Let's Talk About Sexual Health

It’s springtime in the high desert! The bees are buzzing, and the birds have come to nest and lay eggs. April is Sexually Transmitted Infection Awareness Month. Right, it’s time for us to discuss everyone’s favorite topic.

STIs can be prevented, they are not inevitable. Having said that, when someone gets an STI, it’s nothing to be ashamed or embarrassed about. It does not make a person ‘dirty’ or ‘unclean,’ it means they got an STI that is either curable or treatable. To truly know whether you have one you’ll need a test, and if you’re sexually active, you can make STI testing part of your annual physical and lab work.

STIs can be asymptomatic, meaning you can have one and not know, whether you’re male or female. So the hook-up conversation that people often have, the old “I know I don’t have anything, do you?” does not work. The only way to know is to get tested. If you are sexually active with multiple partners, we recommend you get tested quarterly and know your status. The sooner you’re diagnosed, the better your outcome with any STI.

Unprotected sex is the most common way of acquiring an infection, but some people get them without having sex at all. Do you get cold sores, or know and love someone who does? Cold sores or fever blisters are expressions of the herpes simplex I virus. Most who have this virus got it as a child, when they were told to go and kiss aunt or uncle so-and-so, or as infants being passed around for people to snuggle and kiss. We find herpes simplex II (genital herpes) around some people’s mouths, from unprotected oral sex, kissing, cunnilingus, fellatio or analingus. Once someone has HSV I or II, they will have it for life. But there are effective medications to suppress these viruses in the body.

Hepatitis B and hepatitis C are both viral STIs. You can get a vaccine to prevent hepB, but there is no cure. With hepC there is a cure, but no vaccine. These STIs can go undetected for years and cause complications in your liver.

Chlamydia, gonorrhea and syphilis are all curable bacterial infections. In Arizona last year there were 38,175 reported cases of chlamydia, 13,130 of gonorrhea and 3,262 of syphilis. I emphasize ‘reported’ because some are never reported to health departments, and some where the folks may not have had symptoms or received treatment.

HIV is a virus and it is treatable, but there is no vaccine or cure. Once considered a death sentence, today people engaged in treatment live long lives with HIV. June 5 is our Long-Term Survivors Awareness day. This could be renamed ‘Long-Term Thriver’s Day.’ When an HIV-positive person has an undetectable viral load, they cannot transmit the virus: U=U, undetectable = untransmittable. The National Institute of Allergies and Infectious Disease followed 2,600 serodiscordant couples, (one person HIV-positive and the other negative) for ten years. They had all kinds of sex, and if the HIV-positive partner had an undetectable viral load, they never transmitted the virus to the other.

With regular testing you can get quick treatment. For HIV prevention we offer PrEP and PEP. PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) are safe and effective medications to prevent HIV. Northland Cares offers these services at both our Cottonwood and Prescott offices.

The simplest way to prevent STIs is condoms and lube. We offer condoms in every color, size, shape and flavor. There are specialty condoms. For example, we have one called the Pleasure Dome, specifically designed for males with large-glans penises, or ‘mushroom caps.’ This has the extra girth necessary for a comfortable fit. There are also internal/female condoms that can be placed inside for protection. Part of this condom hangs out for easy removal. You have to put them on correctly for them to work properly. All our condoms are free to the public.

This month Northland Cares is hosting a Condom Connoisseur Contest. Stop by an office or testing event and pick up a pack of condoms. A QR code in the packet will take you to a site to give us feedback on the condoms, their performance and how you rate them. Each pack has ten condoms in different styles, flavors, fit and color. This feedback helps us with education and knowing what people prefer. By entering you have the chance to win a $25.00 Fry’s gift card!

Our Outreach Department also offers sexual-health education and harm-reduction services. Please join us in reducing the stigma surrounding sexual-health education, treatment and STIs. Having an STI is not a reflection of a person’s character or worth. They are communicable and common to every human community.

This is Hedda Fay reminding you that sex is a part of the human experience and an important part of your overall health and wellbeing. Resources are available to prevent the spread of STIs.

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It’s estimated that every 68 seconds a person is the victim of sexual violence or abuse in the US. That comes to about 1,271 people every day. 

People respond differently to sexual assaulted/abuse and threatening situations. We’ve all heard of the fight-or-flight response, but there’s another that’s not mentioned enough: the freeze response, a very common response to stress and violence.

It’s a physiological response that begins in the amygdala, the part of our brain that senses danger and sends signals to our brainstem, which controls motor response. If the amygdala senses a threat that’s non-life-threatening, the freeze response can occur. This is a natural, neurobiological, unconscious response that our brain makes in processing fear.

Freezing during an assault does not mean that the person has not been sexually assaulted. Consider Harvey Weinstein: his defense team said that many victims froze and didn’t fight him off. The man weighed almost 400 pounds, and he was extremely powerful and influential. Thankfully he’s been removed from society for a long time.

Sexual assault comes in many forms and affects every group, class, gender, faith, orientation, ethnicity, profession, etc. It’s an equal opportunist, a horrible, life-altering, criminal act. These acts cause sexual, psychological and physiological harm to the victims. I am a survivor of sexual abuse/assault, I know the different facets of my life it affected, and the work, healing and enlightenment I needed to thrive after, a journey of healing I continue today. It’s survivable, and with work you can thrive after it. I have had friends and relatives who survived their sexual assaults only to die by suicide afterward. Sexual assault can kill, even after the assault.

Can someone always tell when they’ve been violated? What if you are out with friends, or on a date, and you wake up the next day not recalling what happened, because someone put a drug in your food, drink or vape that rendered you unconscious? Do you need to have physical signs of trauma to have been assaulted? Not always. These instances of predatory people rendering others unconscious so they can have their way happen more often than most people realize. If something like this has happened to you, you are the victim of a crime. Please get help and support — do not suffer alone in silence.

Sexual assault is defined as “illegal sexual contact that involves force upon a person without consent or is inflicted on a person who is incapable of giving consent (because of age or physical or mental capacity) or who places the assailant in a position of trust or authority.”

Here in Arizona we have strict laws and statutes that protect victims and society. Under Arizona statute a person convicted of violent sexual assault may receive a natural-life sentence. In my opinion this should be the standard for all sex crimes — child molestation, sexual assault, sexual conduct with a minor, possession of child pornography (not a victimless crime), continuous sexual abuse of a child, sexual extortion, bestiality, etc. Sadly, I don’t get to make the rules.

What happens if you are attacked from behind, or in your home, or have said no to someone and they force themselves on you, or you agree to kissing and cuddling and the person takes it further than you have agreed, or someone spikes your food, drink or vape and you wake up feeling violated, or your child is violated — what can you do?

Here in Yavapai County we also are fortunate to have the Yavapai Family Advocacy Center and the Verde Valley Sanctuary, where trained professionals offer advocacy, mental-health and forensic support. These agencies work with law enforcement to provide a full spectrum of victim-support services so you never have to be alone. Our local law-enforcement agencies have specially trained officers/detectives to respond to these crimes.

Not everyone is able to come forward when these crimes occur. There can be fear, victims may have been threatened, there could be a power disparity between the perpetrator and the victim. The agency Rape, Abuse and Incest National Network (RAINN) has a website, rainn.org, where you can find support and learn if your state has a statute of limitations on reporting and prosecuting sex crimes. Arizona has statutes of limitations based on the class of the felony or misdemeanor. For crimes involving minors/children, in our state the definition of a minor is anyone under the age of 18.

If you or someone you know has been the victim of sexual violence, please get help. You are not alone. You are not to blame, it’s nothing to be ashamed or afraid of. You will survive this with help, support and nurturing, and that help is available. If you are in a situation where you cannot negotiate who you have sex with, because you are being forced or exploited, please get help.

The RAINN 24/7 line is 800-656-HOPE (4673). The Arizona Coalition to End Sexual and Domestic Violence has resources too at 602-279-2900 or info@acesdv.org. YFAC: 928-775-0669; Verde Valley Sanctuary Help Line: 800-930-7233 or 928-645-2511.

This is Hedda Fay encouraging you to get support. If you’re suffering from a crime that happened to you years ago, there is therapy available to you today. There are groups and armies of people trained to provide you with help and guidance in navigating the healing journey. I’m sending love and support to everyone who has ever experienced sexual violence or assault: I believe you, and believe in you.

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As a woman in my fifties I know the importance of intimacy in my relationship. Intimacy is sex, yes, and more than sex. A recent study I read about showed 54% of men and 31% of women over age 70 report they are sexually active. Another by the Mayo clinic showed that seniors in their 80s and older enjoy expressing their sexuality, and that a healthy sex life is important as we age. Sex is a means of expression, improves overall physical health, and can help maintain and improve self-esteem.

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Physical changes that happen as we age through menopause and andropause can impede our ability to express ourselves sexually with partners. This month let’s talk about ways to adapt to them.

For males, depending on health and hormone levels, some may experience erectile dysfunction, for myriad medical reasons, and a range of devices available through retailers and online can help achieve and maintain erections.

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Penis pumps create vacuum around the penis, drawing blood into the tissue and facilitating an erection. A good companion for the penis pump is a constriction or tension ring, placed at the base of the penis to help prevent blood from flowing out. These devices can enhance the experience for both partners by helping the erection last, and represent a relatively inexpensive alternative to pharmacological intervention. Note that whenever you are considering using an enhancement device it’s important to consult with your medical provider to make sure it’s appropriate and safe for you.

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You want to look for high-quality products designed for medical use. Once you get the pump it’s important to keep it clean and in good condition. You want to start with a clean, flaccid penis, and apply a water-based lubricant to the base for a comfortable seal. Insert your penis and begin pumping; this will draw blood down into the tissue. Once you achieve erection, slide the constriction ring down to the base of your penis to maintain it. You don’t want to wear this for more than 30 minutes. If you feel discomfort or numbness, immediately remove the ring.

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Ladies, your vaginal tissue ages and needs hormones to maintain its wet and plump properties. Make sure that if you’re experiencing dryness, discomfort or lack of self-lubrication you consult your provider about hormone-replacement therapy. Without maintenance the vagina can atrophy and even tear, but have no fear, a vaginal dilator can help. You’ll want a medical-grade dilator that varies in size, starting out small and gradually increasing.

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As with all sexual-enhancement devices, you want to make sure both you and it are clean. Use a water-based lubricant on the dilator before insertion, hold it in place for a few minutes and allow your vaginal muscles to adjust to the stimulation. As you become more comfortable you can increase the dilation. Don’t forget to breathe, and relax! Again, consult with a medical professional before using a dilator or Kegel ball, which can help strengthen your pelvic-floor muscles. For women who’ve experienced childbirth or trauma, these can be beneficial to overall health, including when you sneeze and suddenly need to urinate.

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As we age, we get drier, trust me. Self-lubrication is not as it once was. There are silicone-based, water-based, CBD-insert and melt lubricants, oil-based, etc. It’s important to use a lubricant that works with what you’re doing. If that’s sex with a partner or an orgasm-initiating device for self-play, make sure it will work with the item. All lubricants are not created equal.

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These items are designed to help keep us enjoying sex into our golden years. That includes naked cuddling, couple massages, feather play, silky sheets, candlelight. With Valentine’s Day coming up it might be time to discuss enhancing or being able to reconnect sexually. There are plenty of websites, and even local stores, with knowledgeable staff who can walk you through the different items and devices mentioned. In our area the median age is over 60, so there is greater need for these devices and services. It’s nothing to be ashamed of. Instead, celebrate your body, with all its dots, marks, wrinkles, scars, etc. It’s a part of you that is beautiful and needs connecting. As humans we need to connect.

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This is Hedda Fay encouraging you to explore the available options so you can enjoy sex well into your golden years. There are healthy, affordable options to continue connecting sexually with the people you love and care about.

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Working in HIV outreach and prevention, one of the things we get to share with people is that none of us living in the US has to die of AIDS anymore.

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Recently I learned that a young person who’d lived in our county for many years was diagnosed as HIV-positive in December 2022, at a local hospital. This person was never referred to our agency for care. We never got a call, and they were not sent to our local clinic. They never shared the diagnosis with family. They likely didn’t know that there is hope for people with HIV, it’s very treatable. I recently learned that this young person died of AIDS in a hospital in another county.

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This shocked, upset and deeply saddened me. Here we are, living in the US, where we have the best HIV medical technology available, including medications that can halt AIDS and even reverse it. But what good are these if people don’t know about them? They may as well not exist.

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People in the US who engage in HIV treatment can live to 100. You can survive being HIV-positive longer than most people with Type II diabetes or high blood pressure. Someone who has AIDS can take our antiretroviral medications and in a matter of months they no longer technically have it.

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Yes, AIDS can be reversed now, a completely unheard-of idea years ago. For diagnostic purposes a person has AIDS if their CD4 level falls below the threshold of 200. I have observed CD4 levels increase from six and 24 to a robust 800+ in a matter of months on these medications.

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In some countries, if you’re diagnosed as HIV-positive, you will still die, a reality that many people in the world face. These places lack the resources to test for and treat the virus.

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Sadly, some people still die from HIV-related AIDS in the US too, in large part because many still believe that HIV and AIDS are mutually inclusive. Not anymore.

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I’m not suggesting that if this young adult had been referred to us, they would be alive today. But we missed the opportunity to educate them and let them know that they would survive being HIV-positive, that they can live their life to the fullest, fulfilling their goals and dreams, that our agency would take good care of them. But we didn’t have the opportunity to meet , and we will never know whether the outcome could have been different.

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I spoke with this person’s mother at length, and promised her that we would change how we do business, with the hope that no one would slip through the cracks in our local medical continuity of care — that we will be on call 24/7 for hospital and urgent-care staff to contact us after hours, anytime they have a patient in their ED/ER who is HIV-positive. They can call us and we will respond to their facility with medications, support and an appointment for that patient, and make sure they know they will survive HIV and live a long time.

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As a fast-track clinic we can start people on HIV medications when they test positive or even preliminarily positive. We have staff on call Monday through Friday after hours and over weekends and holidays to respond to these emergencies.

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We can mend the cracks in our local healthcare continuum and make sure no one falls through them again. We can resolve this at a local level, and we are committed to providing these services, to prevent another unnecessary death due to HIV and AIDS. 

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We have the medical technology to reverse AIDS, but it means nothing if people are not educated about it. We have to be able to talk about this virus publicly, just as we do with other health conditions. We have an ethical obligation to provide education to everyone, letting people know that HIV is treatable, that you can survive and thrive with HIV. We have an obligation to our community and society to talk about STDs openly, acknowledge that they happen and spread the word that they are either treatable or curable.

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Whispering about HIV and other STDs increases and perpetuates stigma about them. They’re just as communicable as the flu, Covid or pink eye — we get them, it’s human, and there’s no shame in them.

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I don’t care who you are or what you have, it’s not your fault, and no one deserves these viruses, they just happen. If you have any form of unprotected sex, including kissing, you can get one or more of these. In the US today it’s the stigma, shaming and blaming that kills. We have to stop the judgment and start talking with one another, just as we do about cholesterol, trans fats, smoking and other health issues.

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This is Hedda Fay, with a heavy heart, yet hopeful that we can be the instruments of change by starting to talk about STDs and that HIV is treatable. Please, share this information with five people and ask each of them to share it with five more. Pretty soon the whole county will know that it isn’t a death sentence. Help effect change locally, lives depend on it!

In the vast landscape of Yavapai County, where rural communities are scattered, access to comprehensive healthcare services is often a challenge. But nestled in the heart of our region is a beacon of health and hope: the Northland Cares rural healthcare clinic. Specializing in HIV care, medical case management, HIV-prevention strategies, testing services, PrEP, PEP and hepatitis-C curative services, our clinic plays a pivotal role in transforming lives. In this column I’ll delve into the critical importance of donations, illustrating how even a modest contribution can have a profound impact on our local healthcare landscape.

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Comprehensive HIV Care: Our clinic is a lifeline for individuals living with HIV in Yavapai County. Donations support the provision of state-of-the-art medical care, ensuring that patients receive the attention, medication, and support necessary for managing their condition. This comprehensive approach not only improves the health of individuals, but also reduces the transmission of the virus within our community.

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Medical Case Management: Donations play a crucial role in sustaining our medical case-management services, which guide our patients through the complexities of our healthcare system. Case managers ensure that individuals receive timely and appropriate care, navigate insurance processes, adhere to treatment plans and provide our patients with the support they need. Case managers help provide housing and utility-payment assistance, as well as vision and dental care. They are essential to our medical team, removing barriers that can prevent patients from taking their antiretroviral medications, and as a result 94% of our patients have undetectable viral loads, which means there is less HIV in our county.

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HIV Strategies PrEP and PEP: Beyond treatment, our clinic is dedicated to preventing the spread of HIV. We provide PrEP services to people throughout the county and surrounding areas, and are available for PEP emergencies, such as needle-stick injuries and sexual assault, 24-7. Donations support education and access programs for pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), two crucial prevention strategies. We also provide medical case-management services to people using HIV-prevention strategies such as PrEP and emergency HIV medication, PEP. This personalized approach enhances health outcomes and empowers individuals to take control of their wellbeing.

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By contributing, you actively participate in breaking the cycle of transmission and safeguarding the health of our community.

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Rapid Testing Services: Our clinic’s commitment to accessibility includes rapid HIV and hepatitis-C testing. Donations directly impact our ability to offer these services promptly, offering timely diagnosis, counseling, and support. Early detection not only improves individual health outcomes, but also contributes to community-wide disease-prevention efforts.

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Mobile Health Unit: Donations fuel the operation of our mobile health unit, a literal lifeline reaching the farthest corners of Yavapai County. This unit extends the reach of our clinic, taking essential services directly to underserved communities. Your contribution helps us provide medical care, testing and prevention services to more people, reducing barriers to access and promoting overall community health.

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Qualified Charitable Organization: Northland Cares is a 501c3 nonprofit Qualified Charitable Organization. We have been recognized by the IRS as charitable, meaning your donations are tax-deductible. By donating to us you are choosing to support a cause you believe in, and you can enjoy financial incentives that make your philanthropy more cost-effective. You can take control of where your tax dollars go rather than leave your tax contribution solely to government allocations, choosing to have the money align with your values and priorities. This empowerment offers you a sense of agency in shaping the positive impact you hope to see in your community and beyond. Your tax-deductible donations to Northland Cares allow you to support healthcare and medical justice while championing a cause and making a tangible difference in our community. You get a dollar-per-dollar deduction from your state tax burden. Individuals can donate up to $400, and couples $800. So if you owe the state of Arizona $400 in state taxes and donate $300 to Northland Cares, you’ll only owe $100 to the state. (I’m not a tax professional and can’t provide tax advice, so I recommend you speak with your tax professional for guidance.)

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Our rural healthcare clinic stands as a testament to the transformative power of accessible and comprehensive healthcare. Your donation, no matter the size, is the force behind our ability to provide vital services to Yavapai County’s diverse population. By contributing you become an agent of positive change, supporting not only the health of individuals, but also the wellbeing of our entire community. Together, let’s continue building a healthier, more resilient county, where every donation, no matter how modest, truly helps a great deal!

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We’re all busy and passionate people hoping to affect change, and your continuing support for Northland Cares does that in your community. This is Hedda Fay, thanking you for being a friend of Northland Cares and supporting our mission for a healthier Yavapai County.

This month’s topic is PrEP and PEP. These HIV-prevention strategies are for more people than you may realize, maybe even yourself. Northland Cares has been providing services and health care to people living with HIV for more than 20 years, but it’s just in the last two that we’ve been able to offer these important prevention services.

Pre-Exposure Prophylaxis (PrEP) is a safe medication that can be taken daily, and we now offer an injectable version that will prevent HIV transmission if taken as prescribed. PrEP medications do not prevent any other sexually transmitted diseases, but we test our PrEP patients every three months for other STDs to be sure we can provide treatment when it’s needed. All STDs are either treatable or curable, and we offer services for both.

How do we know that PrEP medications are safe and effective? I’m glad you asked! We know this because we have used these medications for years to treat HIV-positive patients and been able to successfully suppress the virus in them with these pills. Some people have concern about PrEP medications because they’ve heard that some people develop kidney problems using a medication called Truvada. The adverse effects of Truvada affect 1-3 percent of those taking it, and once they quit taking it and switched to a different prescription those issues resolved.

A range of medications can be prescribed for PrEP HIV prevention, including a new injectable medication called Apretude (aka cabotegravir), an excellent preventive medication. This does not require taking a daily pill, but it does require regular treatment, so patients can’t miss their appointments.

Our providers are infectious-disease specialists, so all our patients receive a very high level of preventive care. PrEP medications are for everyone. If you enjoy having sex with a variety of people, or occasionally step out on a partner, this is an excellent prevention strategy for you. For those who occasionally have sex with different people in the course of a year, PrEP is a great prevention tool.

I hear people say that we all should just use protection or have a committed monogamous relationship, but what’s real is that those are just not for everyone. There are many reasons why some people don’t use prophylaxis (condoms) and are not in committed relationships, but they still want to enjoy sex and the intimacy of sex.

Did you know that 85% of new cases of HIV in heterosexual women are from unprotected heterosexual encounters? It's true, fact-check me. Still, many people inaccurately think of HIV as a disease that mainly affects the LGBTQ+ community. Well, there are more cases of HIV in the heterosexual community than in the LGBTQ+ community, and those among heterosexuals are on the rise, largely due to this misconception.

I work in outreach, so I hear it all in talking with members of our community. There are many misconceptions circulating with help from well meaning but poorly informed individuals. When we can, we educate.

Did you know that the LGBTQ+ community tends to be more responsible with their unprotected sex than the heterosexual community? It’s true, and we see that daily. I want to invite anyone who is in a swinger group, a party-and-play group, or has sex with anonymous partners or one-night stands to come and get a free rapid HIV and Hepatitis C test from us at Northland Cares. We provide curative services for Hep C, and that's much easier to get than HIV.

Let’s have a PEP talk. Post-Exposure Prophylaxis (PEP) is an Emergency HIV intervention that we carry in our office. A lot of people might need PEP: first-responders, housekeepers, thrift-store employees, janitorial staff, sanitation workers, trailhead, creek or park clean-up volunteers, and anyone who is at risk of or experiences a needle-stick injury.

This medication is also for people who are victims of sexual assault or have had their beverage or food drugged and are victims or possible sexual/exploitative crimes. PEP is an excellent HIV prevention strategy. We only have 72 hours from the time of exposure to get the medications into the person — the closer to the time of exposure, the more effective the medications are. Did you know HIV can survive in a discarded syringe for 42 days? Even a dirty, janky-looking syringe can hold live virus material. It only takes a split second for it to enter your system through a needle-stick injury.

Law-enforcement and rape-crisis workers, you can add our services to yours by simply calling us when you encounter a victim of sexual assault. We’ll come to you, the hospital, urgent-care center, shelter, wherever, with the medications and a new-patient packet. We’re only a phone call away, or just walk into one of our offices in Prescott and Cottonwood. You do not need an appointment to start PEP, you just have to walk in or call us if you live farther away. We can meet you in a mutually safe location to get you started on PEP.

To date we have not had any PEP patient become HIV-positive at Northland Cares. If you are having sex with someone with unknown HIV status and the condom breaks, call us or come in for support. If you hook up with someone, check their medicine cabinet and find HIV medications and are afraid to ask, you can call us. You can also ask the person if they are undetectable. HIV-positive people who are undetectable, meaning their viral load cannot be detected using venipuncture labs, cannot transmit the virus, even with unprotected sex.

The NIAID followed 2,500 couples in which one person was HIV-positive and the other negative for ten years, and they reported all sorts of unprotected sex. The agency found that when the person who was HIV-positive had an undetectable viral load, HIV was not transmitted to the partner. That is some good solid evidence!

This is Hedda Fay reminding you that we’re here for you, with excellent, safe HIV-prevention strategies, in the form of PrEP and PEP, and free prophylaxis! We want you to have enjoyable and safe sex!

I’m in my fifties, and many of my friends are in my age group or near it. Talking with some friends I learned that their husbands’ moods had recently, suddenly and drastically changed. Their fun-loving partners of many years had become more like Jekyll and Hyde than their cuddly normal selves. They were experiencing mood swings, sometimes severe bouts of tears or rage, and appeared to be all over the place. I thought that there must be a scientific term for males who are experiencing a change in life, and discovered andropause.

Andropause normally begins in males in their late thirties or early forties, caused by changes in testosterone and estrogen production, like menopause in females. Men, you need hormones for more than your libido. You need both testosterone and estrogen. All humans can benefit from varying amounts of these hormones for physical, mental, and emotional health.

Estrogen is typically discussed as the ‘female’ sex hormone and testosterone as the ‘male’ sex hormone, but you should know that both sexes need both hormones in varying amounts. Our bodies are ruled by hormones for a lot of functions, and today we’re discussing sex hormones. In addition to estrogen and testosterone we all have follicle-stimulating hormones and luteinizing hormones that stimulate our gonads (ovaries and testes) to make estrogen and testosterone.

So let’s explore andropause. When men approach periandropause and andropause, they can experience a variety of symptoms that are normal factors in this change of life.

Falling estrogen levels can affect mood and emotions in males too. Estrogen is an important component in every person’s emotional balance and a multifunction hormone for males, crucial for promoting sexual function, maintaining bone density and helping regulate cholesterol. In males there are two types of estrogen, estrone and estradiol, both necessary for proper functioning.

You need estrogen in your body to produce sperm. Another concern with low estrogen in males is hypogonadism, which is a condition that causes a lack of hormone production in your whole body, meaning lower testosterone too. Too much estrogen can cause myriad problems, including erectile dysfunction (due to impairment of blood flow), weight gain, gynecomastia (manboobs), reduced sex drive, depression, reduction in sperm production and lower-quality sperm, muscle loss and more. It’s a careful balance between too much and too little.

Let’s look at testosterone in andropause. As males age, their production of testosterone slows and reduces. This can cause many symptoms, including loss of energy, mood swings, irritability, increase in body fat, reduction in muscle mass, difficulty getting and maintaining an erection, reduced sex drive, depression, angry outbursts, rage, testicular atrophy (shrinking of the testicles), loss of elasticity in the skin, swelling of breast tissue, thinning of hair and even hair loss, and erosion of cognition and memory.

More serious medical problems can come for males with the reduction in testosterone, like stroke, gall-bladder problems, ulcerative colitis, uncontrolled diabetes, and myocardial infarction (heart attack). It’s very important for males to get their testosterone checked in their thirties and forties to prevent problems. If you or a loved one is experiencing these symptoms, go see your medical provider, who can run some blood tests to determine your hormone levels and recommend treatment.

Another important sex hormone in males is progesterone. Progesterone helps with sleep, production of bone mass, thyroid hormone production, and brain activity. This is another hormone level your provider may check.

These changes are nothing to be ashamed of, and if you’re out there feeling like you’ve changed and lost control of your libido, emotions or cognition, it could be because you’re experiencing andropause. If your hormones are off balance, there are ways your medical provider can assist you with options for getting them back to the levels you need for homeostasis. Primary-care doctors, endocrinologists and even some cardiologists do this.

If you or a loved one is experiencing any of these symptoms, see your provider. If you have no insurance, the Yavapai County Health Department lists providers who can see you on a sliding-scale fee basis. They also have wonderful people who can help you apply for AHCCCS and other health plans. You do not have to suffer in silence or inside your head. There are therapies that can correct these imbalances and get you feeling like your old self soon.

This is Hedda Fay reminding you that our bodies are fleshy machines, sometimes they need extra stuff to keep us moving around and feeling comfortable. If you’re feeling foreign in your own skin, go see a provider and get a hormonal tuneup!

As a woman in my 50s I’ve experienced both perimenopause and menopause. As a sister to three, with many female friends and colleagues, I know how important it’s been to share these changes in my body with my girlfriends. These changes and chapters are different for each of us. If you’re lucky enough to live long enough to experience them, don’t fret, embrace them! Embrace the process of gradual transition. After all, we are more than people who menstruate and can birth a child.

The age at which females begin to experience perimenopause can vary just as much as the onset of our periods/menses. Some will experience it earlier than others, and that’s all right. I want to stress that if you’re experiencing these symptoms, you’re not alone. A visit with your OBGYN or primary-care provider can give you support and a road map to homeostasis. Perimenopause starts in the twilight of our reproductive abilities, with fluctuations in estrogen levels. Both males and females produce estrogen, and it’s responsible for regulating a lot of body processes, including our emotions.

With these fluctuations we can experience vaginal dryness, depression, weight gain, night sweats, mood swings, breast tenderness, changes in blood cholesterol, lower bone density, fatigue, pain, anxiety and stress. (Sounds a lot like Menses Part 2, right?) Fear not, you should notice a decrease in menses occurrence and volume, which can save you a little money.

It can be uncomfortable with our partnerswhen we’re trying to engage in sex and feel  aroused, yet find we’re not self-lubricating as we once did. This may also make our partners feel as though they’re not turning us on and cause a whole other situation, if you know what I mean. Yes, there is personal lubricant. You may want to make an appointment with your provider and bring your partner, so they can understand that more foreplay is important and this is biological. It happens to us all. I found myself having vaginal dryness even just walking around, so I kept lubricant packs in my pocket or purse, and would put some on after using the bathroom so I wouldn’t have toilet paper stuck to my parts.

Your provider can check your hormones and thyroid too. We humans are ruled by hormones. If they find your estrogen and testosterone are low, or one is higher and one is lower, they can treat that with hormone-replacement therapy.

If you have close girlfriends or sisters you can talk about your life with, you can probably bring up what you’re going through. Think back to when you started your period, and old Aunt Flo first came to visit. Mortifying, right? Painful, both physically and emotionally. As women we’re past that, some of us have given birth and others not, all normal. This is easier to discuss because we’ve been through hundreds of menses. Now we’re older, more mature, and able to discuss life more easily than we were in our teen and preteen years. If you haven’t discussed this, try talking with your friends. They’re probably experiencing similar changes.

For those of us that must have our parts removed prior to the onset of menopause, depending on what’s removed, you may have rapid-onset menopause. Here again, your OBGYN can recommend hormone-replacement therapy to offset the symptoms of menopause.

The climacteric phase of life, when our ovarian activity begins to slow down and dwindle, continues through menopause and the end of ovarian activity. Some females experience no symptoms or experience them so mildly they may not notice.

It can feel mild, or like someone going through drug withdrawal. Talk about it. If you start to experience one or more of these symptoms, consult your provider, and get your hormone levels checked. Not getting help can cause more severe complications, like atrophic vaginitis, or thinning of the vaginal wall due to low estrogen. This can cause vaginal itchiness, pain with sex, urination urgency, and with sex can even lead to a tear in the vaginal canal, something none of us wants. People may discuss the changes with humor, but they can be serious if left untreated. Talk to your girlfriends, sisters and the females in your life.

I have found taking hormones to be a great way to alleviate these symptoms. Treatment forms vary — homeopathic, medication and even bioidentical hormone pellets that are put in your hips every three to six months. I recently switched from taking estradiol to these pellets, and have found them to be more effective for me.

The first step to finding relief is to talk with your provider. A nice thing about taking daily hormone pills is any adverse reaction can be quickly gone. It’s good to try options to see what works for you.

This is Hedda Fay reminding you that you’re not alone, and the symptoms you’re experiencing are part of living long enough to have them. Talk with your provider, your girlfriends and relatives. It’s part of the world sisterhood, and it’s okay to experience this.

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Next month: andropause!

Last year, in a conversation with a friend who is back to the dating scene, she asked me about two terms she’s noticed on some dating apps: ‘side’ and ‘pegging.’ They were foreign to me as well, so I began my research.

For ‘side,’ think of a big meal; there is a main course, then there are side dishes and desserts. With sex, if receptive/insertive vaginal and anal intercourse is the main course, then the sides are everything else. Some people no longer want to have insertive or receptive vaginal or anal intercourse.

There are myriad reasons for this. It could be due to previous lived experience, pelvic-floor dysfunction, pain, antidepressant use, medical condition or many other medical issues that make vaginal and anal intercourse impossible. Vaginal intercourse can be overrated for females, as it is estimated that only 25% of us achieve orgasm that way. Unless the female is on top or having sex doggy style, they won’t have clitoral stimulation, which is what helps with orgasm. Let’s be honest, we all want orgasms — they feel fantastic. But females don’t need vaginal intercourse to reach the height of orgasm. This is where toys come in.

Sides enjoy robust sex lives filled with satisfying orgasms, and intimacy with their partners. Think about the many of ways to achieve orgasm without intercourse: cuddling, caressing, touching, playfulness, whole-body embracing, hand massaging, digital stimulation, oral stimulation and the use of vibrators, dildos, or penis sleeves. Couples who enjoy side forms of sex enjoy the same intimacy as those engaging in intercourse. They may be even more in tune with one another. Showing one another, through masturbation, how they like to be touched and how you enjoy sex with yourself is extremely revealing and intimate.

It’s estimated that three-quarters of females need clitoral stimulation to achieve orgasm. Clitoral stimulation is easily achieved using vibrators, toys or finger play. Males do not have to be fully erect to achieve orgasm or sexual pleasure. Most people believe that if a man isn’t six-to-midnight, they are not aroused, and that is not true. After the age of forty, males’ ability to obtain an erection can be unreliable. For males with erectile dysfunction there is 30% chance that medications like Viagra will not work. But these males still enjoy the stimulation of cuddling, caressing and other body-engaging activities to stimulate the brain to release those feel-good orgasmic hormones.

If you are back in the dating pool, or in it for the first time, if you see a category for ‘side’ you’ll understand what that person means.

‘Pegging’ is a newer term for an age-old practice, receptive anal sex for males. Why do men like or find pleasure in anal sex? For starters, the biological male has a prostate gland between the bladder and penis. When stimulated, the prostate (which has millions of nerve endings) can initiate an orgasm. Males can experience sexual stimulation through receptive anal sex and achieve orgasm.

If a male likes to have receptive anal sex, that does not make them gay. There is a term in the sexual-health and prevention community called MSM, which stands for men who have sex with men. These MSM males do not identify as gay or bisexual. Men having sex with men is a behavior, not an identity.

Pegging is when a male asks a female to wear a strap-on penis and penetrate them rectally. It is a thing. Since the prostate gland is erogenous, stimulating it can increase the length and intensity of orgasm when ejaculating. Some men who engage in pegging describe the orgasms they achieve as among the most powerful they ever experienced.

Enjoying receptive anal sex has a biological component, not an orientation one. Prostate massagers have been used for years to treat prostatitis. They come in a range of sizes and shapes. Some have discovered they liked prostate play after a medical provider recommended stimulation to reduce the swelling caused by prostatitis. Men who enjoy pegging/prostate play and stimulation report experiencing uniquely powerful, full-bodied, deep orgasms. Men also report enjoying the vulnerability they experience when their female partner penetrates them. For their female partners, pegging can be very empowering too.

Anal training is needed before penetration, for safety and to reduce the fissures that can come with anal sex. Lube is important; lots of lube should be available when engaging in anal play of any kind, especially if it has been an exit-only opening. Make sure your lubricant is compatible with the toy or prosthetic you decide to use. Silicone lube doesn't work well with silicone toys, for them you want something water-based.

This is Hedda Fay reminding you that sex is variable and different for every one of us. To know what you like, you have to try different things. Use protection and get tested regularly to prevent sexually transmitted infections.

When I was a child growing up in the 1970s there was a robust Stranger-Danger campaign that taught us as children not to get in cars with strangers or communicate with people we didn’t know. It created visions of maniacal, trench-coat-wearing weirdos out kidnapping and harming children. It is still a great idea to teach children not to get into a car with a stranger. But there’s more to it.

In my former career I was a sex-offender coordinator who processed packets for sexually violent predators for the state of Arizona. I did this job for several years, in which I learned the reality of “grooming.”

That reality is that most children are sexually assaulted by people who are in their social circle or social periphery. The perpetrators of these crimes are pedophiles. Pedophilia is when a person is sexually aroused by children, typically aged 13 years and younger.

Who are these predatory people? They are family members, parents, older siblings, aunts, uncles, cousins, grandparents and in-laws. After family members, you have teachers, coaches, clergy, troop leaders, family friends and mentors in the social periphery. These are people who will find ways to access children, including the most vulnerable, to use for sexual gratification and abuse. There is a power/dominance influence with these relationships. Lately we see a lot of commentary about “grooming” minors. How does that look?

There are stages of grooming. Understand these “groomers” also “groom” the parents and guardians of the minors. These predators must first identify a victim. Pedophiles have different “types” regarding appearance, gender and age, and most pedophiles look for victims they see as vulnerable. They then gather information on their target by speaking with the child or the parent/guardian in casual conversations. Then the pedophile will fulfill an identified need. Impoverished children may be given expensive gifts or tickets. If the child is lonely or a loner, the pedophile will become their “friend.” Then the pedophile will lower the child’s inhibitions. They may deploy alcohol or drugs, or engage them in a game or activity that involves touching one another or getting undressed. They may offer to show them pornography or illicit magazine materials.

These are people who look for families in distress, who need help. The pedophile wants to be the “savior,” the good guy/gal/person, by watching children, taking them out, helping with bills. Once the abuse starts, they may blame the child, threaten to harm the child, the parents or other people they care about, including pets, to keep their silence. Remember the power/dominance in this relationship. If there is an adult who knows a lot about your child and what they like, etc., be wary of that person. It’s sad that those who appear the most helpful, kind, giving, and supportive can be the people you most need to worry about.

Of the sexual crimes reported to law enforcement by juveniles, 93% knew the person who was abusing them, 59% were acquaintances, 34% were family members and 7% were strangers. This also means that in most cases a parent knew the perpetrator.

If your child comes forward, believe them first. It may be difficult to hear as a parent that someone you know may have harmed your child. You may scream “no!” on the inside, but take all allegations seriously. Look for changes in your child’s attitude, behavior or school performance. If your first instinct when meeting an adult who will have access to your child is that you do not trust them, trust that. Your parental instinct says this person may not be as they portray themselves. If your child doesn’t like a certain adult, trust that too.

Some pedophiles want rights and to be identified as a protected class, that their sexual orientation be recognized like the LGBTQ+ community. The LGBTQ+ community finds pedophiles as reprehensible as the heterosexual community. Why? These community members have been victimized by pedophiles too. They will not add this group to their flag or acronym.  Organized pedophiles have been trying to associate themselves with the LGBTQ+ community since the beginning of that identification in 1978.

It’s important to point out that LGBTQ+ community members engage in consensual relationships with one another, and value consent in relationships and sex as much as everyone else does.

The idea that pedophiles are any less dangerous because they watch child porn is a fallacy. Child pornography is not a victimless crime. With the advancement of technology and the use of the internet on mobile devices, the numbers of photos and videos of children being sexually violated are at record levels. That means there are more children being victimized — supply and demand.

This type of abuse is damaging. Having your dignity removed from you as a small child or teenager can have lifelong impact. What can victims do? In Arizona you have the right to sue the abuser for up to twelve years after you turn 18. In Arizona if the child victim is between 15 and 16 years of age there is a seven-year statute of limitations from the time law enforcement is made aware of the crime to charging the perpetrator. If the victim is under the age of 15 at the time of the crime, there is no statute of limitations.

If you have been victimized and you do not know where to get help locally, contact the Yavapai Family Advocacy Center (928-775-0669) or The Sanctuary in the Verde Valley (928-634-2511). They have trained professionals to help victims of violence and sexual violence. They also work with forensic interviewers, therapists and law-enforcement to aid in bringing these predators to justice. You do not have to go into a police station to get help, they will come to you. Law-enforcement officers take these allegations extremely seriously.

This is Hedda Fay reminding you that your body is yours. You have the right to decide who touches it and who doesn’t. If that is ever violated, you are a crime victim and deserve justice. The pedophiles may appear powerful and influential in communities, but they do not have power over laws designed to protect us from them and their actions.

I get to talk about sex and prevention a lot in my day-to-day here at Northland Cares, and why is sex important. Sex is a part of who we are, both as individuals and a species. Good sex needs three ingredients: consent, good feelings, and safety.  Sex is fun! Right, those butterflies in our stomachs turn into sweaty palms (sometimes), giggles, feeling flushed and excited about connecting with someone.

For those of us who have experienced sexual trauma, and I had my share while growing up too, experiencing sexual trauma does not mean you can’t find joy, satisfaction, and fulfillment sexually. You can; you just may have to do some self-pleasuring and therapy to regain your power when it comes to sex.

Sex does not have to lead to orgasm for it to be pleasurable, although the Big O does help body, mind, and spirit in myriad ways. Did you know that sex is good for your health? Recent studies show that for males, having 21 orgasms each month can reduce the risk of prostate cancer by 33-35%. Studies have shown that males who have sex at least twice a week (including masturbation) are less likely to suffer cardiovascular disease than men who have sex/orgasms once a month.

Ladies: the more sex and orgasms you have, the stronger your pelvic wall will be. What does that have to do with me, you may wonder. As females age and have children, our pelvic walls can weaken (having a hysterectomy can also influence this), affecting our ability to control our bladders. Strengthening the pelvic wall can reduce urinary incontinence or leaking — no more rushing to the toilet due to leakage or an unexpected need to urinate. If you don’t have a partner, masturbation can help build a stronger pelvic wall, as can the Kegel exercises we know and love.

The many health benefits we can attribute to sex include reducing blood pressure, specifically systolic blood pressure, the first number on your blood-pressure test. Sex can’t replace a vigorous workout, but it is a form of exercise. You burn more actual calories than couching it, and it boosts your heart rate and muscles, depending on your sex.

Better hormonal balance is another result of having sex, helping keep your testosterone and estrogen levels in balance. Sex and orgasms can reduce physical pain, releasing a hormone that can raise your pain threshold. Sexual stimulation can do the same even if you do not reach orgasm.

You can get better sleep after sex. After you climax your body releases a hormone called prolactin, which is responsible for feelings of relaxation and drowsiness.

Sex can reduce your stress level. When embracing, hugging, kissing and engaging in intercourse, your brain releases the ‘feel-good’ hormone, the endorphin called dopamine. Dopamine lifts your mood.

Having sex can improve self-esteem and boost overall happiness. Sex can also activate your immune system — not enough to stop the transmission of sexually transmitted infections, but those who have sex once or twice a week lose fewer days to sickness. Their bodies produce higher levels of Immunoglobin A, an antibody found in the mucosa of the lungs, genitals, stomach and intestines that fights bacteria and viruses. Their IgA may be 30% higher than those who are not having sex as often. That’s additional protection.

Sex can increase your libido. That’s right, just as exercising makes exercise easier, it’s the same with sex. People who engage in sex and self-pleasure can reach orgasm more easily, and women more easily self-lubricate during coitus.

This is Hedda Fay reminding you that sex has to be consensual, fun, and safe. Consent also means that both parties understand the risks and what is being requested or suggested. Now go out there and have your best sex ever!

In the past six months I have been approached by several people who have Klinefelter Syndrome, a genetic condition that often goes undiagnosed. Klinefelter Syndrome is an aneuploid genetic condition, in which a biological male has an extra X-chromosome, not XY but XXY. Having an additional X-chromosome does not provide any superpowers or advantages in life. In fact it creates some bumps on that path. Aneuploidy simply means the presence of an abnormal number of chromosomes in a cell: instead of 46, they can have 45 or 47. This endocrine disorder was first discovered in 1942.

Worldwide the estimate is one of 500 males born will have some variation of Klinefelter Syndrome, and a recent study estimates that half of those are unaware they have it. About 80% of Klinefelter cases possess the 47XXY karyotype. The remaining 20% either have the higher aneuploidy karyotype 48XXYY, a more severe form, or one of the mosaicism karyotypes 46XY or 47XXY, the milder forms of the genetic disorder. A karyotype is the complete set of chromosomes for a particular species or organism, you know, like us primates. It also refers to the imaging of a person’s chromosomes.

Klinefelter Syndrome can be diagnosed through karyotyping, a blood test designed to look for chromosomal abnormalities. Hormone testing for low testosterone can be done, and a prenatal amniotic fluid chorionic villus in the placenta can also be checked for chromosomal abnormalities.

There are different degrees of Klinefelter syndrome. For example, some males have the  extra chromosome in only some of their cells, resulting in a milder syndrome, and this is referred to as mosaic Klinefelter syndrome. Males with more than one additional chromosome (XXXY) tend to have more severe symptoms that those with the mosaic version. These variants are rarer, occurring in about one in 50,000 births.

Symptoms can help parents and caregivers spot Klinefelter syndrome in young males. Babies can show delay in motor-skill development, reduced muscle development and strength, smaller testicles, low testosterone or weak bones. As these males age, they may have delayed puberty, smaller testicles, broader hips, a tall, thin stature, reduced sex drive, increased belly fat, or even some defects in cognition.

A mild case, as evidenced by hormonal testing, may not require treatment. If it is more than mild, it’s important to seek hormonal therapy at the onset of puberty. Males with low testosterone are at increased risk of developing osteoporosis, breast cancer (yes, men get this more often than you think), diabetes, autoimmune conditions like lupus, heart disease, blood-vessel complications, anxiety or depression, infertility, or poor sexual function.

It’s estimated that 10% of the boys with this disorder also have a diagnosis placing them on the autism spectrum. Boys with Klinefelter are taller than 60% of their counterparts by age eight. Males with this disorder tend to be taller, have narrower shoulders, longer legs, wider hips, and a larger arm span than men with 46 chromosomes. This syndrome does not appear to affect life expectancy. It’s further estimated that half the males living with this are undiagnosed. If you are a parent of a male or a male who has experienced any of these symptoms, you may want to get your testosterone checked, and if need be a karyotype test to determine whether this is what is affecting you or your child.

These symptoms and effects can be mitigated using testosterone replacement therapy, particularly at the onset of puberty, which will promote muscle development, increase the strength of body and bones, and promote body-hair growth. Early diagnosis is the key to mitigating these problems. One way to optimize potential is to test for the syndrome and treat it, allowing men the medical, educational support necessary for them to have a fulfilling life and their own families.

This is Hedda Fay reminding everyone to be kind to one another, you do not know what syndrome a person may have that affects their appearance or journey in life. Be grateful their burden is not your own, and be supportive however you can. We are all neighbors here, we share public toilets and leisure areas, let’s be a community for each other. If you have an idea for an article, email me! I appreciate all reader feedback and commentary.

My friends, men can be and are underrepresented and underreported victims of intimate-partner violence. The numbers may shock you.

As a female with three sisters and lots of women friends, I know all too well about what we experience regarding violence. I had no idea about the magnitude of male victimization. The numbers are astonishingly high.

I read up on studies from the CDC, ADHS, WHO, NIAID, the National Coalition Against Domestic Violence, the Bureau of Justice Statistics and others for data and information. To stay current I’m always reading articles, blogs, vlogs, etc., regarding sexual health.

The estimates are that one in ten men is a victim of intimate-partner violence, and it’s generally believed that this kind of incident is underreported. Among men who report this kind of physical assault, sexual assault or emotional abuse, 97% identify their abusers as female. When males are “made to penetrate” someone for sex, 79% of the time the perpetrator is also female. Think about that.

Most stalking trainings I’ve attended involved the lethality of stalking violence and what’s now referred to as ‘traditional’ stalking: following, trying to talk to the victim’s family, colleagues, friends, calling, approaching, sending unwanted or misunderstood gifts, or attempts at in-person contact at a victim’s personal or professional location. There is also a lot of cyberstalking. A shockumentary on Netflix called The Most Hated Man on the Internet is a terrifying look into the internet/ email dangers, crimes, and psychology of what a slowly expanding number of people can do to others, cyberstalking on steroids.

Two-thirds of cyberstalking involves unwanted phone calls, VMs, DMs or texts. Almost 60% of traditional stalking included being watched or followed, while almost half experienced their stalker showing up where they would not normally be — think driving or walking by where you work, live, or work out. Approximately 30% of cyberstalking victims report being threatened to have private, intimate photographs or information about themselves released online.

There is a current case of extraordinary violence against a male by a female perpetrator. Taylor Schabusiness, 25, is currently being held on a $2-million bond for the sexual assault, murder, bodily dismemberment and mutilation of her “lover,” Shad Thyrion, then 25. She allegedly raped him, strangled him with a chain, chopped him up and tossed pieces of him around a home in Wisconsin in February 2020. Then on Valentine’s Day 2023 she attacked her own attorney in court.

This unusual case demonstrates that males are victims of violence at the hands of women, including extreme sexual violence. Intimate-partner violence against males, both in terms of incidence and severity, will increase over time, and it can be difficult to detect.

Abusers use hurtful language, threats and intimidation to control their partners: name-calling, interfering with family relationships, preventing you from seeing friends, controlling money or what one wears, acting jealous and possessive, threatening violence, hitting, shoving, kicking, burning, slapping or choking, forcing sex, threatening to accuse you of violence, and blaming you for their behavior.

For gay, bisexual and transgender men there are additional types of violence and threats; if you leave, you’re admitting your lifestyle is wrong, that law enforcement does not care about gay/bisexual/trans men, attempts to tell you that you are not gay/trans/bisexual, threats to tell your family and friends about your sexuality/orientation.

Abuse is cyclic. The abuser will pick a fight (verbal), threaten you, strike you, then apologize and provide a gift or token of affection, and tell you and the world they will never do it again. Shortly the fighting starts again, and we’re back where we started.

The National Coalition Against Domestic Violence estimates that one in 18 men has been stalked by a partner, one in 71 has reported being raped in their lifetime, one in seven has been the victim of severe physical injury by an intimate partner, 44.9% of male rape victims report being raped by an acquaintance, 13.4% of male high-school students report being physically or sexually abused by a partner, and more than half of stalkings of males are perpetrated by females, 5.1 million men in the US have reported being stalked by an intimate partner, and it is estimated that 20 people are victims of intimate-partner violence every minute in the US. That means that of 1,440 minutes in a 24-hour period, 28,800 people are victimized daily in this country.

If you or someone you know may be a victim of intimate-partner violence, there is help: call the National Domestic Violence Hotline at 800-799-7233 (SAFE), visit ndvh.org, or call the National Dating Abuse Helpline at 866-331-9474 or loveisrespect.org.

This is Hedda Fay encouraging you to break the generational abuse cycle in your own life. If you grew up with violence, as I did, you can break the generational curse your family is experiencing — get help. If you have a friend or loved one in the throes of abuse, talk with them and help them develop a safety plan.  Try to get them help before it’s too late.

Gonorrhea is back in the news, with headlines across the nation warning about it becoming a medication-resistant superbug.

Gonorrhea is a curable bacterial infection, for now. This bacterium has been with us primates at least since 2,600BCE, when the Chinese Emperor Huangdi, aka the Yellow Emperor, described it in his classic medical text. Hippocrates wrote about it as well, and in 1,100CE the English enacted strict laws trying to stop the spread of the disease. Once commonly called “the clap,” this communicable bacterium caused armies to lose wars.

Early treatments for gonorrhea included smacking the infected area (penis) with books to get the pus out, inserting alcohol-soaked eeds into it, using heat, mercury, oils extracted from tree sap and silver nitrate injected into the ureters and urethra. It wasn’t until 1943 that US military hospitals began using penicillin to treat gonorrhea. In 1946 four patients were documented with a strain that was resistant to penicillin, which is how far back the current challenge goes. The ‘60s brought new treatment with tetracycline. Gonorrheal resistance seems to develop after only a few years with every medication that has been initially effective.

You might wonder, why the concern now? We are running out of medication options to treat this infection. Bacteria have one goal, survival, so they naturally develop resistance whenever antibiotics or antimicrobials are introduced. Their presence puts a lot of pressure on the bacteria, forcing them to adapt to what’s attacking them to survive. The problem with antibiotics is they are equal-opportunity killers, unable to differentiate between good and bad bacteria. Their mission is to wipe out all bacteria, including those naturally occurring in our bodies that help us, leading to other kinds of health problems.

We call harmful bacteria pathogens. They want to live, so they develop their own strategies for survival. They develop proteins that can harden their survival mechanisms. Bacterial DNA is evolved to assist with survival. Bacteria can share their tricks and strategies for survival with other pathogens that have not even been exposed to antibiotics, making their pathogen friends wise to what can happen and how to prepare. They deliver their strategies firsthand.

Part of the resistance we’re seeing now is due to laboratory failures. Culture testing was once the standard, in which a sample would be placed on a nutrient plate, grown and then exposed to different antibiotics to evaluate what treatment would work to kill it. The decline in the use of culture testing and the inability of labs to perform this kind of test has created a challenge in early identification and detection of resistant strains.

Crazy, I know. So, what can we all do about this medication-resistant strain? Get tested! Gonorrhea can be asymptomatic in up to half of males and 75% of females. Untreated it can cause infertility and sterility by attacking the fallopian tubes in women, causing permanent scarring, and the urethra in men, causing scarring inside the penis. It can also cause pelvic inflammation in women, making intercourse painful.

Recently two cases of medication-resistant gonorrhea have been found in Massachusetts. Health officials identified the same strain in these individuals, who’d had no contact with one another, meaning there are others out there with a similar strain and likely unaware of their infection. These two people were eventually cured using Ceftriaxone, but the bug showed reduced vulnerability to this medication and others that were previously effective in curing gonorrhea.

How common is gonorrhea? Well, in 2020 there were 677,000 cases reported to the Centers for Disease Control, making it the number-two STI in the US. Given the high percentage of cases with no symptoms, the CDC estimated that the actual number of gonorrhea cases was more like 1.6 million. In addition it estimated that half the gonorrhea cases in 2020 were resistant to at least one antibiotic.

If you do experience symptoms of a gonorrhea infection, it could be burning while urinating, yellow or green discharge, swollen testicles, vaginal bleeding between periods, itching, pain or soreness of the anus. Sexually active people: please make a full sexually transmitted infection panel part of your annual healthcare exam. If you like having sex with multiple people and don’t like using protection, get a full-panel test done every three months. You’ll be helping to stop the spread of this STI and others.

This is Hedda Fay reminding you to get checked this year for all STIs, it’s important for your overall health. If you are diagnosed with an STI and receiving treatment, do not have sex with anyone (besides yourself) till you’ve completed your treatment, and best up to seven days after treatment stops, to help keep medication-resistant strains from developing.

Sexually transmitted infections in Arizona continue to circulate. That’s right, we have viral and bacterial STIs throughout our state.

Syphilis is one that continues to cause harm to people and fetuses alike. Syphilis is curable in people, including mothers and their unborn children. When we have babies born with syphilis that means we have pregnant people not going in for prenatal care. Why would someone not go in for prenatal care? Besides everyone wanting to touch their growing abdomens, pregnant people face a lot of scrutiny.

Side note, ask before touching anyone, especially hormonal pregnant people. I digress.

Between January 1 and August 31 last year we had 121 babies born in Arizona with syphilis, and 13 of them died. This means more babies were born with syphilis in the first eight months of 2022 than in all of 2021. Trust me when I say you do not want to start life with syphilis.

On a happier note, we were able to prevent 95 cases of syphilis in newborns because those mothers sought prenatal care. It’s amazing how well this works. It also means that we need to be more supportive and less judgmental of pregnant people, and encourage them to seek prenatal care. If they are uninsured, they can get insurance and care for themselves and the unborn baby by going to a County health clinic. The people there can assist those without insurance by applying for AHCCCS and Women, Infant and Child care to help with the growing baby. WIC provides a lot of help to mothers. For people who do not have documentation, there is still assistance available for their health and the health of the unborn child.

Syphilis affects the brain, liver, bones, joints, optic nerve and eyesight. It is a curable but insidious bacterium.

It’s sometimes called the Great Pretender because it can look like other health conditions, making diagnosis a medical cat-and-mouse game. It may look like someone has meningitis, losing eyesight, dementia, mental illness, loss of depth perception, loss of peripheral vision, and more. There will be body rashes that can resemble an allergic reaction to a detergent or body product.

Let’s talk about symptoms and how the disease spreads. Syphilis spreads between humans through contact with mucous membranes or skin. The first sign of a syphilitic infection is a small and painless chancre sore in the area of contact, which can be the mouth, penis, vulva, vaginal area or rectum, so unless you are checking your undercarriage after sex you may miss it. Syphilis develops in stages, and symptoms can overlap and vary. The chancre is easily missed and even if discovered, because it is painless, it’s easy to dismiss. The chancre will heal on its own over three to six weeks.

After the chancre heals, time will pass and you may develop a rash across your torso that will then cover your body, including palms of hands and soles of feet. This rash will not itch. At the site of your exposure to syphilis you may develop wartlike sores that may hurt. These white-to-grey lesions are called condylomata lata, and they’re reported in 10-45% of people infected with syphilis. See how the symptoms vary?

You may lose some hair, develop a fever, swollen glands, achy muscles, soreness at the site of exposure, and these symptoms will pass, too. They can also reappear or come and go for a year.

The annual average incidence of syphilis in women has increased 449% since 2015 in Arizona. Up to 40% of syphilitic pregnancies result in newborn deaths or stillbirths, and 77% of babies born with syphilis are asymptomatic. We can do better for ourselves and the children coming into the world.

How can we do better with syphilis and other sexually transmitted infections? It starts with each of us. Talk about them, spread awareness. We can also quit judging others who get these communicable diseases. That’s right, make 2023 the year we collectively stop the stigma. Stigma kills, and it has been killing people for millennia. Stigma prevents people from seeking care, from talking about things and finding answers. Think about a time when you were judged, and people did not have all the information about you. How did it make you feel? Let’s stop the stigma and work as a society to improve the health of everyone in our community. We can stop syphilis and stigma at the same time.

This is Hedda Fay reminding you that you are a primate and you have 27 bones in each hand and 26 in each foot that you may not even be able to name, but they help you every day. So don’t be too quick to judge others when you are still learning about yourself!

We do a lot of outreach events here at Northland Cares. We get asked all sorts of questions and hear what’s happening locally.

Sadly, we’ve heard that people are being drugged against their will at local establishments. Recently we were testing some younger people, and one told us that she and some friends had gone out and one of them was injected with an unknown substance, from behind. They had to take her out of the place as she had begun to lose consciousness and her ability to function independently.

Please understand there are predatory people in our community. Some of them will ask you out for a date, try to engage you in a rapport, and have a nefarious agenda simultaneously. People are still drugging beverages, food and now, apparently, injecting people from behind with foreign substances to take control.

When going out for a night, have a designated sober person. You know a friend who can keep an eye on your group. With the rise of Uber there are not as many designated drivers available, who traditionally filled the group’s “sober one” role. It’s still imperative to have someone in your group maintain all their faculties on a night out. They can be your sentry to monitor what’s happening, watch the drinks and people around you.

This is a crime. If you are drugged without consent or prior knowledge, or injected with anything, it is a crime and you are not at fault! I repeat: you are not at fault! Imagine that I’m yelling this to you in all caps. I wish I could scream it from the rooftops.

Having a designated sober person is not the only answer. This is not just happening to females in our community, it’s happening to males, too. For you men out there, if this happens to you, it is also a crime and not your fault! I understand that after waking up foggy-headed, unsure of what transpired the previous evening and suspecting that they may have been violated, many people don’t want to say anything.

Do you need to have genital, rectal or other bodily trauma to have been violated? No. You may have been in such a relaxed state that your own inability to physically react made it less likely for you to have injuries.

The substances used to gain control of a person’s body can be odorless, colorless and tasteless. Some may change the color of a light-colored drink to a light-blue hue, others act quickly and the person drinking will most likely not know.

If something like this happens to you or a friend, it’s important to get help immediately after the incident. Do not sit and negotiate with yourself if something transpires, what happened, etc. You woke up with little or no recollection of the previous evening, and did not consume that much alcohol.

There are many resources to address this situation. The people at the Yavapai Family Advocacy Center have counselors and medical staff who can perform a Sexual Assault Nurses Examination (SANE). These can take an hour or more depending on what they find. The nurses are trained to collect DNA evidence to help in the prosecution of people who commit these crimes. The people at YFAC can assist you in filing a police report. These officers understand that you may have little or fragmented information. They are also interested in removing these predatory people from the public sphere.

You can also call us here at Northland Cares. We can get you started immediately on PEP medications. Post-exposure prophylaxis will prevent you from becoming HIV-positive following direct or potential exposure to HIV.  We can also assist you in filing a report with law enforcement and getting services scheduled at YFAC. SANE exams can be conducted several days after the incident.

If in doubt, call for help. You will not be judged or discriminated against. If you are a sex worker, or by necessity you trade intimacy for money or a place to stay, and something like this happens to you, understand that it is a crime. You have the right to have control your own body. You have the right to decide what form of intimacy you are willing to exchange. I am not advocating for sex work; it is a dangerous job that is presently criminalized. Sex workers can be victims of drugging and abuse as well.

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If something like this happens, please call:

YFAC: 928-775-0669.

Northland Cares: Prescott 928-776-4612, Cottonwood 928-649-0833

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Be careful out there. When going out, take a friend, or two.

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This is Hedda Fay telling you that we have predators in our community, so be careful in public.

Hello friends, it’s been an incredible year here at Northland Cares, and I have a lot to report! First, thank you to all who have shown your support for us here at our Prescott, Cottonwood and our Outreach and Education Offices. We could not do the work we do without all of you.

This year Northland Cares opened its first Outreach and Education Office, in The Crossings on Willow Creek Rd. This is where we provide our TelePrEP services, and we’re now serving over 1,000 patients and clients with PrEP care. What is PrEP, you ask? Pre-Exposure Prophylaxis is a medication people can take daily to avoid becoming HIV-positive. When taken as prescribed it is 99.7% effective at preventing HIV transmission.

Our Outreach and Education staff also provide our One-Step PEP, weekend and holiday on-call PEP services to the community. PEP stands for Post-Exposure Prophylaxis, medication that if taken after direct exposure to HIV can prevent infection.

We developed this program because in 2019 Yavapai County experienced a 275% increase in new HIV cases. We have staff available on weekends and holidays to respond to PEP emergencies within the community, when you or someone you know experiences an accidental needle stick, a condom break, is the victim of sexual assault by someone of unknown status or wakes up foggy headed because someone spiked food or beverage. This medication will prevent you from becoming HIV-positive.

HIV can survive in a discarded syringe for 42 days. We only have 72 hours to get this medication into your system to stop transmission. Call us on weekends or holidays at 928-910-6707, Monday through Friday at 928-776-4612 Prescott | 928-649-0833 Cottonwood | 928-771-0023 Outreach and Education.

We are getting a mobile testing and vaccine unit! That’s right folks, we will be mobile and on the road in 2023. This will allow us to serve our neighbors and community members from Bagdad to Black Canyon City, from Congress to Sedona, Seligman to Peach Springs and everything in between. We will be on the road offering Rapid-Free HIV and Hepatitis C testing as well as Covid vaccines to the community. These services are free to residents and community members.

Our Prescott office is in the process of expanding to provide more services, including phlebotomy and mental-health counseling services. In Cottonwood we moved just across the walkway into a larger space, where we’ll be adding services in the coming year. We hope to have a ribbon-cutting ceremony at the new location in January.

If you’d like to know how you can partner with Northland Cares — we need volunteers! — you can check out our website and sign up to volunteer at one of our testing or outreach events, or help us make our Bits Kits, providing protection for one’s nether bits.

We will be rolling out some new educational cartoons on sexually transmitted infections, prevention, and stopping the stigma associated with pathogens. If you have not already liked and followed us on Facebook, Instagram or YouTube, we hope you’ll do that now. We’ll be using our social media for more community connection and engagement in 2023. You’ll be able to track our mobile unit across Yavapai County and see where we are. We partner with Sonoran Prevention Works to provide a one-stop shop for prevention and harm reduction, so there will be times we can provide, Naloxone, Narcan, safe syringes, drug-testing kits, hygiene and first-aid kits. Make sure to like and follow us!

Northland Cares is a 501c3 nonprofit, and we don’t have a big company or hospital overseeing us, we’re just a small, rural clinic providing these services to our community. You can donate and get a direct dollar-for-dollar deduction from your state income-tax burden, up to $800 for a married couple filing jointly or $400 for singles or separate filers. To qualify you’ll have to complete Arizona Department of Revenue Form 321, and total your nonrefundable income-tax credits on form 301. Don’t forget to include all applicable forms with your tax return.

We’d like to take this opportunity to thank our board of directors, our community partner agencies, our amazing clients, volunteers and of course our generous donors. We could not do the work we do without your support! We want to welcome you to come in for a rapid HIV and Hep C test. We hope to see you at our office or an event soon! Here’s to 2023!

This is Hedda Fay reminding you that you’re a mammal and that STIs are equal-opportunists that do not discriminate! Use protection or prevention when navigating sex!

Hello everyone, I want to share this very important public service announcement: HIV is not gay, I repeat, HIV is not gay!

As an HIV education and testing facility, we hear all the time from well meaning people, “I don’t need a test thanks, I’m not gay.” The thing is, HIV is a virus and self-replicates, so it is completely asexual and an equal-opportunist. HIV is not gay, and it’s not heterosexual, either.

Across the globe, HIV has affected people in every culture, socioeconomic status, religious group, etc. Its only requirement is a host, like you or me. HIV does not judge or discriminate. An article in The Guardian from February this year reported that “49% of new diagnoses in England are among straight/heterosexual people (with an almost even split between men and women), compared with 45% for gay and bisexual men.” You may be thinking, “So what, that’s England,” but I’m here to tell you that the LGBTQ+ community has done an excellent job of self-advocacy and education, and their numbers are not increasing as they are in the heterosexual community. Do not imagine that similar patterns aren’t in play here, especially among those who believe they are protected against the virus simply based on their sexual preference.

Discrimination, poverty, homophobia and especially stigma are all social issues that can prevent people from getting high-quality health care. Stigma kills. As a child I heard my parents and relatives only whisper the word ‘cancer.’ Imagine that! Those whispers made it something to hide, and many people were hesitant to get cancer screenings, so they put it off. Now we know that early detection is the most important factor in preventing death by cancer.

That same sort of unwarranted stigma and unnecessary suffering still happen because many believe HIV is a gay person’s virus. When heteronormative folks think they may have it, they are often hesitant to get tested, because they worry about what others might think or say about them. Stigma about HIV and other sexually transmitted infections is everywhere. Fear about what others could think or say is killing people.

We offer medications to prevent HIV, and well-meaning people ask me all the time whether it is “morally okay” for me to offer pre-exposure prophylaxis (PrEP). I work for a healthcare facility, we’re not a church or the police. PrEP medications are safe, effective and save lives.

HIV is no longer a death sentence, but with that diagnosis comes increased risk of certain types of cancers and other conditions. PrEP medications are for anyone who is sexually active and does not regularly use protection. You can acquire HIV from a single unprotected sexual encounter. Good science estimates that 85% of new HIV cases among females are from an unprotected heterosexual encounter. When taken as prescribed PrEP is 99.7% effective in preventing HIV. Sex workers and people who inject drugs can also benefit from these medications. PrEP is 74% effective in preventing HIV in those who inject, which is pretty good considering they’re injecting the virus directly into their veins.

We also offer post-exposure prophylaxis (PEP). PEP is a medication that can prevent you from becoming HIV-positive even after a direct exposure to it. We have these medications on hand in our office to respond to any PEP emergency, we even have staff on-call on weekends and holidays in the event of an exposure. Call: 928-910-6707.

A PEP emergency is an accidental needle stick, a condom break, a sexual assault by someone of unknown status, or you wake up foggy after a night out and someone had spiked your beverage and possibly taken advantage of you/your body in an incapacitated state. Yes, date or out-drinking rape is a real issue here in Yavapai County.

If this kind of attack happens to you, we have PEP to help you avoid becoming HIV-positive. Do not hesitate to come for care. Do not be afraid or embarrassed, it isn’t your fault. The assault drugs can be colorless, tasteless and odorless. Rohypnol does turn blue in light-colored drinks, ketamine acts almost instantly. Remember, if it happens to you, don’t be afraid to get help.

We have offices in Cottonwood and Prescott to help you. No judgment, blaming or shaming here. Northland Cares is a stigma-free zone!

This is Hedda Fay reminding you that sex is an important part of who we are as mammals, and there are prevention tools to keep it safe for you and your partner(s).

I won’t discuss Roe v. Wade here, I’ll leave that to the legal and political pundits. Let’s talk about pregnancy prevention. Did you know there are many ways for people to avoid becoming pregnant?

Females are the ones carrying the highest pregnancy burden, both physically and socially. Men can help prevent unwanted pregnancies, too. Females can have one pregnancy each year, whereas males can impregnate hundreds of females in a calendar year. Let’s look at ways we can avoid unplanned and unwanted pregnancies.

Abstinence. A sure way to avoid an unexpected pregnancy is to not have sex. People abstain from sex for a variety of personal reasons. Some want a sexual sabbatical, others for work, sports, beliefs, commitments. This is 100% effective.

The pullout method, also known as preejaculation withdrawal, has an estimated 73% success rate. Who knew it was that high? Still not 100%. The pullout game is never solid.

Natural family planning, or the rhythm method, takes some work. It involves the female tracking her monthly cycle, from period to ovulation. This can help determine when they are most fertile and least likely to become pregnant. If the pen and pad are too much, today you can buy an ovulation tracker, which measures estrogen, luteinizing hormone and progesterone to know when’s the best time to become or avoid becoming pregnant. Some products even claim the ability to assist those with irregular cycles and polycystic ovarian syndrome in becoming pregnant. Some manufacturers claim they are 99% effective; the science says the tracking method can be effective 76% of the time.

Spermicides. There are foams, films and suppositories that can prevent pregnancy 82% of the time. Placed inside the vagina before sex, these chemicals block the cervix to prevent the sperm from connecting with an egg.

Emergency contraceptives. People ask us whether the morning-after pill constitutes an abortion. It does not. This pill prevents the egg from becoming fertilized by the sperm. The name is a little misleading because some such drugs can prevent pregnancy when taken up to five days after sex. Now you can even go online and take a quiz to see whether you’re a good candidate for these services, which can be 98% effective.

Barrier protection in the form of condoms, male and female, if used properly,  can prevent pregnancy 95-98% of the time. They’re affordable and easily accessible, especially at Northland Cares, where we give out over 18,000 per year in Yavapai County, free. Use them correctly, check the date, squeeze the sealed packaging to make certain there is air inside that you can feel. Dry condoms don’t work!

Vaginal rings, diaphragms and pessaries. This group of pregnancy-preventers have been around for centuries. In cultures around the world people have used honey, plant leaves, wool covered in oil, acacia gum, fennel, and other methods to block sperm in the vagina. Thankfully today we have diaphragms and vaginal rings to replace the pessaries of yore. Diaphragms are 94% effective, they are small, flexible, often silicone or latex cups that go inside the vagina to block the sperm. Vaginal rings can be used as contraceptives as well, small, flexible rings that females can insert into the vagina. These deliver hormones to the vagina to prevent fertilization, and are about 91% effective in preventing pregnancy.

Permanent birth control. Tubal ligation, having fallopian tubes tied or blocked, is typically done in a healthcare center or hospital and is 99% effective in preventing pregnancy. Males can elect to have a vasectomy, also known as male sterilization, where the small sperm tubes in the scrotum (seminiferous tubules) are cut or blocked off to prevent the sperm from leaving the body. This form of birth control is extremely effective in preventing pregnancy, almost 100%.

Intrauterine devices (IUDs) are small, usually T-shaped devices that fit inside the uterus. These are 99% effective and can last inside the uterus for three to ten years. They come in plastic and copper, and require a medical professional to insert.

Implants are little hormone-filled rods that can be implanted in the upper arm to slowly release the hormone progestin, which will stop the ovaries from releasing eggs. These are nice — no daily pill reminders and fewer side-effects than pills, and they can be removed. They also thicken the mucosa in the cervix, which prevents sperm from entering. For the uninsured, most county health departments provide this service to community members at little or no cost. Implants are 99% effective.

Shots. For those who struggle with pill compliance, this is a great alternative. These inject progestin into an arm or hip, and are 99% effective for three months.

Patches. Hormone patches furnish progestin through the skin (transdermally) and are 99% effective in keeping the ovaries from releasing eggs. Like the implants and shots, the patches also thicken the cervical mucosa.

The Pill. Birth-control pills are 99% effective when taken as prescribed, meaning at the same time each day, to keep the ovaries from releasing eggs.

These prevention methods do not protect against communicable pathogens — no, not even condoms can be 100% effective at that. I want to encourage you to take charge of pregnancy avoidance and be proactive. If you don’t have insurance, go to your local county health department, which has Title X funding and can offset the costs of these prevention methods. Sex does not have to equate with pregnancy.

This is Hedda Fay reminding you that you oversee your body. Be bold, stand up, dust off and take control of your personal reproduction. There are many options, and I’ve listed a few to get you started.

Sexually transmitted infections come in different categories, which makes them act differently, so we treat them differently. STIs can have a profound effect on the health of individuals and communities. Some are curable, others are treatable. In Part 1 (July) I covered bacteria and viruses. Now I'll get to the plant and animal world.

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‍Parasites

Parasitic STIs are caused by protozoans, nematodes and arthropods.

The most common is trichomoniasis vaginalis, a protozoan parasite. This is typically treated with metronidazole.

You can spot the egg, nymph and adult stages of pediculosis pubis, the crab louse or pubic louse, which is easily treated with the same medications you would use on head lice. We also have an itch mite called sarcoptes scabiei, aka scabies. These parasites reproduce by laying eggs in the pubic-hair region that take six days to hatch. Females can lay three to five eggs daily, and they live up to a month. Crabs feed excessively on blood, sipping four or five times each day.

Two other parasitic STIs are amebiasis, caused by entamoeba histolytica, and giardiasis, by giardia lamblia. These parasites are usually diagnosed with an examination of a stool specimen. Giardia is often found in people who engage in anal sex. Both are easily curable conditions.

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Fungi

Fungal overgrowths are the most commonly occurring STIs, which makes it great that they’re so easily cured. Fungal infections love the warm, wet, moist human body and its mucosa, ideal habitat for them to grow in.

‍Tinea cruris, aka jock itch, is a fungal infection more common in males than females. It likes warm, damp areas like the groin, including the skin between thighs and groin.

Vulvo-vaginal candidiasis (VVC), aka the yeast infection, is candida, a kind of yeast that occurs naturally in small amounts throughout the body, and there are over 1,000 species. At times an imbalance can cause the yeast to multiply, and we experience an overgrowth. This is easily cured with a topical cream or an anti-fungal pill. The vulva/vagina environment encourages candida growth and proliferation, with its dark, warm, moist mucosa. It is its own life form, part yeast, part fungus, parts vegetable, bacterium and animal. It can adapt and change form and shape, making it difficult to treat. It creates a biofilm made of proteins, plant cellulose, DNA, RNA and fats. It can reproduce sexually on its own, because each nucleus carries two copies of the chromosomes to create two separate cells that meet and fuse to create a new cell.

Yeast is either anerobic or aerobic. Lacking oxygen it produces energy by converting sugars to CO₂ and ethanol, which is why some with systemic candida report feeling brain fog — it’s the alcohol!

Prevention

To prevent these STIs you can use a condom correctly, and lubricant with the condom. If you don’t like that we recommend a full-panel STI test every three months, so when you do pick up something, you can get it cured in a timely manner and avoid long-term health problems from it.

I’m Hedda Fay reminding you that there are sexually communicable viruses, bacteria, fungi and parasites everywhere, and if you have enough unprotected oral, vaginal or rectal sex, you will meet one or more of them. Be responsible and get checked today to avoid problems later. Suit up, lube up, and be safe out there, it’s a microbial jungle!

Sexually transmitted infections come in different categories, which makes them act differently, so we treat them differently. STIs can have a profound effect on the health of individuals and communities. Some are curable, others are treatable, and I’ll be breaking all that down here.

‍

First let’s talk bacteria.

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Bacteria are unicellular microorganisms, single-cell organisms that lack nuclei. Bacteria have no nuclear membrane, no mitochondria, and reproduce asexually. In contrast with viruses, they do not have to take over a cell to infect you.

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When bacteria conjugate, they simply transfer DNA between two cells. No flowers, fancy dinner or dancing going on here. Bacteria can survive on the most inhospitable of surfaces. They can form groups and communities where they encase themselves in a slimy polymer matrix, called a biofilm.

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Bacteria are found everywhere, thriving even in the harshest environments, from hydrothermal undersea vents to frozen Antarctic tundra. They can certainly survive inside the wet, warm, mucous-laden, 98-degree petri dish you call your body.

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As our primary bacterial antagonists we have chlamydia, gonorrhea and syphilis.

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Chlamydia is the most common STI in the US, infecting over 1.5 million of us annually. It’s curable, with a but. Researchers at the Arkansas Children’s Research Institute discovered that antibiotics can cure it genitally, but it can survive inside the GI tract, waiting to reinfect. So if you find you chlamydia has come back, wait before accusing your partner of stepping out again.

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While antbiotics have been the standard cure for bacterial infections, we’re now seeing a strain f medication-resistant gonorrhea. We’re hoping this won’t be the next superbug. Gonorrhea forever does not sound fun.

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Viruses

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Viruses cannot do anything alone — talk about codependent! They can’t reproduce on their own. They have to get into our body and take over a cell. The virus comes armed with its own genetic material in the form of viral DNA or RNA.

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Viruses enter our bodies through our eyes, nose, mouth, vagina, penis or rectum. There are many types of viruses, and these infect every type of life form on earth. A virus that infects your dog is not likely to make you sick. Viruses can adapt, change or mutate to be able to infect another host. Usually it’s one virus and one host. A virus is usually made of genetic material (DNA or RNA), a protective protein shell and a fatty envelope (like a cell barrier).

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Once a virus gets into a cell, it uploads its DNA or RNA and tells the cell to follow its directions and make the parts necessary for the virus to survive. Then the new viruses escape the cell, killing it, and they seek out new cells to infect. It’s a hostile takeover of your body’s cells.

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Viruses are much smaller than bacteria. They can travel in bodily fluids, breast milk, sputum, blood, semen, vaginal fluids, rectal fluids, preseminal fluids, spit and even snot. Yes, that greenish-yellowish paste that we sometimes find in our noses can carry certain viruses, though not the STIs we’re discussing. Think Covid, the other ‘C’ word.

‍

Our bodies react to viruses protectively. Once the body discovers a viral infection it raises its temperature to destroy the virus, and makes your eyes and nose run to flush out trapped viral particles.

‍

Viral STIs are different, first in that antibiotics can’t touch them. Some have been known to go away on their own, like human papilloma virus (HPV), but that’s not the rule.

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HSV, HPV, Hep B and C

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There are vaccines for HPV and Hepatitis B, meaning they can be prevented — well, Hep B anyway. The HPV vaccine protects a person from developing cancer later in life if they have been exposed.

‍

There is now a solid cure for Hepatitis C, an eight- to twelve-week course of medication that works well, without the side-effects of the former “cure,” interferon.

‍

We have treatment options for herpes simplex virus (HSV) I and II, antiretroviral medications that can help suppress the viruses in the body.

‍

In Part 2 next month: Parasites,Fungi and Prevention

‍

Part 1: Bacteria and Viruses

‍

Sexually transmitted infections come in different categories, which makes them act differently, so we treat them differently. STIs can have a profound effect on the health of individuals and communities. Some are curable, others are treatable, and I’ll be breaking all that down here.

‍

First let’s talk bacteria.

‍

Bacteria are unicellular microorganisms, single-cell organisms that lack nuclei. Bacteria have no nuclear membrane, no mitochondria, and reproduce asexually. In contrast with viruses, they do not have to take over a cell to infect you.

‍

When bacteria conjugate, they simply transfer DNA between two cells. No flowers, fancy dinner or dancing going on here. Bacteria can survive on the most inhospitable of surfaces. They can form groups and communities where they encase themselves in a slimy polymer matrix, called a biofilm.

‍

Bacteria are found everywhere, thriving even in the harshest environments, from hydrothermal undersea vents to frozen Antarctic tundra. They can certainly survive inside the wet, warm, mucous-laden, 98-degree petri dish you call your body.

‍

As our primary bacterial antagonists we have chlamydia, gonorrhea and syphilis.

‍

Chlamydia is the most common STI in the US, infecting over 1.5 million of us annually. It’s curable, with a but. Researchers at the Arkansas Children’s Research Institute discovered that antibiotics can cure it genitally, but it can survive inside the GI tract, waiting to reinfect. So if you find you chlamydia has come back, wait before accusing your partner of stepping out again.

‍

While antbiotics have been the standard cure for bacterial infections, we’re now seeing a strain f medication-resistant gonorrhea. We’re hoping this won’t be the next superbug. Gonorrhea forever does not sound fun.

‍

Viruses

‍

Viruses cannot do anything alone — talk about codependent! They can’t reproduce on their own. They have to get into our body and take over a cell. The virus comes armed with its own genetic material in the form of viral DNA or RNA.

‍

Viruses enter our bodies through our eyes, nose, mouth, vagina, penis or rectum. There are many types of viruses, and these infect every type of life form on earth. A virus that infects your dog is not likely to make you sick. Viruses can adapt, change or mutate to be able to infect another host. Usually it’s one virus and one host. A virus is usually made of genetic material (DNA or RNA), a protective protein shell and a fatty envelope (like a cell barrier).

‍

Once a virus gets into a cell, it uploads its DNA or RNA and tells the cell to follow its directions and make the parts necessary for the virus to survive. Then the new viruses escape the cell, killing it, and they seek out new cells to infect. It’s a hostile takeover of your body’s cells.

‍

Viruses are much smaller than bacteria. They can travel in bodily fluids, breast milk, sputum, blood, semen, vaginal fluids, rectal fluids, preseminal fluids, spit and even snot. Yes, that greenish-yellowish paste that we sometimes find in our noses can carry certain viruses, though not the STIs we’re discussing. Think Covid, the other ‘C’ word.

‍

Our bodies react to viruses protectively. Once the body discovers a viral infection it raises its temperature to destroy the virus, and makes your eyes and nose run to flush out trapped viral particles.

‍

Viral STIs are different, first in that antibiotics can’t touch them. Some have been known to go away on their own, like human papilloma virus (HPV), but that’s not the rule.

‍

HSV, HPV, Hep B and C

‍

There are vaccines for HPV and Hepatitis B, meaning they can be prevented — well, Hep B anyway. The HPV vaccine protects a person from developing cancer later in life if they have been exposed.

‍

There is now a solid cure for Hepatitis C, an eight- to twelve-week course of medication that works well, without the side-effects of the former “cure,” interferon.

‍

We have treatment options for herpes simplex virus (HSV) I and II, antiretroviral medications that can help suppress the viruses in the body.

‍

In Part 2 next month: Parasites,Fungi and Prevention

‍

That headline’s not as appealing as “Let’s Talk About Sex,” is it? How do we communicate about sex and sexual health? How did you learn about sex and sexual health? Was it the often awkward birds-and-bees discussion with your parents or guardians? How thorough was this conversation? Did you explore risks beyond pregnancy? Was there a discussion about STIs, how they’re transmitted and shared? Did you hear the chatter of older siblings or adults, with no clue what they referenced with their sexual slang?

How do you express yourself or your needs to your partner today? Do you know what you like? Have you explored yourself? Yes, I’m asking whether you have given yourself a successful orgasm — you know, masturbation. This is truly how we learn what feels good, what’s stimulating to us, by touching ourselves. For some, how to say no to a partner is the most difficult issue, due to potential embarrassment on one or both sides.

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When we begin a new relationship, it’s steamy, hot and exciting. The butterflies, being tongue-tied, nervousness, the gentle hand-touching and the first kiss. Before the first kiss, do you ever discuss the kiss? No, right? It’s the gazing into one another’s eyes and getting closer before the lips meet. The kiss may be awkward, mushy, wet, and so on; was it amazing? Of course, because it was what we’d been thinking, daydreaming and fantasizing about. Of course it was perfect.

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A few months pass and the sex is still going well, two to four times a week. But is there something missing from the physical connections? Is there something you like sexually that concerns or embarrasses you, thinking that your newfound partner may not like or have experienced it? How do you mention your sexual fantasy, desire or kink? Is there something about the sex you’re having that, due to an earlier lived experience, makes you uncomfortable?

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Talk about it. It’s important that we can mutually enjoy our sex life with a partner.

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There may be something for you both to try and share with one another that neither of you has experienced. Let’s be honest, if you don’t like something, you need not have to do it right. How do you say no to something that your partner wants to try, but that you’re not comfortable with?

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Let’s take anal sex as an example. Women routinely ask me how to address this sexual albatross with a partner. Men or people with penises especially can derive satisfaction from receptive anal sex, because the prostate is there, and when manipulated or stimulated it can cause arousal and orgasm. (Some men only learn this after turning fifty, during their very first prostate exam. But I digress.)

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Anal sex may not be pleasant for females or people with vaginas who lack a prostate gland. How then do you say “no” to a special-occasion backdoor rendezvous with an anally excited partner? You can say, “I don’t like anal sex.” You can give specifics if you choose: simply saying that it’s not something you like is okay too. Let your partner know your position on whatever it is that you dislike.

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How do you have the talk? When do you talk? My recommendation: name your need, write it down on paper, look at it, reflect, and practice articulating it. If you don’t know how to express your sexual health needs, practice! Practice saying it alone in the car while driving and rocking out to your favorite tune.

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Practice in front of a mirror, with your pet. If your need or request elicits an emotional response in yourself, I want to stress the need for practice before that discussion. Take some of the power out of the action, kink or desire by literally practicing saying it. The more you say it, the easier it will be when having the discussion with your partner.

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Then, having practiced what you are to say, when you do sit with your partner to have the talk, it will be easier, and you might be surprised how easily the conversation goes. I hope you surprise yourself.

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Now that you know what you need to say, you’ll want to find a time that works for you both, where you can sit comfortably and have an uninterrupted conversation. Express yourself. Try and use “I” statements when discussing your needs. It’s also important as a partner to show appreciation to our partner. Do not forget that discussing your intimate needs and desires is also a suitable time to ask your partner whether there is anything that they like or enjoy that you haven’t tried.

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If you’re someone who has unresolved sexual-health trauma from your lived experience, get some support to work through that. It is possible. If you have physical damage, there are therapists and exercises you can do to strengthen and rebuild your pelvic wall.

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You may not have had any control over how you learned about sex, but you are 100% in charge of how you do it moving forward.

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This is Hedda Fay encouraging you to express yourself to yourself and your partner. If you can’t speak to what you need, it may never be fulfilled! Remember, when out exploring the sexual landscape, take protection.

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In males, genitals are both internal and external. The obvious external parts are penis, scrotum, and testes. For every slang term for female genitalia there are probably three or four for the male equivalent.

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What is a penis? The penis is made from three cylindrical pieces of erectile tissue and a large cover, (sometimes removed). The two corpora cavernosa are side-by-side, and as the name suggests, these are spaces that fill with blood when the male is aroused and make the penis erect. The third cylindrical part is the corpus spongiosum, and this covers the urethra. The foreskin, if not removed, covers the large end or tip of the penis, which is called glans penis. If you have had an erection, you can thank the corpora cavernosa and corpus spongiosum for that!

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The scrotum, sometimes referred to as the ballsack, is a thick sac of skin that protects the testes and regulates their temperature, so they can hug the person’s undercarriage when it’s cold or hang lower and looser when warm. The testes have to be a few degrees cooler than the rest of the body for optimal sperm production and nourishment.

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Testes is the term for two testis. A common nickname for these is the family jewels, because they are precious and important to reproduction. The testes have two primary functions: producing sperm, also known as spermatogenesis, which carries the person’s DNA, and testosterone, the male sex hormone.

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The seminiferous tubule, located within the testes, is where sperm are produced in a process called meiosis, where stem cells divide to create four daughter cells with half the chromosomes of the parent.

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Sperm is the male gamete or reproductive cell, created when the spermatogonia or male germ cells undergo spermatogenesis to produce sperm. Sertoli cells nourish the male germ cells so they can become sperm.

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Leydig cells are interstitial cells found outside the seminiferous tubes that secrete testosterone and androgens.

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Accessory ductwork

The rete testis carries sperm from the seminiferous tubules to the efferent ducts. It is a space for fluid reabsorption.

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The vasa efferentia are 12-20 ductules connecting the rete testis with the vas deferens, and forming the compact head of the epididymis, making the pathway for sperm cells from the testis. This is important for both system function and sexual pleasure.

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The epididymis is a coiled part of the spermatic ducts that provides the spermatozoa a place to mature and learn to swim. It is responsible for transport and maturation.

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The vas deferens or ductus deferens is a pair of thick, muscular tubes 18-45cm long and part of the spermatic cord, transporting sperm from the epididymis to the ampulla, the reservoir for sperm prior to ejaculation.

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The ejaculatory duct is a muscular canal connecting the vas deferens and seminal vesicles. It passes through the prostate and delivers the sperm in time for ejaculation.

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The urethra is a tube that travels through the penis and connects the bladder to the urinary meatus. In men the urethra carries urine and semen, so it’s a challenge for men with erections.

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The urinary meatus, as in women, is the opening for the urethra, where urine and sperm exit during urination and ejaculation. See, simple!

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Men have two urethral sphincters, internal and external. The internal sphincter regulates involuntary control of the flow of urine from the bladder to the urethra, and the external provides voluntary control of that flow. The internal sphincter also acts as a guard against semen going into the bladder during ejaculation, which would be a bad thing.

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Accessory glands

The two seminal vesicles are tightly coiled sacs on the back of the bladder extending from the base of the prostate, 2- 4cm long and 1-2mm in diameter. They produce fluid to feed the sperm cells, proteins, sugar, enzymes, and mucus.

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The prostate gland sits in the lower pelvis, in front of the rectum and beneath the bladder. When you’re young it’s the size of a walnut; when you turn 40 it can be the size of an apricot, and when you reach 60 it can be as large as a lemon. It produces the fluid that mixes with sperm to create semen.

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Men have two pea-sized bulbourethral glands or Cowper’s glands, which are responsible for producing the pre-ejaculation fluid secreted during sexual arousal. Urine in the urethra can be acidic enough to kill sperm cells, and this fluid is important to keep them alive.

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Whatever you choose to call these parts, it’s important to know what they are and how they function.

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More than franks and beans, twigs and berries or cock and balls, there’s a whole lot going on inside and out. Did you learn anything about your anatomy or your partner? I hope so!

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I’m Hedda Fay reminding you that your parts are parts of you, take good care of them, get them tested and wear protection when navigating the seas of sex and sensuality. Have a wonderful orgasm!

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Happy March everyone! Did you know that this July Northland Cares will celebrate 20 years of serving the residents of Yavapai County? And have we changed these past two decades!

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We have one outreach office and clinics in both Prescott and Cottonwood, where our clients and patients can see one of our providers, their medical case manager, and a  therapist if that is part of their treatment plan. Our offices are one-stop shops for HIV+ clients and our PEP and PrEP clients.

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Did you know we have the medical technology to stop HIV worldwide right now? We do! The advancements in HIV treatment and prevention have come a long way.

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HIV Treatment: This has come a long way, baby! We have single-pill regimens with few side-effects (upset stomach), and now have monthly injectables, so patients do not have to remember to take a daily pill. This is outstanding news. The new medications work fast fighting the virus in your system. Today no one in Arizona and specifically Yavapai County need develop AIDS. It’s true! Even if we find someone who technically has AIDS, it is easily reversed with the medications we have today.

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AIDS: Acquired Immunodeficiency Syndrome, a side-effect of untreated HIV, is technically when a person’s CD4 (T-cell) count falls below 200. We have seen them much lower when finding people living with the virus who did not know they had it. Once medications are introduced to the patient’s system, we will see the viral load go down and the CD4 go back up to a nice robust, healthy number within a month. That’s fantastic!

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PrEP: Pre-exposure prophylaxis is an excellent prevention tool that anyone who has unprotected sex, shares injection equipment (including steroids), or has multiple partners without using protection can benefit from. Think of it like putting your seat belt on. You won’t have an accident every day you drive, but the potential is always there. It’s the same with unprotected sex or sharing equipment. Taking this pill daily will prevent you from getting HIV. It won’t protect you from any other STI or pregnancy, but if you get a different STI as our patient, we can treat you in-house for those.

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PEP: Post-exposure prophylaxis is another excellent prevention tool that we make available to the public on weekends and holidays. Now with PEP we only have a short window of time — 72 hours, three days — to get the medication into your system. It is more effective the closer to the time of exposure we administer it. Not all local pharmacies keep these medications in stock because they can be cost-prohibitive — $2,000-3000 for one month. Fear not, we keep these medications in stock and have PrEP Navigators available to assist with getting you the rest of the medications within that 72-hour window.

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Who would need PEP, you ask? Anyone who has a condom break, is a victim of sexual assault by someone of unknown status, or gets an accidental needle stick.

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• HIV can live in a discarded syringe for up to 42 days.

• 83% of accidental needle sticks go unreported.

• Yavapai County experienced a 275% increase in new HIV diagnoses in 2019.

• 85% of all new HIV+ diagnoses in cisgender heterosexual women are from an unprotected sexual encounter.

• People who are HIV+ and do not know it can have it up to ten years before they getting a secondary illness that would indicate the condition to a provider.

• STIs like HIV are largely asymptomatic, so if the person doesn’t know, how can you?

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Northland Cares offers PEP Navigation during weekends and holidays. If we know the risk earlier, we get you the medications and a better outcome for you and your family. We have staff on call who will respond if you need PEP medications. Our on-call number is 928-910-6707, available Fridays beginning in the evening till Sunday evening.

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Full-Panel STI Testing: We are now offering full-panel STI testing at our office. We recommend you call first to schedule the test. Soon you will be able to go online and order a kit be sent to your home. We presently test for hepatitis B and C, HIV, chlamydia, gonorrhea and syphilis. If you are sexually active and prefer not to use protection, we recommend that you get these tests done every three months, and we further recommend making an STI test a part of your annual healthcare examination.

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• Arizona is #1 in the nation for syphilis.

• We are #5 in the nation for babies born with syphilis.

• Chlamydia and gonorrhea can be asymptomatic in 75% of people with vulvas.

• Chlamydia and gonorrhea can be asymptomatic in 50% of people with penises.

• Syphilis is called the “Great Pretender” because it can cause meningitis, dementia, blindness or loss of peripheral vision.

• Treatment cannot repair brain or optic-nerve damage from syphilis.

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I’m Hedda Fay reminding you that there are viruses, parasites and bacteria out there, so use protection and get tested so the only thing your orgasm leaves you with is a pleasant memory. Wishing you a safe, healthy and fun sex life!

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Female reproductive organs enjoy a variety of euphemisms: va-jay-jay, vajeen, lady parts, cooter, cooka, pussy. There are literally hundreds of these terms to describe this body part. Comparatively you will find a mere handful to describe one’s thumb, maybe because the thumb does not have the mystique or notoriety that the vulva and vagina have. Just what is the appropriate term for female reproductive parts, ‘vulva’ or ‘vagina’?

The term ‘vagina’ is widely used and accepted as the appropriate term. The vagina is a 4.8- 6.4cm canal that connects the vulva to the cervix, then the cervix to the uterus. It’s a tubular, muscular, fleshy highway from the opening to the uterus, a path for sperm to travel in hopes of fertilizing an egg. It’s where a penis enters for intercourse between someone with a penis and a vagina. It is also the first canal we all traveled to get here today, unless you were a test-tubular pregnancy or birthed via caesarean section.

The vulva is the external part of the female reproductive organs, the covering to the portal to another dimension, where life comes from. It includes the clitoris, vestibular bulbs, vulval vestibule, labia minora, labia majora, urinary meatus, hymen, pubic mound, external opening of the urethra, and vagina.

These days everyone is talking science — “follow the science,” “believe the science” — while simultaneously using incorrect terms. ‘Vagina’ has reigned supreme as the term to use when describing female reproductive parts for many years. Is it because it’s the portal we all traveled to get here, or is it because it is the place that provides heterosexual males the most pleasure? Whatever the reason, it’s important that we know these parts and use correct terminology when talking about sexual health.

Now for some clitoracy. Ladies/people with female reproductive parts, if you are not orgasming with intercourse, you need more clitoral stimulation. It’s fun and will add to your sex life. As women/people with female reproductive genitalia are getting aroused, we become wet and moist in our vulva and vagina. This is not an orgasm. It’s how these parts naturally lubricate during arousal, heavy petting and foreplay.

Let’s look at the vulva parts, shall we?

The clitoris, human females’ most-erogenous zone, is at the front of the labia minora, above the urethra. In humans its only known function is sexual pleasure.

The labia majora are equivalent to the male scrotum, a pair of rounded adipose tissue and skin that cover and protect the inner, more delicate structures of the vulva.

The labia minora are two smaller flaps of adipose tissue, found below the majora and protecting the clitoris, urinary orifice, and vaginal orifice.

The vestibular bulbs are two elongated muscles on either side of the vaginal orifice. They cause the contractions experienced with orgasm.

The vulval vestibule is the body cavity that creates space in the labia minora, providing an opening into the vagina and by extension the urethra.

The urinary meatus is the external urethral orifice, the opening of the urethra.

The hymen is a thin mucosal tissue covering and surrounding the vaginal opening.

The pubic mound is the front part of the vulva, a mass of fatty tissue that covers the pubic symphysis or the pubic bones. In Latin it’s the mons pubis.

To understand how these parts look anatomically, you can view an anatomy book or search online for these folds and parts.

Now that we have differentiated between the vulva and vagina, what do you think the appropriate term is for female reproductive parts, vulva or vagina? Do you even care? I’m not expecting anyone to correct others when using terms or make it a topic of discussion at happy hour this week. My goal is to help educate and let you to decide what terms you want to use.

Love your parts, whatever parts you have. Protect them, clean them, and get them checked.

This is Hedda Fay reminding you to love yourself, use protection and learn about your parts and what feels good to you. Touch yourself — it’s okay, I haven’t turned into a pillar of salt and blown away yet!

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‍The aging penis is our topic this month. People with penises have a lot of penis pressure put upon them. I do not have one and cannot imagine the stress involved with it. Imagine being measured as a human depending on one fleshy appendage! We are not here to talk about the performance or size expectations put on our neighbors with penises, oh no, we are going to talk about what happens as they age.

Yes, as one ages, so does their penis, much differently from the changes people with vaginas go through.

First, penis bearers begin to experience a one-percent annual reduction in testosterone beginning around age 40. For most it is a gradual diminishing, so slight that most don’t notice much difference.

Lower testosterone, also called late-onset hypogonadism, is common among aging people with penises. It can lead to reduced muscle mass, depression, loss of interest in activities including sex, scrotal sagging, and reduction in penis length and girth. It’s estimated that penis bearers with high belly or stomach fat lose half an inch in penis length for every 30 pounds they are overweight. That adds up.

A growing prostate will increase your desire to urinate while restricting the flow. Your semen output can fall as well. Peyronie’s disease is common in people with penises who are 55 years old and older, and you can tell whether you have it from curvature in your penis. As you age the smooth muscle tissue that holds your penis upright is replaced with collagen, which affects size and girth. It’s normal for it to shrink and work differently as you age.

People with penises come under even more pressure to perform as they age.

Erectile dysfunction is common in men 50 and older. Up to half of people with penises in this group experience erectile dysfunction, increasing toas high as 70% in those over 70. If you feel you are experiencing late-onset hypogonadism (age-related lower testosterone), make an appointment with your provider for some bloodwork and a follow up appointment. It is treatable, and there are other medications that get you back to six-to-midnight in no time!

Remember, you are not your penis. Your penis is your penis, and it ages with you. Its needs change as you do. It will hang lower, as will your scrotum. Do your balls hang low, do they wiggle kind of slow? —just kidding, there’s no song. There should be.

People with penises come under even more pressure to perform as they age. They may have their “personhood” judged on how long they can stay erect before ejaculation. I can’t imagine being judged how long Ican hold off an orgasm, and I find that judging metric both unfair and unreasonable.

It’s important to be supportive of our penis-bearers and encourage them to see their providers if they believe they are experiencing low testosterone. A blood test can gauge your testosterone level and whether you may need supplementation. Hormone-replacement therapy can help people suffering from this, and as with any medication it’s important to see a provider before beginning therapy. Hormones can have many side-effects, and your friend from the gym is not the best place to get replacement hormones. Just saying.

The AMA suggests that people with penises get their prostates checked annually to prevent prostate cancer. If you have frequented tanning beds sans bottoms, you are at increased risk for penile skin cancer. Yes, that's a thing as you age, too, so get those moles checked!

If you are going to handle, fondle, caress or insert a penis this holiday season, use protection. Unless that penis with the erection has been checked over with a full medical inspection, do not touch it without protection.

This is Hedda Fay reminding you that to get the most out of your 2022orgasms, make them fun and safe!

Northland Cares is becoming much more than a specialty healthcare clinic for people living with HIV, and we are expanding our services to include STI testing and Hepatitis C testing and treatment.

One-Step PEP Program: PEP(post-exposure prophylaxis) is medication for those who have had direct exposure to HIV. We must get the medication to the person within 72 hours of their direct exposure. The closer to the time of the exposure, the better. Taken daily for 28 days, the medication will prevent becoming HIV-positive.

Northland Cares has medication in the office to allow people to begin treatment immediately. Our One-Step PEP Program involves coming to the office, where we provide one week of PEP medications, a new-patient packet, lab orders, a follow up appointment with our provider, and our PrEP/PEP Navigator Teresa will assist in getting the remaining three weeks of medication. Northland Cares keeps PEP in stock because not every pharmacy carries it, and it can range in cost between $2000 and 3000 for one month. We do not have the luxury of time to locate these medications.

Rapid-Start PrEP: PrEP (pre-exposure prophylaxis) is an excellent tool for preventing and reducing the effects of HIV infection. Think of it as you would a preventive vaccine, only it’s a medication that, when taken daily, prevents people from contracting HIV. For receptive anal sex you need to take the medications for seven days to ensure there’s enough in your system to protect against HIV transmission. For receptive vaginal sex or intravenous drug use, you need to take PrEP medications for 21 days for the same protection.

Engaging people immediately with care improves health outcomes and better serves people in our county.

When someone contacts us for PrEP medication, the first step is for them to come into the office, where we provide a new-patient packet, lab order and follow up appointment. We encourage everyone to get their labs done as quickly as possible, soon the first appointment with the provider they will be able to start the medications and leave with a prescription. No insurance (or not enough)? No problem! We’ll get you covered. Undocumented immigration status? Not to worry, we’ll get you covered!

Fast-Track HIV Care: Fast-Track HIV is an international program we have implemented here at Northland Cares. To achieve the goal of stopping the HIV epidemic, we have to stop it as soon as we find it in the community. That means whether you come to our office for a rapid HIV test or you are being tested at one of our events, if you test preliminary positive for HIV, we will start you on medications that same day!

We will provide a new-patient packet, a sample bottle of Biktarvy, a lab order, a follow up appointment, an appointment with a medical case manager, and an appointment with our in-house therapist if you need that support. We have found that engaging people immediately with care improves health outcomes and better serves people in our county.

Self-Collect STI Tests: That’s right folks, imagine being able to do an at-home or in-office self-collect full-panel STI kit! Just visit the Northland Cares website, input the required information and we’ll mail you a kit. It comes with everything you need for a three-site test for chlamydia, gonorrhea, HBV, HCB, HIV and syphilis — right, we’ll test you for everything. Each kit also comes with a self-addressed stamped envelope for return to the labs, and you’ll get your results in three to five days. If you test positive/reactive for any of it, we’ll get you treated, or cured if it’s curable. STIs like HPV, HIV, HBV are treatable, there is no cure; HCV, syphilis, chlamydia and gonorrhea are curable!

World AIDS Day Celebration: Yes, this does have a lot to do with sexual health. We are having the celebration to raise money and awareness about HIV and other STIs affecting our community. Stigma, fear, and shame discourage many from seeking treatment, and this is how it spreads through the community. We work to raise awareness about STIs and stop the stigma. Why is it we can discuss Covid-19 in public, but not syphilis? HIV is still a worldwide pandemic, even though you don’t have to die of it today.

H is for Human: In January 2022 we’re producing a stage play to remind everyone that the first letter in HIV stands for human — you know, us, as a species. I think people sometimes forget that. Our story follows a cisgender heterosexual young man a she goes through life and an HIV diagnosis. His experience is human, and we are hoping to engage the public with this original story!

Cartoons for 2022: The creative minds in the NC Outreach Department have created cartoon characters who will be educating people about themselves through short interactive cartoons. Characters include HIV, Hepatitis C, Abstinence, Masturbation, Syphilis, Gonorrhea, Chlamydia, Medical Case Manager, Doctor, Community Health Worker, Safe Syringe Program Volunteer, PEP and PrEP. We are thrilled to have this in the works, and can’t wait to show it to the world!

I'm Hedda Fay, wishing you healthy and happy orgasms through the winter season!

This week a friend sent me a meme that said, “dating after 40 is like trying to find the least damaged thing at a thrift store that doesn’t smell.” I giggled, and then went, “Ouch.”

Asa married woman over 50, I no longer need to “date.” But what about the rest of the implication in the silly meme? Damaged, smelly, none of which is age-applicable — there is still some prejudice about sex as we age.

Sex does change as we age, physically, mentally, and emotionally. For starters, our pheromones and hormones change, affecting everyone. When I experienced menopause I happily donated the myriad vaginal-hygiene products and overpriced cotton items to my friends and neighbors. No more seeing Aunt Flo in my house! What a change! Afterward it was harder for my vagina to self-lubricate, even while aroused. My provider sat my husband and me down and explained that, for my vagina to lubricate, we needed more foreplay. My honey was thrilled with the idea of extra time with my “fun bags” and bits.

My desire for sex diminished slightly, which is normal, while the skin and walls of my vagina thinned and slightly narrowed. As we age our bodies produce less of the hormones that help support our integumentary system. Estrogen helps keep our skin tight and healthy ,and assists with elastin and collagen production. As we age, our skin all over begins to thin with the loss of this hormone, and it takes longer for the vagina to naturally lubricate itself.

As we age we care less about what others think, and learn to appreciate more about ourselves. We are all naked or in a state of undress with ourselves daily. How often do we check ourselves out and take a personal inventory of our naked bodies, front and back? One of my favorite comedians, Mo’Nique, asked the reader in one of her books, “when was the last time you took a personal inventory of yourself naked?” My goodness, I see myself every day! What on earth is she referencing? I thought about it and, aside from makeup applications, I was not really looking at all of me.

Right then and there, in my bathroom I stripped, got my compact out and checked myself out naked in the mirror. This one act has helped me accept and love myself where I am at in my own aging process. Every wrinkle, dimple, scar and bruise I can face and accept as part of myself. Being naked and comfortable with ourselves as we age helps us to be comfortable and confident while naked with a partner, hookup, etc. As we age our skin loosens. Sometimes we develop expression lines and wrinkles in places we are not expecting. My perkier breasts sit lower on my chest, and you know what, it’s okay!

As we age our desire for intimacy of different sorts increases. The need to feel close to people and enhance connections is strong. My knees occasionally snap and pop when moving, and my boudoir acrobatics are not what they once were. But with some adaptations to accommodate my physical changes, they can be every bit as fulfilling. Expressing our sexuality is more than the lowest common denominator. It involves different types of touching and genital stimulation. This can happen with yourself, or you can share it with someone else. Sex and orgasms are good for us. They help relax the central nervous system and our minds, burn calories, and masturbation is a form of self-care.

As women we are often judged by our appearances first and character somewhere after that. We are beautiful as we age. Our lines show we have laughed and experienced joy. Those “crow’s feet” are from smiling a lot, and have more to do with expression than being an “old bird.”

So find joy in your newfound wisdom, and allow yourself to experience and love whatever type of sex life brings you happiness today. Embrace your aging process and sexuality. Protection from sexually transmitted bacteria and viruses is as important at 50+ as it was at19 — hey I don’t make the rules, these infections don’t discriminate.

Remember, the only thing you should get from a great orgasm is a fond memory!

There are those who do not believe they’re still around, but yes, herpes is just as common and contagious today as it ever was.

HSVI and HSVII: The two viruses are not as simplistic as their names suggests. There is a lot of misinformation out there about these two viruses, so let’s explore the facts.

All strains of herpes are extremely contagious, and typically spread through saliva, sores and skin-to-skin contact. These viruses are known to “shed,” releasing trace particles of themselves even when the host is asymptomatic. They lay dormant for years before presenting any symptoms. There is currently no cure for either virus, but they are treatable with antiviral medications.

Herpes simplex I(oral herpes) is very contagious. Most people that have this form of herpes obtained it as children from being kissed by relatives. The cold sores people get around the lips and face are beyond their control, but when they do have them, they should be cautious and not kiss anyone. We also sometimes find oral herpes in a person’s genital region, even though we more typically find HSVII there, usually due to oral sex.

Herpes simplex II (genital herpes) is also very contagious, and generally affects the genital area. Two-thirds of genital herpes cases are a symptomatic. Because much of the genitals remain uncovered with proper condom use, during an outbreak you can still contract genital herpes with a condom, which reduces risk by up to 30%. It is always important to know your status and be engaged with care should you need it. The CDC reports that more than one of every six people aged 14 to 49 has genital herpes, it’s that common. The herpes virus can also be shed from skin without a visible sore.

First outbreak: The first things to look for during the first herpes outbreak are fever, swollen lymph nodes, chills, muscle aches and headache. Outbreaks can cause sores, pain in the genital area, mouth or anus, and shooting pain in legs or buttocks, which can occur hours or days before the eruption of a herpetic lesion.

Each year Americans report two million HSVI diagnoses and three million HSVII diagnoses. Unfortunately, there can be unnecessary shame, stigma and embarrassment with a herpes diagnosis, but since this virus is so communicable, it’s vitally important that you get tested if you believe you have been exposed or have had unprotected or risky sex.

If you are in a relationship with someone who has genital herpes, there are ways of lowering your risk:

• Talk with your partner and find out whether they are taking anti viral medication. Intimacy is more than physical interactions, it can include personal health information. If your partner does not have access, refer them to the county health clinic, which treats people for HSVII with or without insurance.
• Avoid engaging in sex, whether vaginal, anal or oral, when your partner has symptoms or feels like a flareup is occurring.
• Use condoms and lubricant appropriately to further reduce your risk when having sex.
• Use dental dams for oral sex.
• Use female condoms for vaginal and receptive anal sex.

Remember to make a full-panel STD test and HIV test a part of your annual healthcare exam. This is Hedda Fay reminding you to send your sexual health questions to me at fay.h@northlandcares.org.I look forward to hearing from you soon!

Dear Hedda: If I am in a monogamous relationship, and I know my partner and I don't have any STIs, is there ever a reason to go get tested? I feel like if I trust my partner not to cheat on meand potentially get an STI from someoneelse, we won't really prioritize getting tested unless we must. Plus, I think I would have a hard time convincing my boyfriend to get off his butt and do so if there isn't a good reason! — Lazy in Love

Dear Lazy in Love: We recommend that everyone who is sexually active make an STI panel test part of their annual healthcare examination. Being in a committed monogamous relationship certainly reduces your chances of encountering an STI, but some are highly contagious and may not appear as such. For example, in the secondary stage of syphilis people develop a rash, the rash appears on the person’s hands, feet and torso. Ask yourself, would you think a rash on a person’s hands, feet or torso is an STI? Probably not, right? The rash may or may not be painful if you touch it, and you can contract syphilis from it. When in doubt, get a test. Your reproductive and overall health may depend on it. Did you know that some agencies offer home STI-testing kits, so you can do the tests in the privacy of your own home? Locally, Northland Cares provides this service — discreet and effective!

Dear Hedda: Do you have any advice on how to talk to someone you are not in a relationship with about using a dental dam while going down on them? I just want to keep us both safe, but they are so uncommon that people get freaked out or offended when I mention it. I have even had someone tell me that wanting to use one was me suggesting they were unclean. Help! — Saran-wrapped Sapphic

Dear Saran-Wrapped Sapphic: Good for you for trying to keep yourself and your partner safe! Dental dams are an excellent prevention tool, they come in a variety of colors and flavors, and using lube can increase the sensation. You may want to talk to your partner and explain that most STIs are a symptomatic, which means a person can have one and not know. Having an STI does not make a person dirty or unclean, it just means a person encountered one while engaging in unprotected sex. These pathogens have been around for centuries and they can have serious consequences if left untreated. Let your partner know that oral STIs can be transmitted between your mouth and genitals and you want to make certain they are protected too. You can also suggest that since you are being intimate together, it may be a good idea for you to both get checked and share your results. This can increase both intimacy and trust.

Dear Hedda: I want to know how I can tell the difference between razor bumps downstairs and bumps that could be something more serious. I feel like I get jaded about seeing bumps down there occasionally when I shave, so I just slap on some lotion and forget about it. I don't want to have to go get tested every time a pimple shows up. Any advice? — Calamine Queen

Dear Calamine Queen: I understand your plight! There are STIs that cause genital sores: syphilis will first appear as a small, slightly raised, painless sore that most people miss. Herpes causes blister-like sores which can appear anywhere on the body and do not resemble pimples. Donovanoisis, aka granuloma inguinale, is rarely seen in the US with about 100 cases per year, and mainly found in India, Guyana, and New Guinea. These sores are painless red lumps on or near your genitals, which will slowly enlarge and then break down to a sore.  Lymphogranuloma venereum is an ulcerative disease caused by chlamydia trachomatis. It starts as a small, barely noticeable blister that will then heal. In the next stage, your groin lymph nodes swell and it can affect your labia. Pubic lice can also cause sores, and these little critters are visible with your eyes, as are their nymphs and eggs. Scabies will itch, present as red papules, and the itching increases at night. If you are up for it, you can search online for good info on these STIs and their respective sores for an afternoon of fun education!

Thank you Lazy in Love, Saran-Wrapped Sapphic and Calamine Queen for writing to me, and for helping ask questions others may be afraid to ask! I’m Hedda Fay reminding you that the best orgasm is one that’s protected!

Hedda Fay is Community Outreach and Program Manager at Northland Cares. Contact Hedda with your questions at 928-776-4612 or fay.h@northlandcares.org.

Welcome to Sexual Health with Hedda, Yavapai County! Share your questions about sexual health, STDs and HIV here, and have your questions answered in this amazing publication.

I am a sexual-health educator, HIV/STD tester and a PEP and PrEP Navigator. I want to talk about sex with the community because my eight-to-four is providing prevention services, testing, prophylaxis distribution and education and educating our community about HIV and STDs, with the goal of stopping both the stigma and the spread! 

This is something we can do right now. It starts with making it okay to talk about our sexual health. I am old enough to remember when my grandmother whispered “C-A-N-C-E-R,” because it was not something people felt comfortable speaking about in public spaces. Now there are public campaigns to raise funds and awareness. We don’t have a March against Gonorrhea or a Concert to Raise Awareness About Syphilis, but we need one. We truly do! 

Having an STD is nothing to be ashamed or embarrassed about. Being unable to discuss your own sexual health is the cause for concern. Think about it: it’s you, your body and your parts. Next to your desire to survive, the second-strongest in us mammals is the reproductive urge. It’s hard-wired into our beings. Without my knowledge or consent, my body sends out and receives chemical responses from complete strangers at the store. It’s my own brain doing it without my knowledge.

Pheromones and hormones are our internal and external chemical exchange. They are why we’re sometimes sexually attracted to a person we would never otherwise consider as a partner or even one-night stand. Honestly, have you ever been turned on by someone and wondered why? Pheromones, baby! That’s for another day.

Today’s goal is to bring awareness of STDs and HIV to everyone and have it be part of the conversation in the newspaper. We need to talk and be able to have open dialogue — without making it smutty — about STDs, HIV, prevention and the latest and greatest advancements in the battle against sexually transmitted infections.

Share your questions and I will do my absolute best to provide you with answers and information so you can be more empowered with your sexual health.

Send in your questions today! I look forward to engaging with each of you.

Hedda Fay Community Outreach and Program Manager at Northland Cares

Contact her by email fay.h@northlandcares.org or

call her at (928) 776-4612 ask for Hedda