Let’s get tobacco smoking out of the closet!

Tobacco smoking is the LGBTQ Community’s biggest health burden.  In 1964 the US Surgeon General issued the first report on smoking and health – a landmark report thathealth began a process of heightened awareness and action, about the health consequences of smoking tobacco.  But it was not until 2001 that the annual report mentioned LGB smoking disparities, and in 2014 the report finally clearly delineated what many LGBTQ researchers and health care professionals already knew — that smoking disproportionally affects all LGBT communities.The American Lung Association has also recognized the urgent health risks of smoking for LGBT people, identifying the LGBT community as a priority population for tobacco control.

In addition, we now know that there are many intersecting identities that add to the burden of stress for LGBT people and families, multiplying the health risks associated with smoking. Within our own community, youth, people of color, and people who are economically disadvantaged have a much higher rate of smoking and smoking-related health problems. As a community, we spend more on tobacco every year than is spent on programs to benefit LGBTQ people and famlies.  The smoking rate in the LGBT population is 68% higher than the rest of the population.  So it is time for all us – smokers and non-smokers alike, to speak out and reach out to raise awareness and participate in positive action.

Here is a typical story:

My smoking history is closely tied to my coming out as a lesbian – I smoked for about 10 years, off and on, during the early years of my lesbian life.  I cannot tell you which of these experiences was supposedly more closeted for most of those years – being a lesbian or smoking!  Some part of me felt that both were bad and struggled to come to terms with both, not ever realizing how closely related the two actually were although of course only one of them was “bad!”  Eventually, I began to realize that my sexual orientation was a part of me that I valued, I began to connect with a group of lesbian friends who were out and proud, and finally managed to stop smoking!

This story holds a key to understanding how we can all address this issue — we can live out and proud, and support those around us who may be ready to take the really difficult steps to stop smoking!  There are effective programs for smoking cessation, but they are sadly underused.  In the San Francisco Bay area, “The Last Drag” program offers free smoking cessation course 4 times a year .. the next session starts on April 1!  If you can’t find a local LGBT-focused cessation program, the American Lung Association offers help for all!  If you know of something that might help other LavenderHealth readers, share your comments and ideas here!  We welcome any and all suggestions!

smokinglgbt

Click image to download this Infographic from LGBT Healthlink!

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Marriage Equality is a Health Issue!

In recent years, many health profession organizations have issued policy statements in support of marriage equality, including the American Academy of Nursing, the American gay-marriagePsychiatric Association, the American Medical Association, the American Academy of Pediatrics, and the American Psychological Association.  Their support for marriage equality has been a response to growing social acceptance of same-sex marriage, but also has been a major factor in affirming the fact that committed relationships, and including the legal/social recognition of these relationships in the form of marriage, has important health benefits.

I for one have always had misgivings about the institution of marriage as we know it, primarily because of the fact that it is grounded in heteronormativity that perpetrate gender roles and gender stereotypes, and because of the close ties to religious views and beliefs that have not been kind to LGBTQ people.  But despite these drawbacks, the fact remains that many LGBTQ people have sustained committed relationships for years, even decades, and have benefited from many of the health-related benefits that come from intimate, sustained daily connections that provide support, love, and nurturance that contribute to health and well-being. Of course no long-term relationship is without its challenges and problems!  But for LGBTQ people who have sustained these relationships in a social context of disapproval and denial of their relationships, the challenges have been multiplied many times over!

Now that the majority of LGBTQ people in the United States, and all in several other countries, live where their committed relationships can be openly and legally recognized, some of the challenges and stressors around same-sex relationships have gradually being lifted.  While it is true that even in northern California, on of the most liberal geographic areas in the world, we still approach every public encounter wondering if our relationship will be accepted, gradually the reality is coming through that we can now enjoy the same kinds of social acceptance that many heterosexual couples have enjoyed for their entire lives.

As a recent article in Psychiatry Advisor notes: “multiple studies have found that psychosocial stress associated with having a lesbian, gay, bisexual, or transgender identity is implicated in the increased rate of mental health disorders found in LGBT persons. This stress comprises discrimination, concealment of sexual identity, and internalized negative attitudes about sexual or gender identity. Other studies more specific to marriage bans report that lesbians and gay men living in states where such bans were implemented had increased rates of mood and anxiety disorders, compared with lesbians and gay men living in states without constitutional amendments.”

The social, psychological and physical benefits of marriage equality have yet to be fully researched and documented, and much of the evidence to date is anecdotal. But now that more and more couples are emboldened to be “out,” the research evidence is mounting that the social/legal recognition of same-sex relationships does provide a substantial degree of mental health protection and resilience – health benefits that are vital to the well-being of LGBTQ people, couples and families.

Here at LavenderHealth.org, we will report on reearch findings along this line from time to time, and will include in our resources information related to this important issue.  So watch this space!  We welcome your comments, and if you have information to share with us at any time, let us know!

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I Am Joe’s Man Gland (Revised): Prostate Health for Queer Men

Readers of a certain age will recall that present in almost every physician’s office from the 1950s to 1980s were back issues of the monthly Reader’s Digest, a compendium of condensed literature and non-fiction, including a semi-regular feature on human anatomy and physiology, “I Am Joe’s ___” or “I Am Jane’s ___,” with the relevant body part or system filling in the blank.

It’s time to update the tactfully euphemistic “I Am Joe’s Man Gland” for a queer male readership, particularly because the prostate occupies a special place in men’s sexual lore and practice.

Nestled between the rectum and the bladder, this walnut-size organ produces the fluid that carries sperm (produced in the testes), and its smooth muscles squeeze during orgasm to ejaculate the seminal fluid.

Infamously, the prostate is also susceptible to cancer, but typically it is a slow-growing cancer. Most men, if they live long enough, will develop a prostate cancer that is usually managed with watchful waiting. We usually die from other conditions.

Bad news and good news for gay men: While according to one 2011 study gay men are twice as likely to be diagnosed with cancer, we are significantly less likely to be diagnosed with prostate cancer (Boehmer, Miao, & Ozonoff, 2011).

Other prostate problems are more benign. A slightly enlarged prostate (known by the medical term benign prostatic hyperplasia, or BPH), normally accompanying aging, may cause some inconvenience. According to the National Library of Medicine’s Medline Plus:

Less than half of all men with BPH have symptoms of the disease. Symptoms may include:

  • Dribbling at the end of urinating

  • Inability to urinate (urinary retention)

  • Incomplete emptying of your bladder

  • Incontinence

  • Needing to urinate two or more times per night

  • Pain with urination or bloody urine (these may indicate infection)

  • Slowed or delayed start of the urinary stream

  • Straining to urinate

  • Strong and sudden urge to urinate

  • Weak urine stream (National Library of Medicine, 2013).

The wise patient, however, will bring up these symptoms with his primary care provider in order to rule out other more serious problems.

Prostatitis, an inflammation of the prostate, may be the product of an infection or other cause and is usually temporary. Some men find prostate massage a source of sexual pleasure. Whether it can also bestow a health benefit for men with chronic prostatitis is still not clear; Shoskes and Zeitlin (1999) found a benefit to a combine antibiotic and massage therapy, but more recently Ateya et al. (2005) could not find a significantly improved response and recommended antibiotics only. Prostate massage, moreover, may entail some risk if done too vigorously, and one risks tearing the delicate wall of the rectum.

A variety of anal probes designed to stimulate the prostate are commercially available as sex toys. Paradoxically, product web sites consulted for this article all provided disclaimers waiving the manufacturers from liability from harm in their use, with one announcing “not for internal use.”

Harvard Medical School (2011) provides advice on exercise and diet for prostate health, with benefits for cancer and prostatitis risk reduction.

In addition, some women and men find helpful exercises to strengthen the pelvic floor muscles,  the so-called Kegel exercises, both to strengthen urinary continence and for sexual pleasure (Mayo, 2012).

In conclusion, remember: A healthy prostate is a happy prostate.

References

Ateya, A., et al. (2005). Evaluation of prostatic massage in treatment of chronic prostatitis. Urology, 67, 674-678. doi:10.1016/j.urology.2005.10.021

Boehmer, U., Miao, X., & Ozonoff, A. (2011). Cancer survivorship and sexual orientation. Cancer, 117, 3796-3804.

Harvard Medical School. (2011, October 4). 10 diet & exercise tips for prostate health. Harvard Health Publications. http://www.health.harvard.edu/healthbeat/10-diet-and-exercise-tips-for-prostate-health

Mayo Clinic. (2012, September 25). Kegel exercises for men can help improve bladder control and possibly improve sexual performance: Here’s a guide to doing Kegel exercises correctly. Healthy Lifestyle: Men’s health. http://www.mayoclinic.org/kegel-exercises-for-men/ART-20045074?p=1

National Library of Medicine. (2013). Enlarged prostate. Medline Plus. http://www.nlm.nih.gov/medlineplus/ency/article/000381.htm

Shoskes, D. A., & Zeitlin, S. I. (1999). Use of prostatic massage in combination with antibiotics in the treatment of chronic prostatitis. Prostate Cancer and Prostatic Diseases, 2(3), 159-162. doi:10.1038/sj.pcan.4500308

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3 more days to enroll!

February 15th is coming soon – the deadline to enroll in a health care plan of your choice!  Where-to-Start-What-to-Ask-coverIf you or someone you know is not yet covered, get the information and the help you need to make sure this happens!  Medical coverage for LGBTQ people and our families is important as never before — because now it can happen!  Visit the Strong Families web site today for specific information about LGBTQ coverage – do it now!

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LGBTQ Valentines?

Valentine’s day, another one of our many commercially-driven “holidays,” is a bastion of heteronormativity.  The origins of the holiday are not known, but one version of the history claims that St. Valentine, who secretly performed marriages in opposition to the valentineRoman Emperor Claudius II, who outlawed marriage for soldiers because he believed that single men made better soliders than married men. Another version claims that it evolved as a Christian substitute for the popular pagan celebration of the fertility festival of Lupercalia, celebrated on the ides of February.  Regardless of its origin, it unquestionably assumes heterosexual romantic love – a message that sows seeds of doubt and shame for even young children who know that they feel physical and emotional feelings for someone who is the same gender or sex.

So there are two health issues here that deserve serious consideration: the damage that is heaped on LGBTQ kids and adults who are not only struggling with challenges of relationships and intimacy, but the undeniably painful challenge of going against a powerful social construct of heteronormativity.  The other health issue is the distortions that the heteronormative romantic ideal  imposes on all intimate and mutually nurturing relationships.  This romantic ideal obscures the real meaning, significance and experience of  the the kinds of human love, support and intimacy that are essential for health.

Nevertheless, most of us live in a world that celebrates this holiday, and in addition to raising these important issues that effect LGBTQ people, we also have the option of using this occasion to bring LGBTQ love into the open!   So if you are so inclined, instead of decorating your work space with typical red hearts, find an LGBTQ valentine symbol to decorate whatever space you can!  Here are a couple sources to consider:

Buzzfeed - 20 Adorable LGBT-Themed Valentines

Revel and Riot

And go out and have a party with your LGBT friends, decked out in LGBTQ valentine gear!  You ask what that is?? Make it up, and send us photos!

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70 Research Studies confirm: Gay Parenting Does Not Harm Kids

A landmark online research portal focusing on LGBT Equality at Columbia Law School “What we Know” has just launched with its first report on what scholarly research says about the children of gay or lesbian parents.  The results are stunning – they reviewed 73What_We_Know_Blog___About recent studies that examined the well-being of gay or lesbian children.  A total of 70 of the studies concluded that children of gay or lesbian parents fare no worse than other children.  Three of the studies conclude that they face added disadvantages.  Visit the “What we Know” web site to see the details, where there are links to the abstracts of all the studies as well as to the sources where each article can be found.

The project they are working on next is equally important – “What does the scholarly research say about the impact of conversion therapy on LGB people?”  Visit their site for more information about the project

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‘That’s My Sister!’ Taking a Twin’s Gender Fluidity in Stride

This post was originally published on January 18, 2015 in the New York Times, Motherlode blog. It was written by Dr. Winifred Curran, my friend and colleague from DePaul University. This is a beautiful piece, well worth the 3 minutes it’ll take you to read it.

Credit KJ Dell’Antonia

Do you have a sister? This is the “question of the day” that greets us as we enter my twins’ preschool class. My heart sinks. Question like these can be difficult to navigate in my family. Can we just say sibling?

One of my twins was born a boy but, for the moment at least, identifies as a girl. This has evolved from insisting on wearing dresses by the age of 2, to wanting to go to the bathroom with the girls at 3, to firmly identifying as a girl, crying if referred to as a boy, by the age of 4. And so, the debates on what exactly constitutes woman and sisterhood are personal and immediate. But as it turns out, everything I need to know about sisterhood, I learned from a 4-year-old.

I am in no rush to define my child as anything; who knows how she will identify years from now? But the world does insist on forcing the issue. The ambiguity of my child’s gender makes people decidedly uncomfortable, and it often seems that conformity is more important than what is best for my child. Complete strangers feel free to tell me that I should force my child to wear “boy” clothes. My sister believed it was simply a matter of providing more “boy” toys. The pediatrician said we had to get her out of wearing dresses because she was too pretty. People seem to feel that they deserve an explanation when they ask for the twins’ names and one of those names is a typically male one.

My child’s evolving gender identity has been part of a learning curve for me, our extended family, her teachers and classmates. Though I am an academic well trained in feminist theory and the idea that gender is a social construction, having a child who presents as transgender has made me far more sensitive to how gender is defined and policed.

All of this has made me an ambassador of sorts for transgender issues with my children’s teachers, other parents and school officials. I have explained to other preschoolers that people can be whatever they want to be and that there are lots of ways to be a girl. I am always and everywhere an advocate for my child. But even I sometimes revert to male pronouns.

Only one person has taken every transition in stride, often, in fact, explaining them to everyone else. That is her twin sister. It was she who explained to me that the reason her twin didn’t want to go to school was because she no longer wanted to go to the bathroom with the boys. Once we knew this and the school agreed, the problem was solved. It is she who corrects me, and other people, if they refer to her twin as he. She generously shares dresses and princess toys and fire trucks and doctor sets. She accepts her twin as she is, even as this changes and evolves, because she loves her. She knows her as she is and has no conception of how she is “supposed” to be.

For her, the definition of gender, the politics of it, and the way some people may look askance don’t matter. When someone recently referred to her twin as her brother, she quite forcefully yelled, “That’s my sister!” Her twin is who she says she is. They are a source of strength for each other, a team (except, of course, when they are bickering the way 4-year-olds do).

So, do you have a sister? I read the question to my twins and the joy of recognition lights up their faces. They both, without hesitation, answer yes. In light of the recent suicide of Leelah Alcorn, who killed herself because, “The life I would’ve lived isn’t worth living in … because I’m transgender,” can’t we agree that our common assumptions are not more important than people’s lives? One report among many shows that transgender people face pervasive discrimination, are more likely to live in extreme poverty, and over 40 percent attempt suicide.

As parents and sisters and friends, our response must be, as Jennifer Finney Boylan argues, to read, write and scream against the injustice of it all. We can choose to accept our children for who they are, in all their wonderful complexity, and liberate ourselves from the narrow conceptions that gender places on all of us.

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Caring for Transgender Patients

An article by GLMA nursing colleagues Laura Hein and Nathan Leavitt  appears in the November/December 2014 issue of  Nursing Made Incredibly Easy. The article is free, and Caring_for___Transgender_patients___Nursing_made_Incredibly_Easyyou can earn Continuing Education based on the article! Another article in this same issue addresses the spiritual needs of LGBT patients, authored by Rabbi H. Rafael Goldstein.

It is worth noting that this issue focuses on diversity, but unlike most discussions of diversity that only address race, ethnicity or culture, only one of the articles in this issue addresses “different cultures.” In addition to the two articles focusing on LGBT issues, other articles focus on caring for nontraditional families, patients with disabilities, patients with tattoos and body piercings, incarcerated patients, and patients of different religions.

Check out this very significant issue in the nursing literature!  It is ground-breaking!

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LGBTQ Scientists

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If you work in a science related field, you have undoubtedly heard of the push for “stem.” STEM is an acronym for “science, technology, engineering, and mathematics.” Higher education institutions across the United States are trying to bolster their STEM programs and attract more students to these programs. This commentary is not about STEM though… it is about the LGBTQ people who work in STEM professions.

I am an emerging scientist in the nursing discipline. As an out gay man, I have not experienced much discrimination from colleagues, administration, or students. This can probably be chalked up to the fact that gay men are universally accepted in the nursing profession. However, this is not the case for many other STEM professions, such as chemistry, physics, engineering, computer technology, and mathematics.

I know of a few “closeted” scientists in academia who are afraid to disclose their sexual orientation to their colleagues. Although I have never questioned their fears, I imagine they fear the progression of their career. Much of a scientist’s career depends on the judgment of their peers (publications, grants, and promotions). If a scientist works in a climate that is not accepting of LGBTQ people, they may risk promotions and career progression if they are open.

My claim that LGBTQ scientists may be afraid to be open is more than anecdotal. Dr. Erin Cech, assistant professor of sociology at Rice University, authored a paper titled, “Navigating the heteronormativity of engineering: The experiences of lesbian, gay, and bisexual students.” She interviewed 17 engineering students and found that engineering is a heteronormative climate, requiring students to “cover” their sexual orientation. This requires tremendous emotional work on the part of the student, resulting in isolation, lying, and hiding. Although the interviews were conducted with students, it gives insight into the environment for the working scientists as well.

The issue of unwelcoming STEM environments is so pervasive that there is an actual guide on how to support LGBT physicists and astronomers in academia. The issue has even garnered the attention of Nature. They recently published an edition on diversity in science and the highlight news feature was specific to LGBT scientists. Other commentaries on this issue can be found here, here, and here.

Thankfully, a few great organizations are bringing awareness of LGBT people to the STEM professions. Two of the prominent organizations are oSTEM (Out in Science, Technology, Engineering, and Mathematics, Inc.) and NOGLSTP (National Organization of Gay and Lesbian Scientists and Technical Professions, Inc.). I think it is especially important to make STEM students aware of these organizations.

The purpose of this blog was to bring more attention to this issue. I urge you to click on the links that I provided and read up on this topic. Also, if you work for an academic institution that offers STEM degrees, please urge your institution to consider creating an oSTEM or NOGLSTP chapter (or at least advertise the organizations to students and faculty members).

I end with a video of a lecture by Professor David K. Smith about LGBT scientists, “Not all scientists wear white coats (some wear purple shoes).”

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HIV/AIDS 30 Years On: MSM Ignorant, In Denial

For more than three decades we have lived with HIV/AIDS. The earliest years of the epidemic were characterized by both dread and hope, anxiety and action. Community-based peer education and activism emerged among sexual minority collectives. When public officials failed and fell short, the HIV infected and affected marshaled energy and intelligence, learning about treatments, teaching each other risk-reduction strategies, and forcing changes in medical research, public policy, and law through direct action like ACT UP.

With the development and introduction of anti-retroviral treatments in 1996, the AIDS epidemic turned a corner. From a nearly guaranteed death sentence, HIV infection became a manageable chronic condition. Over the past two decades HIV has become a nuisance rather than a nemesis.

Men who have sex with men (MSM) have largely become complacent, careless, and in denial.

A new study conducted by the Henry J. Kaiser Family Foundation, HIV/AIDS In The Lives Of Gay And Bisexual Men In The United States, has found:

  • Half of MSM respondents said that HIV/AIDS is somewhat or very significant to them, but only one-third were concerned about becoming HIV infected and over half said that they were not concerned.
  • Most are ignorant of infection trends — that new infections among MSM are rising — thinking that infection rates have stayed the same or declined.
  • Most MSM are unaware of current treatment recommendations, including early intervention after HIV infection and even PrEP prevention to reduce infections among those who are engaging in risky behavior.
  • Most report that they have not discussed HIV/AIDS with friends or even sexual partners.
  • One-third have never been tested for HIV, while only one-third have been tested in the past year.
  • More than half have never had a primary care provider recommend HIV testing, and almost two-thirds reported that their primary care providers did not initiate a conversation about sexual behavior.

These disturbing findings constitute a wake-up call for MSM (many of whom do not identify as “gay” and who may not be connected to gay social networks).

They remind us how essential it is the initiate a conversation with primary care providers about our sexual practices and relationships.

They remind us how essential is our taking ownership of our health, disease prevention, and self-management of chronic conditions.

As journalist and chronicler of the AIDS epidemic, John-Manuel Andriote, has written of this Kaiser report: “The most powerful gay liberation movement we could ever launch would be to liberate ourselves from the many harms that ignorance can inflict on us. The movement’s success starts with each one of us making healthful choices. The first step forward is to know your own HIV status.”

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