the idea still impacts many individuals today. For women, purity culture often pressures them to preserve their virginity. For men, the dynamics of hookup culture can push them in the opposite direction. The push and pull between these two can have disastrous consequences. While a man may be ridiculed for inexperience, a woman may feel shunned for promiscuity. Both circumstances feed into purity culture, hindering individuals from seeking the support they require. In other words, it can prevent both men and women from asking questions about safe sex and consent. Moreover, the concept of virginity can force individuals to focus on the aftermath rather than the experience itself. These stigmas that can be carried over time, eventually turning into generational cycles which condemn sexuality as a whole.

Navigating the concept of virginity can be just as tricky as navigating relationships or sexuality itself. However, it reflects our relationship with ourselves—our thoughts, feelings, desires, and ultimately, our choices.

Complete Article ↪HERE↩!

— For Men

By Charles Runels, MD

During the month of September, Sexual Health Awareness Month, it may help to notice something: Men and their doctors have significantly more options to help with sexual function than do women and their clinicians. Moreover, the education of physicians regarding the examination and treatment of women for sexual dysfunction has been and remains, even now in 2024, much less thorough than for men.

Not convinced? Let’s take a quick tour.

The New Sexual Revolution and the Growing Anger

photo of Newsweek 50 Shade edition

Around the time of the release of the book and movie 50 Shades of Grey, Newsweek put the cultural sensation on its cover.

I bought the magazine at the airport and, while waiting for my plane, showed the story to a woman sitting next to me. “What do you think — is this the new ‘sexual revolution’?” I asked her.

She glanced at the cover and answered as accurately as if she had written the article: “In the ’60s, it became okay for women to have sex; now, it’s okay for women to demand good sex.”

I would add to that: Women are demanding good sex, and they want to define for themselves what “good” means.

That social revolution rages, still.

You would think that the demand would bring a corresponding response in clinical medicine. You would be wrong. Although efforts in some sectors are heroic, overall, the results are lagging the forward movement of women wanting better sex.

The Lag in Sexual Education

To examine the progression of the education of physicians regarding the treatment of female sexual dysfunction (FSD), Codispoti and colleagues examined the curricula of seven medical schools in and around Chicago. They found the following: Only one institution identified all anatomic components of the clitoris — one! Four of the seven discussed the physiology of the female orgasm. Only three of the seven highlighted the prevalence and epidemiology of FSD or the treatments for FSD. Only one of the seven explained how to do a genitourinary physical exam specific to assessing FSD.

When assessing obstetrics and gynecology clinical materials, sexual pleasure, arousal, and libido were not included anywhere in the curricula.

I have been teaching physicians about the therapies I developed (over 5000 clinicians in 50-plus countries over the past 14 years). During those sessions, I often stop the class and ask, “Who in here was taught how to retract the foreskin and examine the penis for phimosis?”

All hands will go up.

Then I will ask, “Who in here was taught in medical school how to retract the clitoral hood and examine the clitoris for phimosis?”

Not once has anyone raised a hand.

The Sex Remedies Gap

When I first published research offering support for using platelet-rich plasma to improve sexual function in women, women had not one drug approved by the US Food and Drug Administration (FDA) for the treatment of sexual dysfunction — none. Men had over 20. Today, men have a growing number of FDA-approved drugs for erectile dysfunction, including the “fils“; women have three.

Women have access to only one FDA-approved medication that primarily affects the genitalia: prasterone. This drug is indicated only for the treatment of pain in postmenopausal women. It does not directly enhance desire or improve orgasms. Said another way, although the incidence of sexual dysfunction is higher in premenopausal women than in other groups, they do not have a single approved medication designed to improve the function of their genitalia.

The other two of the three available drugs — flibanserin and bremelanotide — primarily affect the brain and could accurately be called psychoactive agents. They are available only for premenopausal women to improve desire. Flibanserin resulted in one extra sexual encounter per month on average, and patients are advised to avoid alcohol while using the drug. The other can make you vomit.

I do think all three of these treatments can be of great help to some women. I am not advising their disappearance. But in contrast to what is available to men, they are woefully inadequate.

Historical Perspective

In 1980, the medical establishment believed “most instances of acquired impotence are psychogenic.” Then, with the accidental discovery of the benefits of phosphodiesterase type 5 inhibitors , we realized that most cases of male sexual dysfunction involve the vasculature of the genitalia, not the neuroses of the brain. Yet, our two FDA-approved drugs for women with sexual dysfunction are designed to affect the brain. Women have nothing but off-label therapies to improve the function of the genitalia.

Despite the fact research supports the use of testosterone in women for both libido and orgasm, and despite the fact millions of women are treated with testosterone off-label for the benefit of sexual function, the only widely used FDA-approved class of drugs for women that affects testosterone — birth control pills, by blocking pituitary hormone production (the way they prevent pregnancy) — lowers the production of testosterone.

One might wonder, considering our expanded understanding of the endocrinology of both men and women, at the irony of why it is acceptable to lower the testosterone level of an adolescent girl knowingly, as if her development did not require the hormone (such would never be acceptable in an adolescent male unless sexual transitioning were the goal); yet, we are fearful of giving testosterone to grown women who can no longer make it.

Premenopausal Women: An Orphan Population

The concept of “orphan populations” can partially explain the gap in available therapies between men and women.

Women of childbearing age are risky to study; so, with testosterone, for example, it is safer and cheaper for pharmaceutical companies to prove the benefits for men and ride the profits from the off-label use for women. I don’t mean to condemn the manufacturers of testosterone, only to point out the phenomenon of why up to 30% of the prescriptions written by a primary care physician are off-label; off-label use is common among cardiologists (46%); up to 90% of children in the hospital receive at least one off-label drug; and approval of drugs for premenopausal women is more expensive than approval of drugs for men.

What Can Be Done?

The regrettable situation does not reflect evil intent on the part of regulators, educators, or physicians. But the gap between what women want and what medical education and the pharmaceutical-regulatory complex are providing is intolerably wide.

First, I would recommend a standard, required curriculum for the study of female sexual anatomy and function be established and widely adopted by medical schools. The reproductive system contains different components and a different purpose from the orgasm system, with modest overlap. Both systems should be taught in every medical school.

Second, physicians should be required to undergo a course in understanding their own sexuality. Research demonstrates doctors will avoid conversations about sex, and it seems to me this could be secondary to being uncomfortable with their own sexuality. After all, to talk with a patient about sex, you cannot be fearful of where the conversation may lead.

Third, the FDA might reconsider the requirements for the approval of drugs for FSD. Currently, to approve a drug for men, an objective finding — ie, an erection — can be sufficient. However, a higher bar, “satisfaction,” which is subjective, must be obtained with women.

Regenerative therapies have proved helpful but are not yet widely adopted; more grant money for the study of regenerative therapies would be a good start here.

Finally, by the definition of FSD, a woman must be psychologically distressed. The idea of sex is not pleasure alone. Sexual function affects family relationships, emotional health, confidence, even sleep, as well as the emotional well-being of the children who live in the house. Saying women are wonderfully and mysteriously made may be poetic, but it is not an excuse for not learning more and closing the gaps.

Complete Article ↪HERE↩!