Vindication of Pleasure

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SRHR isn’t just about domestic and international policies on gender-based violence, unintended pregnancy and STI’s. While that’s very important, pleasure is also a critical part of sexual and reproductive health and rights! Bergen Cooper from the Center for Health and Gender Equity sits down to talk to us about why pleasure matters when discussing reproductive health.

It may come as a shock, but the vast majority of people don’t have sex for reproductive purposes. They have sex for a variety of reasons, including pleasure. But, many people aren’t prepared to talk about pleasure with doctors, partners, friends, or sex education teachers. It turns out that refraining from talking about pleasure is a disservice to ourselves and young people around the world- how can we expect people to have fulfilling, pleasurable and safe sex lives if sexual pleasure isn’t discussed within the context of SRHR?

Pleasure isn’t a part of a lot of conversations under the umbrella of sexual and reproductive health and rights. For example, pleasure is completely left out of the conversation on female genital mutilation and cutting. We often talk about ending FGM/C and the medical and health effects that come along with it, but rarely do we talk about how the procedure impacts female pleasure. 200 million women and girls around the world have undergone FGM/C, and data shows that these women and girls experience less desire, arousal, and orgasm. While discussing the ending of this practice, we can’t forget to keep in mind alternatives for seeking pleasure.

Lack of conversation around pleasure also exists for women post-reproductive age. Women’s health is so often linked to their reproductive capacity, and when, for whatever reason, women don’t have reproductive capacity, they are often forgotten about. Women have sex far past reproductive age- into their 50’s, 60’s, 70’s, and 80’s. If a friend, provider, or family member doesn’t view a woman as someone who has a sex life, they might be asking the wrong questions, or not asking questions at all! For example, women need STI testing past reproductive age, experience gender-based violence past reproductive age, or find other ways to experience sexual pleasure. Providers need to be comfortable having those conversations so women can receive the services and care they need.

Don’t forget, pursuing a pleasurable, safe, and satisfying sex life is a human right!

Links from this episode

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Transcript

Jennie: Welcome to rePROs Fight Back a podcast on all things repro. I'm your host Jennie Wetter. In each episode, I'll be taking you to the front lines of the escalating fight over our sexual and reproductive health and rights at home and abroad. Each episode, I will be speaking with leaders who are fighting to protect our reproductive health and rights to ensure that no one's reproductive health depends on where they live. It's time for repros to fight back.

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Jennie: Welcome to this week's episode of rePROs Fight Back. I'm really excited about this week's topic for a couple of reasons. First, it was one of the topics suggested by listeners when we had our recent giveaway. So that makes it super exciting to do. Um, we got so many great suggestions that it can't wait to do another giveaway and see what all you guys suggest. Um, but also feel free to reach out anytime, if you ever have a topic that you would like us to cover. Um, a second, this is a topic that is really at the center but never, ever talked about. Um, so that's right. Today we're gonna talk about pleasure. So helping me talk about all things pleasure. I'm super excited to have the amazing Bergen Cooper from the Center for Health and Gender Equity with me today. Jennie: Hey Bergen.

Bergen: Hey.

Jennie: Thanks so much for doing this and having me at your place.

Bergen: Oh, I'm so happy. We're talking about pleasure and I'm so happy we're talking about pleasure in my apartment in Brooklyn because you know, this is just a joy.

Jennie: Exactly. Like this is like the perfect place.

Jennie: Nice and cozy.. So yeah,

Bergen: We have our candles going. We're really setting the mood.

Jennie: Uh, so why should we be talking about pleasure?

Bergen: Ah, pleasure is a critical part of sexual health. We know where we should be talking about sexual health. We're used to talking about sexual health, but I think we're used to talking about the negative outcomes, the, the STIs, the unwanted pregnancy, the gender based violence. And, and that's important. And that contributes to the global burden of disease and, and, and that matters. And we spend a lot of time talking about policies and programs and education to prevent those unwanted aspects of sexual health. We do not spend enough time talking about the positive aspects of sexual health, wellbeing, autonomy and pleasure. Pleasure matters. We know that bad sex has negative impacts on your life. Good sex has positive impacts on your life. And we do ourselves a disservice when we only focus on the negative. Also, September 4th is World Sexual Health day. It's also Beyoncé's birthday. I think this is really important, critical for your listeners to know about. And I mean there's something going on there

Jennie: And honestly it should just be Bergen day, cause when I think of Beyonce and pleasure, I think of Bergen.

Bergen: it's really just the greatest compliment I've ever gotten. Yeah. But it's so important that we're talking about pleasure because pleasure does have good outcomes in a person's life. But it's a topic that people feel nervous to talk about. Um, people aren't prepared to talk about it with their doctors. They aren't prepared to talk about it in sex education in schools, they aren't prepared to talk about it with their partners. And really sometimes it's hard to talk about with their friends or even admit to themselves what they find pleasurable. So I'm really glad we're having this conversation today.

Jennie: All cards on the table. I went to Catholic school K through eight and I had definitely had sex ed from a nun. So like talking about pleasures like that last, like, oh my God, I can't believe we're having this conversation.

Bergen: Yup, Yup. Absolutely. Um, I, I went to a private school in Washington DC and it was very progressive and we had, um, you know, we had biology where we learn sort of the mechanics of sex and then we had some human development courses and there where, you know, school assemblies, but there wasn't really, at that time, a structured sex education course that, that took on the full components of sexual health. And, um, and I think that's changed at that school. And I think it's changed in many schools, uh, around the country. But there's still a lot of work to be done. I see that people are more comfortable having conversations around consent and that's really important. Bringing the conversation of consent into sex education is critical.

Jennie: And yet only seven states require it.

Bergen: It's just ridiculous.

Jennie: Yeah, that's kind of mind boggling to think about it.

Bergen: How many states do you think require sex education includes topics of pleasure?

Jennie: I'm going to say none.

Bergen: I'm gonna say its probably not a requirement. And we're really doing ourselves a disservice. We're doing a disservice to young people around the world when we don't talk about pleasure because people in general do not have sex for reproductive purposes.

Jennie: Wait, what?

Bergen: But I know, let me say it again. People don't have sex, the vast majority of people do not have sex for reproductive purposes. They have sex for a variety of reasons, one of which includes pleasure. Now, when we're teaching young people about sex and we're not talking about pleasure, how in the world are we expecting them to be able to have pleasurable sex life, the fulfilling sex lives and safe sex lives as they get older if they're not equipped to have those conversations when they're younger? Listen, I, uh, I used to teach sex education. Uh, I taught sex education here in New York City. Um, and I worked with a mobile, uh, mobile health clinics. We went around to all the boroughs, to all different types of schools, to different age ranges from, from early, early adolescents to late adolescence. And one day I was teaching this workshop on healthy relationships. And one girl brought up a question and she said she wasn't enjoying sex. And I said, you know, where's the question? She said, I just don't know why. I don't know what, I don't know what I don't know. And so I said, you know, and we had been talking with this class for a while and I knew that many of the, uh, young women were sexually active. And, uh, and I took a poll and I said, why do you have sex? And people said, oh, well, my partner and I had been together for a while, we love each other, it felt like the next step. Nobody said, because it feels good. Nobody said, because it makes me happy. Nobody said, because it's fun. And sex feels good, should make you happy and is fun. And if we don't talk about that, we're doing ourselves a horrible disservice.

Jennie: And there's so many important conversations that it's not part of. So I figured we'd go for the most dramatic first and go, you know, shock everybody, whatever.

Bergen: Sure.

Jennie: Um, and so that's, so often when you talk, we talk about FGC and I'll let you go ahead and do the little bit of definition of what we're talking about when we say that, pleasure isn't really part of that conversation. We just talk about the medical impacts and the health impacts and don't talk about how that impacts pleasure later or anything.

Bergen: Female genital cutting, some people call it female genital mutilation is a process in which a woman's genitals are cut. Um, and there are a couple of different types of female genital cutting...

Jennie: And if you want to learn more so we won't make Bergen do like a deep dive, we did do an episode on it earlier. Um, and I unfortunately can't remember the exact number, but if you look at, it's titled Female Genital Mutilation or ending female genital mutilation/cutting, I think. And it's with a great researcher from the population council.

Bergen: Oh, wonderful. All right, I'm going to go back and listen to that one. Um, so one of the things thatwe talk about with female genital cutting is ending it, right? And it's so critical to be having these conversations to be thinking about how we can do that. But there are over 200 million women and girls living around the world right now who have been cut. They're living with the ramifications of female genital cutting. What are we doing for them? Now, people often talk about how it can be hard to give birth after being cut and, and that's a critical conversation. But what about women's pleasure? If we are talking about the clitoris being cut or removed, um, for the external clitoris, then we need to be talking about pleasure. Now women and girls who have been cut often, our data show that they experience a less arousal, orgasm and desire. There are 200 million women and girls around the world who are experiencing this. While it is critical to end this practice, it is so important that we think about their needs. That providers when they talk to women who have been cut, are able to talk about sexual health, are able to offer them services, are able to talk to them about alternatives for seeking pleasure. This, these are really necessary conversations that due to so much stigma and shame and lack of education don't happen.

Jennie: It's so rare that you hear that. Any talk about pleasure around FGC.

Bergen: People are comfortable talking about FGC and they'll say the word clitoris when you're talking about removing it. But why aren't people comfortable talking about the word clitoris when a, when it is fully there and women are experiencing pleasure and, and need to be experiencing pleasure. And FTC involves the removal of the external clitoris, but as we know, the clitoris is still internal as well. And women still have capacity to experience pleasure. And this pleasure, uh, is something that women and girls, if they want to have that ability, should have access to.

Jennie: And I think it just kinda goes back to that whole, we just don't talk about pleasure. I mean if we're, if that's not part of the conversation apart of FGC, I think that's just, we're at a time where it would seem so obvious to have that conversation. It just shows how often we just don't talk about pleasure at all in the sexual and reproductive health area.

Bergen: Yeah, absolutely. I mean I think that it's important to realize that you can be talking about pleasure and almost any aspect of SRHR there is room for the conversation and there is a need for the conversation as well.

Jennie: So another area that we definitely don't talk about enough in general and definitely don't talk about pleasure is I know one of your key areas and that's um, pleasure and women post reproductive age.

Bergen: Yes. Ah, one of my most favorite topics to talk about. Um, you know, this all started when at CHANGE, we did a event and we were talking about sexual rights and uh, now my dear friend Katelyn Crockett came up to me and she said, you know, this is really interesting, this data on sexual rights. Can you share with me the data that you have on women past reproductive age? And I looked at her and I realized the data didn't exist and I was embarrassed. And I asked her to get coffee so we could talk about that immediately. This is about three years later and Kaitlyn and I've written probably four or five papers about older women and sexual health. Um, and it's, it's been a really exciting area to explore. So if you think about our global health data, the DHS, the demographic health survey is, is the area where we really get our data from. Now that doesn't follow women past reproductive age because it was a maternal health survey. And so it's hard for us to even collect this data on women past reproductive age. There are incredible researchers around the world right now who are collecting more and new and interesting data on older women. But the data is, is far and few between. And often when we think about women's sexual health, what we're really actually talking about is reproductive health. Women's health is so often linked to their reproductive capacity. So when women don't have reproductive capacity and they might, that might be for a variety of of of reasons, but in this case for the reason of age, if they don't have reproductive capacity, they're forgotten about. Them as sexual beings is not a conversation that has had and women have sex. Women have sex past reproductive age far, far past reproductive age. Women are having sex in their 50s and their sixties, and their seventies, in their eighties, I want to say nineties but I'm not positive on that data and as a researcher, I'm not going to say it, but 80 is for sure. I know off the top of my head and, and this is a huge population because the world is aging and of the aging population, the majority of those people are women. So there's this huge population whose sexual health is completely being ignored now and we talked about some of the negative consequences of sex. This is a real harm on the negative consequences as well because if you don't think of women as sexual objects as, as people who engage in sexuality, who, who engage in a sex life, then as a provider or as a friend or as a family member, you might not be asking them the right questions. For example, women experience gender based violence passed reproductive age, women need STI testing passed reproductive age. If providers aren't comfortable having those conversations with them, then women aren't getting the services they need.

Jennie: And we've definitely seen that with like articles about, you know, outbreaks of STDs in nursing homes and stuff. So, you know, it's clear that those sexual health conversations are not being had. And you know, they probably, if they had sex education didn't have effective or it's been so long and they haven't had to worry about it. So they're missing this, um, sexual health side, um, to even get to pleasure.

Bergen: I mean, you and I were just talking about the sort of sex education we did or didn't have in our high school years. And, and it's, it's come so far in the past 20-30 years. And I'd be think about our, our friends in this sort of education they got 60 years ago. I mean, this is, this is, it's, it's horribly unfortunate that we ignore pleasure in older age. And you know, another reason that it's unfortunate is that we're missing learning some important lessons. As we age, our bodies change and things that were pleasurable before might not be pleasurable now and we might find new things pleasurable. When I was in graduate school, I wish I could remember the name of the study, but I read this qualitative study and it was couples in New Zealand. And Viagra was introduced to the couples, the couples were a heterosexual couples and they used by Viagra, and then some of them chose to stop using Viagra. And so the researchers went and spoke to the couples who chose to stop using Viagra to understand what it was that had changed. And we heard from these couples that they had found different ways to experience pleasure when penetrative sex wasn't an option. They had found different ways to experience intimacy and orgasm. And when penetrative sex was brought back into the conversation, they realized that some of the things that they had discovered before Viagra were what was really exciting and what was giving them pleasure and orgasm. And so they wanted to go back to that. I think there is a lot of, of really exciting room for us to, to think about different types of pleasure as we think about women past reproductive age.

Jennie: Well, and you see that with, you've started to see lots of more uh, writing at least feminists writing about the orgasm gap. Yes. And that is all part of this conversation. Absolutely.

Bergen: So the orgasm gap is, is real. And I actually think this is a critical conversation to come back to sex education. As we talk about pleasure. It is important that people with a clitoris understand the type of pleasure that they can experience with a clitoris. And this should be a normal conversation. This should be a safe conversation. Um, and people should be able to advocate for their own pleasure. If you go through sex education and if you go through your doctor's offices and if you go through your life where you can't talk about pleasure, where you can't talk about orgasms or you can't talk about what makes you feel good, how in the world are you going to be able to advocate for that in your own personal relationship? We need to normalize these conversations so that people can experience the benefit of happy sex lives.

Jennie: Okay. Sorry, I put stress off of, um, post reproductive age women.

Bergen: No, no, no. I, I just, I think it's important that we think about sexual activity, um, and distinguish it from reproductive capacity. And, and when we talk about women past reproductive age, that's, that's one way to do it. But there's so many groups that don't have reproductive capacity and, and so many groups that do and still have sexuality and sexual health and a desire for orgasm. One of my favorite things to say is that, um, as we talked about earlier, people have sex for fun. People have sex for pleasure. And we have the data to back that up. This is a rigorous public health issue and it deserves to be spoken about.

Jennie: Um, you know, it just, it really does get left behind in lots of conversations. And we touched on this a little bit, but like just providers having that conversation with patients.

Bergen: Yes, absolutely. So this is such a critical area. So most patients want to talk to their provider about sexual health, but the provider does not bring up the conversation and most providers are not trained to talk to their patients about sexual health. So we have this disconnect where patients want to talk to their doctors, doctors don't know how to talk to their patients about sexual health. And, and that's a real problem. A number of years ago I was consulting with the World Health Organization and we created guidelines called brief sexuality related communication guidelines. And these are guidelines after we looked at all of the data around, um, providers talking to their patients about sexual health, in those brief moments that they have, what happens? How does it matter? Why does it matter? And, and we found that providers who spoke to their patients about sexual health in those brief moments, it really could make an impact on STIs on HIV, on unwanted pregnancy. And we want it to be able to talk about the impact on sexual wellbeing, on autonomy, on pleasure. The data just wasn't there at the time. It wasn't rigorous enough for those guidelines. But what we were able to say is that providers should be talking to their patients about sexual health and they need the training. The training can happen in medical school but also post medical school this training can occur and it is critical. Providers need to be able to take a client centered approach and talk to their patient and listen. I mean listening is so critical and I think especially around areas of sexual health and of pleasure, giving that space where the provider can hear what the patient needs as opposed to diagnosing them right away is so important. Not every provider is going to be able to fix every sexual health issue. This is why we have sexologists. This is why we have psychologists. This is why we have so many different specialties within the medicine, medical community. But the primary care provider, they are going to be your first point of contact. If you have something that you think is more serious and then they'll send you to a specialist. Sexual health should be no different than any sort of infection or cold or a mental health problem or anything you're talking to your primary care provider about. There's no reason for sexual health, for pleasure, for wellbeing to be cast to the sidelines.

Jennie: I feel like there's a lot that we could probably do full episode on like a relationships with providers and patients.

Bergen: Oh yeah. Put that in another episode.

Jennie: The importance of having like a full conversation about what kind of birth control works for you versus just being like, oh I want something and they're like, oh, here's a pill. Here are pills instead of having the fuller conversation and pleasure can be part of that conversation. And I think, you know, that's something that, you know, we don't have time for like a super deep dive on today, but it's definitely the importance of that doctor patient relationship. And pleasure should be part of that.

Bergen: Yeah. And I know we don't have enough time, but let me just scratch the surface with that one.Um, I have often heard from friends that they worry about types of birth control, uh, impacting their sex drive. And when you take birth control that has hormones, you wonder how are the hormones going to impact my sex drive. There is a need for a systematic review to capture the amount of data that has been collected already. But people wonder about it. And when I was a sexual health educator, I worked with people before they went and saw the provider to pick their type of birth control and over and over and over again, what I heard was, is this going to make me gain weight and is this going to impact my sex drive? And it's, and this is a question that we get all the time and it deserves studies, but these studies need funding. Um, so it's, it's really normalizing conversations around sexual health and pleasure is important, not just for the one on one conversation but for funders, for researchers for, for getting this level of study actually conducted.

Jennie: So you talked about your role is a sexual edgy, sex educator. Um, that doesn't sound right. That's not what I meant. Teaching sex ed. Yeah. Much better. Um, and the importance of having, talking about pleasure in that conversation. Cause again going to Catholic school and having sex ed that was valuing your sexuality with definitely pleasure was not a topic that we talked about. Um, and it's still, I don't think very often talked about in sex ed.

Bergen: Yeah. No, I don't think it is talked about in sex Ed. Um, so the conversation around sexual pleasure in sex education is critical because we don't want young people or any people to think that they have to experience sex in a certain way. What is pleasurable for one person is not pleasurable for another person. What one person gets excited about might not excite another person. And if you get this idea that there is one way to experience pleasure and sexual health that might lead to self doubt, it might lead to insecurities. And it's critical that we talk about pleasure in a way that allows people to see the diversity in sexual health and the diversity in pleasure. And also the when we're talking about pleasure and we're talking about dynamics between, uh, among genders there. It's certainly more normal in our culture to hear about boys' pleasure and far less common to hear about girls' pleasure. We need to normalize women's sexual pleasure. It's critical that we talk about pleasure for people who have clitorises because the clitoris can experience so much pleasure and really the world is a cruel place if people don't know that.

Jennie: I actually, I was a little disappointed to see, weren't wearing your clitoris ring.

Bergen: I don't know where it is and the jewelry box was a mess, but for everyone out there, I do have a clitoris ring, which I should note is a ring that I wear on my finger. Um, one time I was, I was giving a talk to current students at Columbia School of Public Health and I was on the phone and they asked about, um, starting a new job and they said, you know, how do you dress? How do you present yourself? And I said, well, you know, when I started at my job, I certainly dressed more conservatively, but after I found my footing and I started shaving my head and wearing my clitoris ring, well somebody in the audience like a year later told me that they thought I meant a ring through my clitoris. So that's great for everyone. But that is not what I was talking about.

Jennie: Yes.

Bergen: Probably shouldn't share that story.

Jennie: That's okay. It's kind of amazing. I had something not exactly similar, but I was at work and I cause Bergen's amazing ring inspired me to go buy one for myself. Yes. Uh, and I was wearing it and like you forget and like don't think about it. And I was sitting at a desk chair and like moved and someone's like, Oh, you're, you have your clitoris ring on. And I'm just like, wait, what? Oh, right, yes. Yes. The ring on my finger is the clitoris.

Bergen: Yup. I have a, I have a silver necklace that I wear around my neck almost every day, and it's beautiful. It's a little pendant. Um, it's also a vibrator. Oh, nice. Yeah. And it's just a wonderful to wear that into meetings and know that you always have a little pleasure right over your heart.

Jennie: Oh, I like that. So, you know, one of the things that we've touched on pleasure before is that it's often included as part of the definition of sexual rights. So pleasure is a human, right?

Bergen: Yes, absolutely. So, pursuing a satisfying and safe and pleasurable sex life. This a part of the definition of sexual wellbeing. This is a part of the definition of certain definitions of sexual right. If you want to see a fantastic definition of sexual rights, I highly recommend the World Association for Sexual Health. They have a declaration of sexual rights. It includes, if I'm not mistaken, 17 specific bullet points under sexual rights.

Jennie: Oh, nice. We'll make sure to include that in the show notes.

Bergen: Good. Good. It's wonderful. Um, and, and that includes, um, pursuing a safe, satisfying, pleasurable sexual life. Um, sexual rights is a, is a, is a definition that has many definitions, right? Depending on who you're speaking to. But, but often we talk about the pursuit of pleasure as important under sexual rights because as we said, people experience pleasure differently and some people's experience of pleasure is asexuality and not engaging in sex. And that pleasure is just as valid as someone whose pleasure is derived from physical stimulation and sex. So it's, it's really critical that the pursuit is what is protected under our human rights standards.

Jennie: It was really great to see that become part of the, the definition, um, and to see that it's now gaining acceptance as part of a human rights.

Bergen: Yeah, absolutely. And cheers to you and everyone else who's been working on all those sexual rights definitions for so many years.

Jennie: Um, so we usually end the podcast with, uh, what action can people take to fight back? And that seems a little weird in this context.

Bergen: Oh no, I have one.

Jennie: So how do we ensure it doesn't get left out of the public conversation? Seems maybe a little more. It makes a little more sense.

Bergen: Absolutely. Normalize talking about pleasure, whoever you are. If you are talking to your friend, normalize, talking about sexual pleasure. If you are a researcher, normalize the study of, of pleasure. If you are a funder, normalize funding pleasure as a health and human rights issue and if you are a sex educator, please, please get comfortable talking about pleasure. We need to normalize these conversations. Pleasure should not be cast aside as a secret taboo subject. It is valid. It improves our health. It is a health and human rights issue that deserves to be taken seriously and we each have a role in doing that every single day.

Jennie: Yeah, no, I think you really nailed that.

Bergen: Yay. Pleasure.

Jennie: Uh, well Bergen, thanks so much for doing that. Thanks for having me.

Bergen: Thanks for coming to Brooklyn to talk about pleasure.

Jennie: For more information, including show notes from this episode and previous episodes, please visit our website reprosfightback.com. You can also find us on Facebook and Twitter at rePROs Fight Back. If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening.

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