Category: Meditation

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Medicating women’s sexual desire still highly controversial

00Featured news, Integrative Medicine, Low Sexual Desire, Meditation, Mental Health, Psychopharmacology, Sex November, 17

Source: Minjung Gang at flickr, Creative Commons

On August 18, 2015, the U.S. Food and Drug Administration (FDA) approved Flibanserin, a drug that treats low sexual desire in women.

With the medication’s presence on the market, you’d think that low sexual desire in women would be well understood. In fact, there is still widespread debate on the issue. Marta Meana, a psychologist at the University of Nevada, writes:

“Desire is the most subjective and acutely amorphous component of sexuality.”

And Lori A. Brotto, a Professor of Gynecology at the University of British Columbia, offers a similar view, explaining:

“There is no clear consensus on the causes of sexual dysfunction in women.”

While women experience obstacles to fulfillment, the causes are complex. According to Brotto:

“An abundance of data indicates that low sexual desire is strongly influenced by a woman’s relationship satisfaction, mood, self-esteem, and body image.”

Medication is, at best, a partial treatment for problems with desire.

There are also differing perspectives on proper terminology around the issue. In an interview with the Trauma and Mental Health Report, Kristen Mark, Director of the Sexual Health Promotion Lab at the University of Kentucky, said:

“Sexual dysfunction may not be the most accurate way to describe low sexual desire. Women may experience sexual problems, but sexual desire ebbs and flows, so people should expect that it will fluctuate.”

Deciding between the word “dysfunction” or “problem” may seem trivial. But language creates meaning, and shapes how health professionals treat clients and conduct research.

Other clinicians agree. Leonore Tiefer, Associate Professor at the New York University School of Medicine, offers two metaphors for sex. The first is digestion. In this metaphor, sex is “just there”. Like digestion, it does not require learning, but is a natural or innate action that the body is equipped for at birth.

The other metaphor is dance. There are many ways to dance. Some people are better at dancing, and some people like dancing more than others. Tiefer argues that sex, like dance, is a learned skill.

Tiefer has advocated extensively against pharmaceutical interventions for female sexual problems. In 2000, she convened The New View Campaign, a collective of clinicians and social scientists dedicated to reframing the conversation around sexuality.

In a 2006 article on disease mongering, Tiefer explains why a purely biological approach to sexual health is inadequate:

“A long history of social and political control of sexual expression created reservoirs of shame and ignorance that make it difficult for many people to understand sexual satisfaction or cope with sexual problems.”

To emphasize that sex has a social context, the New View wrote an alternative system of classification for sexual problems. The first category is “sexual problems due to socio-cultural, political, or economic factors”, and the second is, “problems relating to partner and relationship”.

These categories includes specific causative factors, such as “ignorance and anxiety due to inadequate sex education, lack of access to health services, or other social constraints.”

According to Tiefer:

“Popular culture has greatly inflated public expectations about sexual function. People are fed a myth that sex is “natural”—that is, a matter of automatic and unlearned biological function—at the same time as they expect high levels of performance and enduring pleasure, they are likely to look for simple solutions.”

The drug Flibanserin is one of these ‘simple solutions’. Its approval has been met with controversy.

According to Loes Jaspers and colleagues at Erasmus University Medical Center, the effectiveness of Flibanserin is very low. In a meta-analysis examining the effect of the medication in about 6000 women, Jaspers found that those receiving the drug experienced, on average, only 0.5 more “sexually satisfying” events per month compared to those receiving a placebo.

At the same time, it carries a black label, which the FDA assigns to drugs that include serious side effects. For Flibanserin, these include sedation and fatigue. When combined with alcohol and other common drugs, it can cause dangerously low blood pressure and fainting.

And non-medical treatments, such as mindfulness-based sex therapy, can be effective for treating low sexual desire. According to Brotto, mindfulness shifts attention away from negative, self-defeating thoughts, and towards sensation and pleasure.

Mark, however, thinks that hope should not be abandoned for a medical solution. She says:

“At this point, I would not recommend Flibanserin for most women coping with desire problems. There may be a medication in the future that meets women’s needs when used in conjunction with other approaches, but this just isn’t it.”

Whether women’s sexual problems should be medically treated is still debatable. But what is clear is that social and cultural factors shaping women’s sexual experiences should not be bypassed for a quick solution.

–Rebecca Abavi, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Medicating Women's Sexual Desire Still Highly Controversial

00Featured news, Integrative Medicine, Low Sexual Desire, Meditation, Mental Health, Psychopharmacology, Sex November, 17

Source: Minjung Gang at Flickr/Creative Commons

On August 18, 2015, the U.S. Food and Drug Administration (FDA) approved Flibanserin, a drug used to treat low sexual desire in women.

With the medication’s presence on the market, you’d think that low sexual desire in women would be well understood. In fact, there is still widespread debate on the issue. Marta Meana, a psychologist at the University of Nevada, writes: “Desire is the most subjective and acutely amorphous component of sexuality.”

And Lori A. Brotto, a Professor of Gynecology at the University of British Columbia, has offered a similar view: “There is no clear consensus on the causes of sexual dysfunction in women.”

While women experience obstacles to fulfillment, the causes are complex. According to Brotto, “An abundance of data indicates that low sexual desire is strongly influenced by a woman’s relationship satisfaction, mood, self-esteem, and body image.”

Medication is, at best, a partial treatment for problems with desire.

There are also differing perspectives on proper terminology. “Sexual dysfunction may not be the most accurate way to describe low sexual desire,” says Kristen Mark, Director of the Sexual Health Promotion Lab at the University of Kentucky. “Women may experience sexual problems, but sexual desire ebbs and flows, so people should expect that it will fluctuate.”

Deciding between the terms “dysfunction” or “low desire” may seem trivial. But language creates meaning and shapes how health professionals treat clients and conduct research.

Other clinicians agree. Leonore Tiefer at the New York University School of Medicine offers two metaphors for sex. The first is digestion. In this metaphor, sex is “just there.” Like digestion, it does not require learning but is a natural or innate action that the body is equipped for at birth.

The other metaphor is dance. There are many ways to dance. Some people are better at dancing, and some people like dancing more than others. Tiefer argues that sex, like dance, is a learned skill.

Tiefer has advocated extensively against pharmaceutical interventions for female sexual problems. In 2000, she convened The New View Campaign, a collective of clinicians and social scientists dedicated to reframing the conversation around sexuality.

To emphasize that sex has a social context, the New View wrote an alternative system of classification for sexual problems. The first category is “sexual problems due to socio-cultural, political, or economic factors,” and the second is “problems relating to partner and relationship.”

These categories include specific causative factors, such as “ignorance and anxiety due to inadequate sex education, lack of access to health services, or other social constraints.”

According to Tiefer: 

“Popular culture has greatly inflated public expectations about sexual function. People fed a myth that sex is “natural”—that is, a matter of automatic and unlearned biological function—at the same time as they expect high levels of performance and enduring pleasure, they are likely to look for simple solutions.”

The drug Flibanserin is one of these “simple solutions.” Its approval has been met with controversy.

According to Loes Jaspers and colleagues at Erasmus University Medical Center, the effectiveness of Flibanserin is very low. In a meta-analysis examining the effect of the medication in about 6,000 women, Jaspers found that those receiving the drug experienced, on average, only 0.5 more “sexually satisfying” events per month compared to those receiving a placebo.

At the same time, it carries a black label, which the FDA assigns to drugs that include serious side effects. For Flibanserin, these include sedation and fatigue. When combined with alcohol and other common drugs, it can cause dangerously low blood pressure and fainting.

And non-medical treatments, such as mindfulness-based sex therapy, can be effective for treating low sexual desire. According to Brotto, mindfulness shifts attention away from negative, self-defeating thoughts, and towards sensation and pleasure.

Mark, however, thinks that hope should not be abandoned for a medical solution.

“At this point, I would not recommend Flibanserin for most women coping with desire problems,” she says. “There may be a medication in the future that meets women’s needs when used in conjunction with other approaches, but this just isn’t it.”

Whether women’s sexual problems should be medically treated is still debatable. But what is clear is that social and cultural factors shaping women’s sexual experiences should not be bypassed for a quick solution.

–Rebecca Abavi, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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No Place to Be a Child

00Anxiety, Child Development, Cognition, Depression, Education, Empathy, Environment, Featured news, Grief, Meditation, Mental Health, Resilience, Social Life, Stress, Trauma, Trauma Psychotherapy, Treatment October, 14

“If we are to teach real peace in this world, and if we are to carry on a real war against war, we shall have to begin with the children” – Mahatma Gandhi

Over 18 million children are currently living in regions affected by war. While most humanitarian aid groups focus on meeting the basic physical needs of these children, in the midst of armed conflict, cognitive, social and emotional development is often inhibited and overshadowed by regional chaos.

Exposed to violent, traumatic and stressful situations that threaten their sense of stability and well-being, children have few places to simply be children, where they can play, learn and socialize safely. And few resources are in place to help them heal from the psychological burdens of war.

As the need for rehabilitative and restorative measures gains greater recognition by the international community, a growing number of child rights advocates, organizations and researchers are stepping forward to understand the implementation of psychologically therapeutic programs for war-affected children. The challenge is in figuring out what is needed, what is available and what will work across a variety of cultures, contexts and settings.

Seeking to bring psychological care on a tight budget, academics and policy advisors have emphasized evidence-based programs. Theresa Betancourt, professor and director of the research program on children and global adversity at Harvard’s school of public health, and her colleagues are evaluating the effectiveness of child trauma programs based in countries such as Uganda, Sierra Leone, Chechnya, Gaza, Sudan, Kosovo, Bosnia and Croatia.

Individual therapeutic interventions such as trauma focused therapy and narrative exposure therapy have shown promise among children affected by war and are approved by UNICEF as preferred techniques.

Group interventions have been used to accommodate the psycho-social needs of a greater number of children. These include Interpersonal group therapy for depression, creative play, mother-child psycho-education and support, and torture group psychotherapy with cognitive behavioural techniques.

Some other psycho-social initiatives have focused on the creation of Child Friendly Spaces (CFS’s) and Temporary Learning Centers (TLC’s) within refugee camp settings or local communities. These provide a child-centered environment for play, basic education and socialization; and they identify children in psychological distress.

But some concerns have been noted. The focus on trauma can lead to community stigmatization. In addition, these therapies are hard to carry out on a large scale due to the high costs of employing highly-trained professionals. Individualized services are rare and reserved for severely distressed children, usually demobilized child soldiers.

Problems arise when trying to apply western definitions and measures of distress that are not necessarily applicable to other cultures and contexts. And in understanding any given child’s psychological functioning, it is important to factor in ongoing stressful events and the social dynamics that a war-affected child must deal with on a daily basis.

There has been a movement away from a traditional western “clinical treatment” model toward a more inclusive, holistic framework of “psycho-social intervention,” termed to reflect the complex interplay between a child’s psychological and social development.

More effective group interventions for children have tended to be those that involve a school setting, address everyday stressors, utilize a form of trauma/grief-focused psychotherapy or use mind-body relaxation and coping techniques such as meditation, biofeedback and guided imagery.

Benefits include decreases in posttraumatic stress disorder, improved coping skills, and greater psychological relief and psycho-social adjustment.

Still, universal, comprehensive, culturally-sensitive psychological services for war-affected children remain a long way off. For more information on mobile psycho-social and education programs for war-affected children, please check out The Freedom to Thrive Foundation. Email FreedomToThriveFoundation@gmail.com to find out how you can get involved.

– Contributing Writer: Adriana Wilson, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today