In February, researchers from The Ohio State University released a study that found that the younger teens lose their virginity, the more likely they are to become juvenile delinquents. The study garnered little attention, however, because the theory had long been believed to be true and incorporated into the teachings of federal abstinence programs.

But a new study, released from researchers at the University of Virginia in Charlottesville, found the opposite to be true. This study, led by Paige Harden, a doctoral candidate in psychology, found that pre-teens and early teens that have consensual sex are less likely to develop antisocial tendencies compared to their celibate classmates.

The latest study relies on behavioral genetics, which seeks to clarify whether one behavior actually causes another, or whether they are merely correlated.

The earlier you have sex, the better, scientists say.

The study by researchers at the University of Virginia says that, contrary to popular perception, those who have sex in their early teens may not have stepped on the path to delinquency.

Rather, they may be less inclined to exhibit delinquent behaviour than peers who waited until they were older to have sex. Early sex may help them develop better social relationships in early adulthood, says the study.

The findings have been published in the online edition of the Journal of Youth and Adolescence.

The findings contradict parts of a study published earlier this year in the same journal that found links between early teen sex and later behavioural problems.

The research team analysed data on 534 same-sex twin pairs in the US gathered at three time points over a seven-year period.

By examining surveys of twins, the investigators were able to eliminate the genetic and socio-economic variables that otherwise might influence the behaviours of adolescents.

“We got a very surprising finding, particularly that early sex seems to forecast less anti-social behaviour a few years later, rather than more,” said Kathryn Paige Harden, the study’s lead author.

She said that there is a “cultural assumption” that if teens have sex early it is somehow bad for their psychological health.

“But we actually found that teens who had sex earlier seem to have better relationships later. Now we want to find out why,” she added.

Harden said that people assume there is an association between early sex and delinquency because “teen sex transgresses parental expectations” and is seen as impulsive.

“But people’s concerns about early sex leading to delinquency may not be warranted.”

Harden acknowledged that early adolescent sexuality is linked to early pregnancy and disease, but said these risks are not inevitable.

In Australia, for instance, there are similar rates and patterns of teen sexual activity as in the US, but drastically lower rates of teen pregnancy, she pointed out.

She attributed this to the poor level of sexual health knowledge in the US, ineffective contraceptive use and lower abortion rates.

Study Debunks Theory On Teen Sex, Delinquency

Researchers at Ohio State University garnered little attention in February when they found that youngsters who lose their virginity earlier than their peers are more likely to become juvenile delinquents. So obvious and well established was the contribution of early sex to later delinquency that the idea was already part of the required curriculum for federal “abstinence only” programs.

There was just one problem: It is probably not true. Other things being equal, a more probing study has found, youngsters who have consensual sex in their early-teen or even preteen years are, if anything, less likely to engage in delinquent behavior later on.

That new analysis, a reworking of the same data the Ohio team used, is one of several recent instances in which a more precise parsing of data has begun to turn long-standing societal presumptions on their head. By bringing evidence to bear on complex social issues, these studies are forcing individuals and policymakers to rethink such hot-button topics as the benefits of breast-feeding, the risks of teen child-bearing and, in the latest example, the harms long presumed to result from teen sex.

Like many of the newer studies, the latest one — led by Paige Harden, a doctoral candidate in psychology at the University of Virginia in Charlottesville — used the powerful techniques of behavioral genetics. The field specializes in studies on twins, research that can help tell whether behavioral traits are the result of genes or the social environment, and that has periodically stirred controversy when it has focused on the genetic underpinnings of criminality and intelligence.

But the specialty’s analytic methods can also help tell whether one behavior, such as early sex, is merely correlated with or actually causes a second behavior that is often found with it, such as delinquency. If two behaviors often exist in the same people but are found not to be connected by cause and effect, then a third factor is likely to be causing both.

That kind of finding can help identify better targets for prevention efforts, experts say.

“Behavioral geneticists have long sought to establish causal links between genes and complex behaviors. So it’s fascinating to see them use the tools of their trade to dispute widely held beliefs” about the social roots of some of those behaviors, said Erik Parens, a senior research scholar who has tracked the field intensively at the Hastings Center, a Garrison, N.Y., science and ethics think tank.

The latest example started when Dana Haynie, a sociologist at Ohio State, and her then-graduate student, Stacy Armour, published a study in February in the Journal of Youth and Adolescence. They analyzed data collected from more than 7,000 children as part of the National Longitudinal Study of Adolescent Health, a federally funded survey that in 1994 began gathering information about the health-related behavior of U.S. schoolchildren who were then in grades seven through 12.

Haynie and Armour divided the children into three groups based on when they first had sex: when they were younger, about the same age or older than the age at which most of their local peers lost their virginity. (It varies by region, but on average, U.S. children lose their virginity at age 16.) They also compiled information on graffiti-painting, shoplifting, drug-selling and other “problem behaviors” by those young people in later years.

Their conclusion: One year after losing their virginity, children in the early category were 20 percent more likely than those who started having sex at the average age to engage in delinquent behavior, even when several other relevant factors such as wealth, race, parental involvement and physical development were taken into account.

Those findings supported the widely held notion that loss of virginity at a relatively young age appears to, as Haynie and Armour wrote, “open the doorway to problem behaviors.”

Harden, at the University of Virginia, didn’t believe it.

Looked at from a similarly high altitude, she said, people might conclude that red meat is a health food, since people live longer in countries where more is eaten. Only when the issue is studied within one country does red meat’s link to chronic diseases appear.

Suspecting such an error in the Haynie study, Harden and three colleagues, including her adviser, Eric Turkheimer, an expert in behavioral genetics, studied more than 500 pairs of twins in the same national survey analyzed by the Ohio team. Because twin pairs share similar or identical genetic inheritances (depending on whether they are fraternal or identical) and the same home environment, twin studies are useful for seeing through false cause-and-effect relationships.

The team looked at identical twin pairs in which one twin initiated sex younger than the other, then team members tallied subsequent problem behaviors. If sex really adds to the chances of delinquency, then early-sex teens should end up delinquent more often than their later-sex twins.

“It turns out that there was no positive relationship between age of first sex and delinquency,” Harden said.

The way to reconcile that with the previous evidence of a link is to conclude that some other factors are promoting both early sex and delinquency, she said. In an e-mail, Haynie agreed. And the Virginia study, to appear in the March 2008 issue of the Journal of Youth and Adolescence, offers some clues.

It found that identical twins, who have the same DNA, were more similar to one another in the ages at which they lost their virginity than were fraternal twins, whose DNA patterns are 50 percent the same — an indication that genes influence the age at which a person will first have sex. Other twin studies have found the same pattern for delinquency.

Together, those findings suggest that some genes — perhaps, for example, those that increase impulsivity and risk-taking — may underlie both behaviors.

“You need to have some appetite for risk-taking to be a delinquent. And the same if you’re 13 and going to have sex for the first time,” Harden said.

Efforts to prevent delinquency can hardly take aim at people’s genes. But the Virginia study also indicates that social factors, as yet unidentified but perhaps involving relationships with family and friends, have an even bigger impact than genes on whether a child will become delinquent. Those are the things that should be identified and targeted by delinquency-prevention programs, said Jeanne Brooks-Gunn, co-director of Columbia University’s National Center for Children and Families.

“I wouldn’t be focusing on early sexuality . . . to alter rates of delinquency,” she said.

Perhaps most surprising, the Virginia study found that adolescents who had sex at younger ages were less likely to end up delinquent than those who lost their virginity later. Many factors play into a person’s readiness for sex, but in at least some cases sexual relationships may offer an alternative to trouble, the researchers say.

Even then, there are emotional and physical risks. Young adolescents, in particular, are less likely to use condoms and so are vulnerable to sexually transmitted diseases and unwanted pregnancies.

The team looked at identical twin pairs in which one twin initiated sex younger than the other, then team members tallied subsequent problem behaviors. If sex really adds to the chances of delinquency, then early-sex teens should end up delinquent more often than their later-sex twins.

“It turns out that there was no positive relationship between age of first sex and delinquency,” Harden said.

The way to reconcile that with the previous evidence of a link is to conclude that some other factors are promoting both early sex and delinquency, she said. In an e-mail, Haynie agreed. And the Virginia study, to appear in the March 2008 issue of the Journal of Youth and Adolescence, offers some clues.

It found that identical twins, who have the same DNA, were more similar to one another in the ages at which they lost their virginity than were fraternal twins, whose DNA patterns are 50 percent the same — an indication that genes influence the age at which a person will first have sex. Other twin studies have found the same pattern for delinquency.

Together, those findings suggest that some genes — perhaps, for example, those that increase impulsivity and risk-taking — may underlie both behaviors.

“You need to have some appetite for risk-taking to be a delinquent. And the same if you’re 13 and going to have sex for the first time,” Harden said.

Efforts to prevent delinquency can hardly take aim at people’s genes. But the Virginia study also indicates that social factors, as yet unidentified but perhaps involving relationships with family and friends, have an even bigger impact than genes on whether a child will become delinquent. Those are the things that should be identified and targeted by delinquency-prevention programs, said Jeanne Brooks-Gunn, co-director of Columbia University’s National Center for Children and Families.

“I wouldn’t be focusing on early sexuality . . . to alter rates of delinquency,” she said.

Perhaps most surprising, the Virginia study found that adolescents who had sex at younger ages were less likely to end up delinquent than those who lost their virginity later. Many factors play into a person’s readiness for sex, but in at least some cases sexual relationships may offer an alternative to trouble, the researchers say.

Even then, there are emotional and physical risks. Young adolescents, in particular, are less likely to use condoms and so are vulnerable to sexually transmitted diseases and unwanted pregnancies.

Similar re-analyses have begun to undermine other conventional notions about health.

A recent study by Scottish researchers asked whether the higher IQs seen in breast-fed children are the result of the breast milk they got or some other factor. By comparing the IQs of sibling pairs in which one was breast-fed and the other not, it found that breast milk is irrelevant to IQ and that the mother’s IQ explains both the decision to breast-feed and her children’s IQ.

In another example, Arline Geronimus, a University of Michigan professor of health behavior who is now a fellow at Stanford University’s Center for Advanced Study, knew that babies born to teenagers are more likely to die in their first year of life than those born to older women.

“But that is an apples-to-oranges comparison,” she said. In New York City, for example, far more teen mothers live in Harlem than on the Upper East Side, she said, and “there are a lot of differences between those groups.”

So Geronimus looked more closely and got a different answer.

“If you compare Harlem teen moms to Harlem older moms, you find that the kids of the teen moms are actually less likely to die,” she said. The reasons include the fact that, unlike older women, poor teenagers are generally not juggling jobs and have older relatives to help.

It can make sense for poor women to have children when they are quite young, Geronimus concludes, and any effort to change that ought to treat it as an economic problem, not a health education problem.

In a different re-analysis, Geronimus made another counterintuitive finding. While it is true that, in general, teen mothers are less likely to breast-feed their babies than older moms, it is not true among poor women. Poor teenagers are actually more likely to breast-feed than poor older moms, in large part because the older women have jobs that don’t grant them the time to breast-feed or pump milk.

Because of that misconception, programs promoting breast-feeding have targeted teens instead of older women, Geronimus said. And they have taken aim, in part, at a concern that teenagers were believed to have: the cosmetic effects of breast-feeding on their breasts.

“So you’ve targeted the wrong population,” Geronimus said, “and come up with the wrong kind of intervention.”

Is sexual orientation something people are born with or a matter of choice? In findings that are bound to re-ignite the debate, a new study weighs in on the side of genetics.

Researchers at McMaster University and Sunnybrook Health Sciences Centre here have found new evidence that shows that your genes are what make you straight or gay.

Led by neuroscientist Sandra Witelson, the study scanned the brains of healthy, right-handed homosexual and heterosexual men using magnetic resonance imaging (MRI).

A decade back, Witelson had demonstrated there are more left-handers in the homosexual population.

Handedness is a sign of how the brain is organised to represent different aspects of intelligence. Language, for example, is usually on the left- music on the right.

In other research, Witelson had also found that left-handers have a larger posterior corpus callosum - the band of nerve fibres connecting the two hemispheres of the brain - than right handers.

This raised the hypothesis for the current study: whether the anatomy of the brain of the sub-group of right-handed homosexual men is similar to that of left-handers.

The researchers found that the posterior part of the corpus callosum is larger in homosexual than heterosexual men.

As the size of the corpus callosum is largely inherited, it suggested a genetic factor in sexual orientation, said Witelson.

“Our results do not mean that heredity is destiny, but they do indicate that environment is not the only player in the field,” she said.

Witelson said the finding may be one additional piece of information for individuals trying to determine their sexual orientation.

“Sometimes people aren’t sure of their sexual orientation.”

Sexual Orientation Development

Sexual orientation is one component of a person’s identity, which is made up of many other components, such as culture, ethnicity, gender, and personality traits. Sexual orientation is an enduring emotional, romantic, sexual, or affectional attraction that a person feels toward another person. Sexual orientation falls along a continuum. In other words, someone does not have to be exclusively homosexual or heterosexual, but can feel varying degrees of attraction for both genders. Sexual orientation develops across a person’s lifetime—different people realize at different points in their lives that they are heterosexual, gay, lesbian, or bisexual.

Sexual behavior does not necessarily equate to sexual orientation. Many adolescents—as well as many adults—may identify themselves as homosexual or bisexual without having had any sexual experience. Other young people have had sexual experiences with a person of the same gender, but do not consider themselves to be gay, lesbian, or bisexual. This is particularly relevant during adolescence because it is a time for experimentation—a hallmark of this developmental period.

Gay, lesbian, and bisexual adolescents follow a develop-mental path that is both similar to and quite different from that followed by heterosexual adolescents. All teenagers face certain developmental challenges, such as developing social skills, thinking about career choices, and fitting into a peer group. Gay, lesbian, and bisexual youth must also cope with prejudiced, discriminatory, and violent behavior and messages in their families, schools, and communities. Such behavior and messages negatively affect the health, mental health and education of lesbian, gay, and bisexual young people. These students are more likely than heterosexual students to report missing school due to fear, being threatened by other students, and having their property damaged at school. The promotion of “reparative therapy” and “transformational ministry” is likely to exacerbate the risk of harassment, harm, and fear.

For these reasons, the experience of gay, lesbian, and bisexual teenagers is often one of isolation, fear of stigmatization, and lack of peer or familial support. Gay, lesbian, and bisexual youth have few opportunities for observing positive modeling by adults due to the general cultural bias that makes gay, lesbian, and bisexual people largely invisible. It is this isolation and lack of support that accounts in part for the higher rates of emotional distress, suicide attempts, and risky sexual behavior and substance use that gay, lesbian, and bisexual students report compared to heterosexual students. Because of their legitimate fear of being harassed or hurt, gay, lesbian, or bisexual youth are less likely to ask for help. Thus, it is important that their environments be as open and accepting as possible, so these young people will feel comfortable sharing their thoughts and concerns. To be able to provide an accepting environment, school personnel need to understand the nature of sexual orientation development and be supportive of healthy development for all youth.

“Coming out” refers to the process of acknowledging one’s gay, lesbian, or bisexual attractions and identity to oneself and disclosing them to others. This process is different for every teenager; however, most adolescents disclose their sexual orientation to others in the following order: other gay, lesbian, and bisexual peers, close heterosexual peers, close family members, and finally, parents.

Many people may wonder why gay, lesbian, and bisexual teenagers and adults feel the need to “come out,” i.e., disclose their sexual orientation to others. This is actually the expression of a normal tendency to want to share personal information about oneself with important others, and should be treated as such by those around the gay, lesbian, or bisexual adolescent. It is healthy for teenagers to share with friends and families their latest crush or how they spent their weekend. This process, however, is often quite difficult for the gay, lesbian, or bisexual adolescent, because there is a strong (and well-founded) fear of being rejected by others.

Sex is a taboo in conservative Islamic countries. Young, unmarried couples are forced to seek out secret erotic oases. Books and play that are devoted to the all too human topic of sex incur the wrath of conservative religious officials and are promptly banned.

Rabat, Morocco. Every evening Amal the octopus vendor looks on as sin returns to his beach. It arrives in the form of handholding couples who hide behind the tall, castle-like quay walls in the city’s harbor district to steal a few clandestine kisses. Some perform balancing acts on slippery rocks and seaweed to secure a spot close to the Atlantic Ocean and cuddle in the dim evening light. The air tastes of salt and hashish. On some mornings, when Amal finds used condoms on the beach, he wishes that these depraved, shameless sinners — who aren’t even married, he says — would roast in hell.

Cairo, Egypt. A hidden little dead-end street in Samalik, a posh residential neighborhood, with a view of the Nile. Those who live here can stand on their balconies at night and see things that no one is meant to see. The cars begin arriving well before sunset, some evenings bringing as many as a hundred amorous couples. Almost all the girls wear headscarves, but that doesn’t prevent them from wearing skin-tight, long-sleeved tops. The boys are like boys everywhere, nonchalantly placing their arms around their girlfriends’ shoulders and even more nonchalantly sliding their hands into their blouses.

The locals call this place “Shari al-Hubb,” or “Street of Love.” The gossips say that children have been conceived here and couples have been spotted engaging in oral sex.

Beirut, Lebanon. As techno music blares from the loudspeakers in the dim light, patrons shout their drink orders across the bar. Boys in tight jeans and unbuttoned, white shirts, their hair perfectly styled, jostle their way onto the dance floor. The men shake their hips, clap their hands and embrace — but without touching all too obviously. After all, those who go too far could end up being thrown out of “Acid,” Beirut’s most popular gay disco. Officially, “Acid” is nothing more than a nightclub in an out-of-the-way industrial neighborhood.

As liberal as Lebanon is, flaunting one’s homosexuality is verboten. Gays are tolerated, but only as long as they remain under the radar and conceal their activities from public scrutiny.

For many in the Arab world, discretion is the only option when it comes to experiencing lust and passion. There are secret spots everywhere, and they are often the only place to go for those forced to live with the contradictions of the modern Islamic world. In countries whose governments are increasingly touting strict morals and chastity, prohibitions have been unsuccessful at suppressing everyday sexuality. Religious censors are desperately trying to put a stop to what they view as declining morals in their countries, but there is little they can do to stop satellite TV, the Internet and text messaging.

A counterforce to Western excesses?

Do the stealthy violations of taboos and moral precepts foreshadow a sexual revolution in the Arab world? Or is the pressure being applied by the moralists creating a new prudishness, a counterforce to the perceived excesses of the West?

For now, everything seems possible, including the idea that a man can end up spending a night in jail for being caught with a condom in his shirt pocket. Ali al-Gundi, an Egyptian journalist, was driving his girlfriend home when he was stopped at a police checkpoint. He didn’t have his driver’s license with him, but it was 4 a.m. and he was in the company of an attractive woman. For the police, this was reason enough to handcuff Gundi and his girlfriend and take them to the police station. “On the way there, they threatened to beat us,” says the 30-year-old. At the station, they took away his mobile phone and wallet and found an unused condom in his shirt pocket.

“They were already convinced that my girlfriend was a whore,” says Gundi. The couple ended up behind bars, even after telling the police that they planned to get married in a few months. Only after the woman notified her father the next day were the two released from jail. For Gundi, one thing is certain: “If the officer who stopped us hadn’t been so sexually frustrated, he would have let us go.”

The sexual frustration of many young Arabs has countless causes, most of them economic. Jobs are scarce and low-paying, and most young men are unable to afford and furnish their own apartments — a prerequisite to being able to marry in most Arab countries. At the same time, premarital sex is an absolute taboo in Islam. As a result, cities across the Arab world — Algiers, Alexandria, Sana’a and Damascus — are filled with “boy-men” between 18 and 35 who are forced to live with their parents for the foreseeable future.

There is one exception, and it’s even sanctioned by the Islamic faith: the “temporary marriage” or “pleasure marriage” — not a bond for life but one designed for intimate sins. Such agreements, presided over by imams, are not regulated by the state. They can be concluded for only a few hours or they can be open-ended. But particularly romantic they are not.

Separating the sexes

Another frustrating development for young Islamic men is the growing separation of the sexes. More and more women are wearing modest clothing. Some choose to wear headscarves or cover their entire bodies, and some even wear black gloves to cover the last remaining bit of exposed skin on their bodies.

Nowadays a woman walking along a Cairo street without a veil stands a good chance of being stared at as if she were from another planet. Journalist Gundi is convinced that “oppression brings out perversion in people.” The men want their women to be covered and veiled because they are afraid of women — “afraid of the feelings women provoke.”

Most Egyptian women now wear a headscarf, but for varying reasons. Ula Shahba, 27, sees the trend toward covering one’s head as an expression of a new female self-confidence, not as a symbol of oppression. For the past two years, Shahba has worn the headscarf voluntarily — out of conviction, as she emphasizes, insisting that no one forces her to do so. But, she adds, the decision wasn’t easy. “I love my hair,” she says, “but it shouldn’t be visible to everyone.” Shahba doesn’t believe that the headscarf is a sign of religious devoutness. “It’s more of a trend,” she says.

A Moroccan study published in early 2006 in L’Economiste, a Moroccan business publication, shows how paradoxical young Arabs’ attitudes toward religion and sexuality can be. According to the study, young Muslims in the Maghreb region are increasingly ignoring the clearly defined rules of their religion. Premarital sex is not unusual, and 56 percent of young men admit to watching porn on a regular basis. But the respondents also said that it was just as important to them to pray, observe the one-month Ramadan fast and marry a fellow Muslim. When seen in this light, young Muslims’ approach to Islam seems as hedonistic as it is variable, almost arbitrary.

Betraying the message of Muhammad

Muslim novelist “Nedjma” (”Star”), the author of “The Almond,” a successful erotic novel, describes Moroccan society as divided and bigoted. Despite progressive family and marriage laws, she says, the country is still controlled by patriarchal traditions in which men continue to sleep around and treat women as subordinates. It is a society in which prudishness and sexual obsession, ignorance and desire, “sperm and prayer” coexist. “The more repressive a society is, the more desperately it seeks an outlet,” says Nedjma, who conceals her real name because she has already been vilified on the Internet as a “whore” and an “insult to Islam.”

Men like Samir, 36, a bald waiter who wears a formal, black and white uniform to work, could be straight out of Nedjma’s novel. Samir grins at the prospect of catching a glimpse of unveiled girls in his cafe in Rabat. But in the same breath, he admits that he would never spend a significant amount of time in the same room with a woman he doesn’t know. “No man and no woman can be together without being accompanied by the devil,” he believes, adding that he is quoting the Prophet Muhammad.

But most sources paint a completely different picture of the religious leader, describing him as a hedonist and womanizer who loved and worshipped women. Indeed, he married 12 women, including a businesswoman 15 years his senior, to whom he remained faithful until her death. Author Nedjma says that Muslim men today are “betraying the message of Muhammad,” whom she describes as a delicate, gallant man. She doubts that the prophet was afraid of female sexuality, as many of the men in her social circle are today.

Even conservative theologians emphasize the compatibility of pleasure and faith — but only after marriage. They can even evoke the Prophet Mohammed, who said: “In this world, I loved women, pleasant scents and prayer.”

This presents an odd contradiction to the puritanical present, which represents a fundamental departure from Islam’s more open-minded past and has instead made way for a humorless and rigorous Islamism.

Journalist Ali al-Gundi believes that Muslim men have a troubled relationship with their own sexuality. “Most men only want to marry a virgin,” he says. “What for? Isn’t it much nicer to be with a partner who has experience?” Gundi talks about his girlfriends who have done everything but actually have sex, so as not to damage their hymens. That would mean social death.

Egyptian filmmaker Ahmed Khalid devoted his first short film, “The Fifth Pound,” to the topic of taboo. The film tells the story of a young couple who use a bus ride to be together and exchange more than just a few innocent, tender words. Every Friday morning, when everyone else is at the mosque for prayers, they meet on the third-to-the-last bench on the bus, a spot where none of the other passengers can see what they are doing. As they sit there, shoulder-to-shoulder, staring straight ahead, they stroke each other’s bodies. Their only fear is that the bus driver will see what they are doing through the rear view mirror. He watches the couple, fully aware of what they are doing, all the while indulging in his own fantasies.

In his imagination, the driver sits down next to the girl, carefully removes her headscarf and unbuttons her blouse. She closes her eyes and presses her fingers into the armrest. The headscarf slowly slides off the seat. Both reach climax, the girl in the bus driver’s fantasy and the boy through his girlfriend’s hand. In the end, the couple pays the driver four pounds for the tickets and a fifth for his silence.

Of course, Khalid was unable to find a distributor for his scandalous, 14-minute short film, and even Cairo’s liberal cultural centers refused to run “The Fifth Pound” without it being censored first. Even though, or perhaps precisely because the film does not depict any actual sexual activity, it excites the viewer’s fantasy — an especially odious offense in the eyes of religious censors.

An ‘Islamic Vagina Monologues’

The Internet is a refuge for hidden desires, even though it offers only virtual relief. Google Trends, a new service offered by the search engine, provides a way to demonstrate how difficult it is to banish forbidden yearnings from the heads of Muslims. By entering the term “sex” into Google Trends, one obtains a ranked list of cities, countries and languages in which the term was entered most frequently. According to Google Trends, the Pakistanis search for “sex” most often, followed by the Egyptians. Iran and Morocco are in fourth and fifth, Indonesia is in seventh and Saudi Arabia in eighth place. The top city for “sex” searches is Cairo. When the terms “boy sex” or “man boy sex” are entered (many Internet filters catch the word “gay”), Pakistan, Iran, Saudi Arabia and Egypt are the first four countries listed.

Homosexuality is more than just a taboo in the Islamic world. In fact it is considered a crime, punishable by imprisonment or even the death penalty.

Yusuf al-Qaradawi, an imam who lives in Qatar and has a television show on Arab network Al Jazeera, considers homosexuality as an especially decadent monster created by the West. It is against the “divine order,” says the religious scholar, citing verses in the Koran that describe homosexuality as a common practice in pre-Islamic Arabia.

Homosexuals are referred to in Arabic as “Luti,” or people from the city of the Lut, which is mentioned in the Koran and the Bible and is described as having been destroyed by God’s wrath. The sources seem to clearly support this notion.

As a result, very few gay Muslims even attempt to reconcile their faith with their sexual orientation. Most, says George Assi, a spokesman of Helem, the only gay and lesbian organization in the Arab world, are in despair over the fact that they cannot be as virtuous as their religion prescribes.

Helem, a Lebanese organization that is neither completely legal nor prohibited, has its office in an Islamic business district in Beirut, a city that offers greater political and sexual freedom than any other place in the Arab world. But even here the organization faces protests and threatening phone calls, especially from the Gulf states. “Many talk about us as if we were sick people who must either be healed or abandoned,” says Assi.

“Shocking, sad” stories

Unlike Lebanon, Egypt is a place where freedom of opinion is always in jeopardy. The country’s once-blossoming worlds of art and literature are especially affected. This makes it all the more astonishing that a play could be produced on a Cairo stage that deals exclusively with sex. Even the play’s title, “Bussy,” is a provocation. It resembles the English word “pussy,” but it is also a slang term Egyptian men use to tell a woman to “look here.”

And this is precisely what the directors wanted: to attract attention — to discrimination, lack of respect and mental immaturity. “We had no intention of being daring or of provoking anyone. We merely wanted to tell the truth,” says director Naas Chan. The performance was created as an analogue to the famous New York play, “The Vagina Monologues.” When the American production was performed at the American University in Cairo, it was met with disgust, indignation and — enthusiastic applause. But because it had little to do with the problems of Egyptian women, a group of students decided to stage a sort of “Islamic Vagina Monologue” with amateur actors.

Ordinary women were asked to talk about love and sex. “Their stories were so shocking, so touching, sad and amusing that they needed no editing,” says Chan. And that was how “Bussy” was created.

In one scene, a girl, her voice choking with tears, talks about the day her mother took her to the doctor, without telling her that he was going to circumcise her. “When I woke up I felt the pain. Something was missing … the flesh that they had stolen belonged to me!” Another woman describes her experience with an imam who, when she was 10, forced her into a closet and raped her. “When I told my mother about it, she said that I was making it up.”

“I was surprised that almost all the stories we got were serious,” says director Chan. The women talked about their experiences with abortions, rapes, female circumcision and plain, everyday discrimination. Each of the 50 stories submitted reflects a slice of Egyptian reality. Telling the stories required a great deal of courage, says Chan. The mere knowledge that one’s own story will be performed in front of an audience represents a break with tradition. Sexual abuse, says Chan, is considered a family matter, and if it is disclosed to outsiders, the family feels dishonored and believes the woman has been deprived of her value.

Abir embodies yet another archetype in Arab-Islamic moral society. She is 32 years old, petite, dark-skinned and wears an expensive, long black wig. She lives alone in a small but tidy apartment. Images from the days of the Pharaohs hang on her walls next to large, white pencils — souvenirs from a trip to Germany’s Rugen Island. Abir sits on a white wooden couch with pink upholstery. She wears shorts and a pink T-shirt. A tattoo of the sun adorns her right upper arm and she has a nicotine patch stuck to her left arm.

Abir married for the first time when she was 23. Her mother was dead, her father bedridden and she had been making a meager living as a maid. The marriage was a nightmare. Her husband beat her, and on one occasion her mother-in-law cut off her long black hair and hung it on the wall — as a warning. Abir obtained a divorce and took a job in a bar, where she met wealthy foreigners.

Abir spreads out a series of photos on her coffee table. They show two happy people, swimming in the ocean, sitting on a park bench, shopping in Germany. But when the man in the photograph, a German named Ingo, still didn’t want to marry her after three years, Abir broke off the relationship — on the phone.

“Why should I waste my life?” she asks.

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Women in a Nepal mountain village have been mailing condoms to their husbands working overseas to protect them from sexually transmitted diseases, a news report said Tuesday.

The women of Pang village have been writing their husbands letters urging them not to have sex with others — but they have been enclosing condoms just in case, the Kantipur newspaper reported.

Social workers have been counseling the women about sexually transmitted diseases.

“As I learned that unsafe relations make a person vulnerable to HIV, I sent a condom along with the letters to my husband,” one of the village wives, Laxmi Sunar, told the newspaper.

An estimated 3 million people from impoverished Nepal work overseas, most as manual laborers, and send money home to support their families.

Indonesia to launch first-ever national condom campaign

Indonesia is to launch its first-ever national campaign to promote condom use to prevent unwanted pregnancies and the spread of sexually-transmitted diseases including HIV/AIDS, officials said Tuesday.

National Condom Week will coincide with World AIDS Day on December 1, said Sugiri Syarief, head of the National Family Planning Board who is overseeing the event.

The groundbreaking campaign will involve condom distribution, education on the benefits of using condoms as well as following safe sex practices, and other events aimed at helping lift the stigma attached to using condoms here.

The event “is aimed at popularising condoms as a tool to prevent unwanted pregnancy and a way to prevent sexually-transmitted diseases, especially HIV” in the world’s most populous Muslim nation, Syarief said.

Government efforts to promote condom use have so far focused on family planning and not generated much enthusiasm, he said, noting that condoms account for less than one percent of all contraception used in Indonesia.

An unsupportive social environment, ignorance as well as a low awareness of the importance of safe sex have conspired against condom use in the world’s fourth most populous nation, he added.

The head of the Indonesian Council of Mosques, Tarmidzi Taher, said the campaign was partly aimed not at getting Muslim leaders to endorse the use of condoms but to allow them to “understand the medical arguments for them.”

Nafsiah Mboi, secretary of the National AIDS Mitigation Commission, said that safe sex education would also help efforts to curb the spread of HIV.

The World Health Organisation warned in February that Indonesia had one of the fastest-growing HIV populations in Asia.

Latest official figures showed that more than 16,200 Indonesians have been infected with the HIV virus that causes AIDS since 1987, Mboi said.

“But unregistered infection cases are much more numerous, with estimates that in 2006 some 176,000 to 247,000 people have been infected by HIV” since it became prevalent, she said.

Basic information about condoms

A condom is a device, usually made of latex, or more recently polyurethane, that is used during sexual intercourse. It is put on a man’s erect penis and physically blocks ejaculated semen from entering the body of a sexual partner. Condoms are used to prevent pregnancy and transmission of sexually transmitted infections (STIs—such as gonorrhea, syphilis, and HIV).

Male condoms are usually packaged inside a foil wrapper, in a rolled-up form, and are designed to be applied to the tip of the penis and then rolled over the erect penis. They are most commonly made from latex, but are also available in other materials. As a method of contraception, condoms have the advantage of being easy to use, inexpensive, having few side-effects, and of offering protection against sexually transmitted diseases. With proper knowledge and application technique—and use at every act of intercourse—condom users experience a 2% per-year pregnancy rate. Condoms may be combined with other forms of contraception (such as spermicide) for greater protection.

Some couples find that putting on a male condom interrupts sex, although others incorporate condom application as part of their foreplay. Some men and women find the physical barrier of a condom dulls sensation. Advantages of dulled sensation can include prolonged erection and delayed ejaculation; disadvantages might include a loss of the erection, or a loss of the pleasure of sexual actions.

Most condoms have a reservoir tip, making it easier to leave space for the man’s ejaculate. Condoms also come in different sizes, from oversized to snug. Most condoms are made of latex, but polyurethane and lambskin condoms are also widely available.

Latex condoms

Lubricants

Latex condoms used with oil-based lubricants (e.g. vaseline) are likely to slip off due to loss of elasticity caused by the oils.

Some latex condoms are lubricated at the manufacturer with a small amount of a nonoxynol-9, a spermicidal chemical. According to Consumer Reports, spermicidally lubricated condoms have no additional benefit in preventing pregnancy, have a shorter shelf life, and may cause urinary-tract infections in women. In contrast, application of separately packaged spermicide is believed to increase the contraceptive efficacy of condoms.

Nonoxynol-9 was once believed to offer additional protection against STDs (including HIV) but recent studies have shown that, with frequent use, nonoxynol-9 may increase the risk of HIV transmission. The World Health Organization says that spermicidally lubricated condoms should no longer be promoted. However, they recommend using a nonoxynol-9 lubricated condom over no condom at all. As of 2005, nine condom manufacturers have stopped manufacturing condoms with nonoxynol-9, Planned Parenthood has discontinued the distribution of condoms so lubricated, and the Food and Drug Administration has proposed a warning regarding this issue.

Testing

Latex has outstanding elastic properties. Tensile strength exceeds 30 MPa. Condoms may be stretched in excess of 800% before breaking.

In 1990 the ISO set standards for production (ISO 4074, Natural latex rubber condoms) and the EU followed suit with its CEN standard (Directive 93/42/EEC concerning medical devices). Latex condoms are tested for holes with an electrical current. If the condom passes, it is rolled and packaged. Batches of condoms are tested for breakage with air inflation tests.

Health issues

Dry dusting powders are applied to latex condoms before packaging to prevent the condom from sticking to itself when rolled up. Previously, talc was used by most manufacturers, however cornstarch is currently the most popular dusting powder. Talc is known to be toxic if it enters the abdominal cavity (i.e. via the vagina). Cornstarch is generally believed to be safe, however some researchers have raised concerns over its use.

Nitrosamines, which are potentially carcinogenic in humans, are believed to be present in a substance used to improve elasticity in latex condoms. A 2001 review stated that humans regularly receive 1,000 to 10,000 times greater nitrosamine exposure from food and tobacco than from condom use and concluded that the risk of cancer from condom use is very low. However, a 2004 study in Germany detected nitrosamines in 29 out of 32 condom brands tested, and concluded that exposure from condoms might exceed the exposure from food by 1.5- to 3-fold.

Polyurethane condoms

Polyurethane condoms can be thinner than latex condoms, with some polyurethane condoms only 0.02 mm thick. Polyurethane is also the material of many female condoms.

Polyurethane can be considered better than latex in several ways: it conducts heat better than latex, is not as sensitive to temperature and ultraviolet light (and so has less rigid storage requirements and a longer shelf life), can be used with oil-based lubricants, is less allergenic than latex, and does not have an odor. Polyurethane condoms have gained FDA approval for sale in the United States as an effective method of contraception and HIV prevention, and under laboratory conditions have been shown to be just as effective as latex for these purposes.

However, polyurethane condoms may be more likely to slip or break than latex, and are more expensive.

Lambskin

Condoms made from one of the oldest condom materials, labeled “lambskin” (made from lamb intestines) are still available. They have a greater ability to transmit body warmth and tactile sensation, when compared to synthetic condoms, and are less allergenic than latex. However, conventional wisdom holds that there is an increased risk of transmitting STDs compared to latex because of pores in the material, which are thought to be large enough to allow infectious agents to pass through, albeit blocking the passage of sperm. Lambskin condoms are frequently called ineffective with regards to preventing sexually transmitted diseases. Nonetheless, hard data regarding the alleged lack of efficacy are lacking. Although a search of the PubMed database of medical literature does not demonstrate any clinical trials demonstrating that lambskin condoms have decreased efficacy, at least one study does suggest that use of non-latex condoms is associated with higher rates of breakage and slippage.

While it may make sense to portray lambskin condoms as simply “ineffective” for the sake of simplicity in educational settings, it is more accurate to state that there are solid scientific reasons to expect lambskin condoms will be less effective in preventing STDs than latex and poluyrethane, though the degree of such presumed decreased efficacy is not known. It is unlikely that lambskin condoms would be “ineffective” in preventing STDs; for example, the risk of transmitting a disease through depositing 1.5 to 5 mLs of ejaculate directly into a partner’s body cavity without the use of any barrier protection would be anticipated to be greater than the risk involved in depositing such ejaculate into a lambskin barrier within a body cavity, with the barrier subsequently removed from the body cavity along with all or virtually all of the ejaculate.

Because the degree of efficacy of lambskin condoms has not been rigorously investigated and because there exists a solid rationale to expect them to have decreased efficacy, it is prudent to treat them as not effective. If one has concerns about the possibility of STD transmission, it is prudent to use latex or polyurethane condoms, rather than lambskin condoms.

Experimental

The Invisible Condom, developed at Universite Laval in Quebec, Canada, is a gel that hardens upon increased temperature after insertion into the vagina or rectum. In the lab, it has been shown to effectively block HIV and herpes simplex virus. The barrier breaks down and liquefies after several hours. The invisible condom is in the clinical trial phase, and has not yet been approved for use.

As reported on Swiss television news Schweizer Fernsehen on November 29, 2006, the German scientist Jan Vinzenz Krause of the Institut fur Kondom-Beratung (”Institute for Condom Consultation”) in Germany recently developed a spray-on condom and is test-marketing it. Krause says that one of the advantages to his spray-on condom, which is reported to dry in about 5 seconds, is that it is perfectly formed to each penis.

Effectiveness in preventing pregnancy

The effectiveness of condoms, as of most forms of contraception, can be assessed two ways. Perfect use or method effectiveness rates only include people who use condoms properly and consistently. Actual use, or typical use effectiveness rates are of all condom users, including those who use condoms improperly, inconsistently, or both. Rates are generally presented for the first year of use. Most commonly the Pearl Index is used to calculate effectiveness rates, but some studies use decrement tables.

The typical use pregnancy rate among condom users varies depending on the population being studied, ranging from 10–18% per year. The perfect use pregnancy rate of condoms is 2% per year.

Several factors account for typical use effectiveness being lower than perfect use effectiveness:

• mistakes on the part of those providing instructions on how to use the method
• mistakes on the part of the user
• conscious user non-compliance with instructions.

For instance, someone using condoms might be given incorrect information on what lubricants are safe to use with condoms, or by mistake put the condom on improperly, or simply not bother to use a condom.

Effectiveness in preventing STDs

Condoms are widely recommended for the prevention of sexually transmitted diseases (STDs). They have been shown to be effective in reducing infection rates in both men and women. While not perfect, the condom is effective at reducing the transmission of HIV, genital herpes, genital warts, syphilis, chlamydia, gonorrhea, and other diseases.

According to a 2000 report by the National Institutes of Health, correct and consistent use of latex condoms reduces the risk of HIV/AIDS transmission by approximately 85% relative to risk when unprotected. The same review also found condom use significantly reduces the risk of gonorrhea for men.

A 2006 study reports that proper condom use decreases the risk of transmission for human papilloma virus by approximately 70%. Another study in the same year found consistent condom use was effective at reducing transmission of herpes simplex virus-2 also known as genital herpes, in both men and women.

Although a condom is effective in limiting exposure, some disease transmission may occur even with a condom. Infectious areas of the genitals, especially when symptoms are present, may not be covered by a condom, and as a result, some diseases can be transmitted by direct contact. The primary effectiveness issue with using condoms to prevent STDs, however, is inconsistent use.

A Harbinger of Heart Trouble

Few men may realize it, but if they’re having problems achieving or sustaining erections, it may signal underlying heart trouble.

Erectile dysfunction, or impotence, affects more than 18 million American men, according to a recent study by researchers at the Johns Hopkins Bloomberg School of Public Health.

And now a growing body of research ties erectile dysfunction to vascular diseases, such as coronary artery disease.

“Erectile dysfunction is often caused by vascular disease,” explained Dr. Ian Thompson, professor and chairman of the department of urology at the University of Texas Health Science Center at San Antonio. “A man could perceive decreased blood flow to the penis as being a less strong, a weaker erection, and that may actually be one of the first indicators of blood vessel disease.”

One recent report found men with erectile dysfunction had poorer scores on exercise tests and other measures of coronary heart disease. They also had evidence of significant coronary artery blockages.

“Our study found that among men who were sent for a stress test by their doctor, the presence of erectile dysfunction was a potent predictor — a strong risk factor — for significant underlying heart disease,” said lead researcher Dr. R. Parker Ward, an assistant professor of medicine and director of the cardiology clinic at the University of Chicago Hospitals.

“It was a stronger risk factor than some of the traditional risk factors we commonly ask questions about, things like high blood pressure and high cholesterol,” he added.

Ward’s study, published last year in the Archives of Internal Medicine, involved men who had been referred to cardiologists for nuclear stress testing, a noninvasive way to determine the severity of coronary heart disease. But even among men without heart symptoms, erectile dysfunction is a strong risk factor for future risk of heart attack, he noted.

In the same issue of the journal, Dr. Steven A. Grover and colleagues studied a group of 3,912 Canadian men, nearly half of whom reported having erectile dysfunction in the four weeks prior to visiting their family physicians. The men’s cholesterol, glucose and blood pressure measurements were taken.

“When you calculated a global cardiovascular risk, [it] was strongly associated with the probability that you had erectile dysfunction,” said Grover, a professor of medicine and epidemiology at McGill University Health Centre in Montreal. “And subsequently there have been other studies that have shown that people who have erectile dysfunction are, in fact, more likely to develop cardiovascular disease in the future.”

Thompson and his colleagues provided the first substantial evidence linking erectile dysfunction and subsequent risk for heart disease in a December 2005 report in the Journal of the American Medical Association. Yet the connection is not as well recognized among doctors and patients as cardiologists and urologists think it should be.

“A lot of men don’t have physicians,” Thompson explained. “They may not know what their blood pressure is or their lipid profiles, or they may be smokers, and they may never have been counseled to stop smoking or to reduce their weight.

“We think that if men with erectile dysfunction went to see their physicians, it may enable the interaction with the physician to discuss other coronary risk factors,” he said.

Erectile problems aren’t always vascular in nature. Sometimes the trouble is psychological or neurological and wouldn’t necessarily be associated with a higher risk of heart disease, Ward cautioned. Still, research linking erectile dysfunction (ED) and heart disease suggests that a proactive approach is the best medicine.

“We as physicians should be asking about, and men should be reporting to their physicians, symptoms of ED, so it can be considered as we work to modify their risk — treat blood pressure, cholesterol more aggressively, advise healthy lifestyle changes like exercise and healthy diet,” he said.

Erectile dysfunction, sometimes called “impotence“, is the repeated inability to get or keep an erection firm enough for sexual intercourse. The word “impotence” may also be used to describe other problems that interfere with sexual intercourse and reproduction, such as lack of sexual desire and problems with ejaculation or orgasm. Using the term erectile dysfunction makes it clear that those other problems are not involved.

Erectile dysfunction, or ED, can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. These variations make defining ED and estimating its incidence difficult. Estimates range from 15 million to 30 million, depending on the definition used. According to the National Ambulatory Medical Care Survey (NAMCS), for every 1,000 men in the United States, 7.7 physician office visits were made for ED in 1985. By 1999, that rate had nearly tripled to 22.3. The increase happened gradually, presumably as treatments such as vacuum devices and injectable drugs became more widely available and discussing erectile function became accepted. Perhaps the most publicized advance was the introduction of the oral drug sildenafil citrate (Viagra) in March 1998. NAMCS data on new drugs show an estimated 2.6 million mentions of Viagra at physician office visits in 1999, and one-third of those mentions occurred during visits for a diagnosis other than ED.

In older men, ED usually has a physical cause, such as disease, injury, or side effects of drugs. Any disorder that causes injury to the nerves or impairs blood flow in the penis has the potential to cause ED. Incidence increases with age: About 5 percent of 40-year-old men and between 15 and 25 percent of 65-year-old men experience ED. But it is not an inevitable part of aging.

ED is treatable at any age, and awareness of this fact has been growing. More men have been seeking help and returning to normal sexual activity because of improved, successful treatments for ED. Urologists, who specialize in problems of the urinary tract, have traditionally treated ED; however, urologists accounted for only 25 percent of Viagra mentions in 1999.

How does an erection occur?

The penis contains two chambers called the corpora cavernosa, which run the length of the organ (see figure 1). A spongy tissue fills the chambers. The corpora cavernosa are surrounded by a membrane, called the tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa and is surrounded by the corpus spongiosum.

Erection begins with sensory or mental stimulation, or both. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps trap the blood in the corpora cavernosa, thereby sustaining erection. When muscles in the penis contract to stop the inflow of blood and open outflow channels, erection is reversed.

Figure 1. Arteries (top) and veins (bottom) penetrate the long, filled cavities running the length of the penis—the corpora cavernosa and the corpus spongiosum. Erection occurs when relaxed muscles allow the corpora cavernosa to fill with excess blood fed by the arteries, while drainage of blood through the veins is blocked.

What causes erectile dysfunction (ED)?

Since an erection requires a precise sequence of events, ED can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area around the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.

Damage to nerves, arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of ED. Diseases—such as diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease, and neurologic disease—account for about 70 percent of ED cases. Between 35 and 50 percent of men with diabetes experience ED.

Lifestyle choices that contribute to heart disease and vascular problems also raise the risk of erectile dysfunction. Smoking, being overweight, and avoiding exercise are possible causes of ED.

Also, surgery (especially radical prostate and bladder surgery for cancer) can injure nerves and arteries near the penis, causing ED. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to ED by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.

In addition, many common medicines—blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer drug)—can produce ED as a side effect.

Experts believe that psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure cause 10 to 20 percent of ED cases. Men with a physical cause for ED frequently experience the same sort of psychological reactions (stress, anxiety, guilt, depression). Other possible causes are smoking, which affects blood flow in veins and arteries, and hormonal abnormalities, such as not enough testosterone.

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