Why Color-Changing Condoms Aren’t the Solution to Reducing STIs

The social media resurgence of a 2015 TIME Magazine article entitled, “Condoms That Change Color In Contact with STD Win Tech Award,” has sparked strong reactions from many, including myself. While the majority seem to view this invention as a step forward for sex education, I view this as further reinforcing the stigmas of sexually transmitted infections (STIs) and fostering fear in sharing conversations about our sexual health with potential partners—all while bolstering penetrative sex.

Getty Images

Getty Images

The external condom (called S.T.EYE), designed by three British teenagers, claims to use antibodies to detect antigens of various sexually transmitted diseases and infections. Upon contact with an STI, the condom would change color depending on which infection it detected. The group of teen inventors claim that they, “…wanted to make something that made detecting harmful STIs safer than ever before, so that people can take immediate action in the privacy of their own homes without the often-scary procedures at the doctors” (IFLScience). The infections are not the problem—it’s our dissemination of incomplete and outdated sex education, lack of communication, and misunderstanding of the associated risks of being sexually active.

These teens’ implied assertion of STI screening panels as unsafe exemplifies perceived stigma at work, which is easily identifiable through their interpretation of screening procedures as “scary.” Despite the fact that 1 in 2 sexually active persons will contract an STI before age 25, society still assigns those who test positive with a scarlet letter (ASHA). Even though young persons account for half of newly diagnosed STIs, only 12% of this population was tested in the last year (Cuffe,Newton-Levinson, Gift, McFarlane, & Leichliter, 2016). The fear of having, living, and disclosing the shame of carrying an STI is one of the main reasons that people are not being tested.

Generally, professionals recommend that sexually active persons be tested at least once per year, and more if they are having sex with multiple partners. If you are sexually active, you should be tested with each new partner. If you are rekindling things with a partner that you’ve been sexual with in the past, you should be retested. If you are engaging in unprotected sex, you should be tested. The American Sexual Health Association (ASHA) outlines The Centers for Disease Control and Prevention’s (CDC) general recommendations in their guide which is organized by infection and population group, but these may change depending upon your personal risk factors. Although many STIs often remain asymptomatic, the CDC does not recommend screening for individuals who do not show symptoms. I believe that this screening recommendation does a disservice to our sexual health and autonomy. The CDC inadvertently strengthens STI stigma and maintains the consistent fear associated with having an infection by not instilling a sense of obligation for sexually active persons to be routinely tested.

This prototype operates within the means of the socially ascribed stigmas of sexually transmitted infections and further commits to their preservation. It bolsters the outdated rhetoric of ‘clean versus dirty’ which attributes shame to those who test positive for infection. Although blissfully unaware of the S.T.EYE’s potential to perpetuate stigma, the inventors do acknowledge that some consumers may not want to know that they have herpes (even though most of the world has either HSV-1 or HSV-2)—so that infection may not be included if the product comes to fruition (Washington Post, 2015). Upon a user’s discovery that the condom changes colors, they will likely be faced with immediate internal shame, as well as their partner’s. This presents a dangerous confrontation of enacted stigma, which includes rejection and, in some cases, physical assaults. Contrary to the teens’ belief that their invention will ensure “more responsible” behavior, they neglect the inclusivity required for effective change.

Not all sexually active persons partake in penis play. Since this external condom caters to penis populations, it further pays homage to penetrative behavior and reinforces the sexual division of power (Wingood & DiClemente, 1998). The sexual division of power includes power-related issues within heterosexual relationships related to authority, control, and coercion (Wingood & DiClemente, 1998). A fellow colleague, Kaci A. Mial, M.Ed., reminded me that condom negotiation is already a challenging task for a number of populations, especially those who may already be in an abusive relationship. The S.T.EYE condom could potentially give abusers a means of shaming and policing their partners.

Condoms, whether STI detecting or not, do not replace conversations that we should be having with our partners about sex and consent. Condoms do not prevent transmission of sexually transmitted infections, they are only able to reduce the risk. If we are not routinely tested and communicating with our partners about our STI status, we need to educate ourselves and accept the risks that come along with being sexually active. I fear that if popularized, the S.T.EYE condoms may contribute to risky behaviors, additional shame, potential partner violence, and further reluctance for folks to advocate for their sexual health.

Additional References
Cuffe, K.M.,Newton-Levinson, A., Gift, T.L.,McFarlane, M., & Leichliter, J.S. (2016). Sexually Transmitted Infection Testing Among Adolescents and Young Adults in the United States. Journal of Adolescent Health, 58(5), 512-519.

DePadilla, L., Windle, M., Wingood, G., Cooper, H., & DiClemente, R. (2011). Condom use among young women: modeling the theory of gender and power. Health Psychology, 30(3), 310-319.

Wingood, G.M., & DiClemente, R.J. (1998). Partner influences and gender-related factors associated with noncondom use among adult African American women. American Journal of Community Psychology, 26(1), 29-51.

 

My Doctor Won't Test Me for Herpes, Now What?

Earlier this year, I wrote a post entitled, “Where In the World Can I Get Tested for Herpes?” The post was inspired by an overwhelming number of messages that inquired about types of testing, availability, and access across the globe. After further exploration into countries ranging from Australia, to Canada, to New Zealand, and India, it became increasingly clear that available testing does not translate to accessible testing.

Screening vs. Diagnosing: What’s the Difference
Screening
tests are performed on individuals who are considered as high risk for sexually transmitted infections, but do not have symptoms (Medical Institute for Sexual Health). Diagnostic tests are used in individuals who present with signs and symptoms of sexually transmitted infections (Medical Institute for Sexual Health). Screening and diagnostic tests may be the same for some infections, but not all. For example, if lesions are present, PCR testing will be used as a diagnostic test. This method cannot be utilized on an individual who does not present with symptoms.

CDC Herpes Screening Guidelines and Recommendations  
In the United States, the Centers for Disease Control and Prevention (CDC) does not recommend screening for individuals who do not present with symptoms of genital herpes. While guidelines across the globe vary (and several can be found within this post), the CDC does not currently recommend screening because:

  1. diagnosing someone without symptoms (asymptomatic) has not proven to change sexual behavior (i.e. safe sex practices);

  2. false positive testing is possible; and

  3. the negative psychosocial impact of the diagnosis can be substantial even in asymptomatic individuals.

Although the guidelines seem to discourage testing in asymptomatic individuals, the CDC offers possible circumstances in which practitioners may test for genital herpes because it “might be useful” (CDC).  These circumstances include:

  1. presenting symptoms on the genitals that may be related to herpes;

  2. engaging in sexual behaviors with a discordant, HSV+ partner (meaning that this
    partner tests positive for herpes, and you do not).

  3. if you have multiple sex partners and desire a complete panel.   

These scenarios are in existence, but not necessarily in practice. From conversations with friends and inquiries online, it appears that it is not as simple as telling a doctor that you engage in sexual behaviors with multiple partners or have recently broken off a relationship with a partner who had genital herpes and that you’re looking to know your own status. Even a desire to know one’s own status, which is encouraged in comprehensive sexuality education programs, is often disregarded and dismissed by practitioners as unnecessary per mandated guidelines.

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So What Do You Do?
No matter how prepared you are when you arrive to your appointment, and how certain you are in your right to be screened (which, for the record, is both your right and responsibility), you may still be declined by your healthcare professional. Leaving the doctor’s office defeated, hopeless, and confused, there are still viable options for testing. STDcheck.com, a HealthLabs.com company, offers accessible testing panels and individual tests that can be purchased online and taken at one of their 4,500 testing centers across the United States.

How Does It Work?
STDcheck.com is HIPAA compliant, BBB accredited A+, offers FDA-approved tests, and hosts CLIA-certified labs (govern all clinical lab testing facilities within the U.S.). Their 10-Test Panel includes HSV-1, HSV-2, HIV Type 1, HIV Type 2, Hepatitis A, Hepatitis B, Hepatitis C, Gonorrhea, Chlamydia, and Syphilis at a cost of $198. If you are looking to screen for a more specific infection, like genital herpes, you can purchase blood tests for HSV-1 and HSV-2 for $65 each, or $130 combined. It should be noted that it may take significant time for antibodies to develop to the virus (3 weeks to 6 months), so if you are tested within days of exposure, your results may still be negative.

IgG typed tests are the most accurate blood test when screening for herpes and can break strains down by HSV-1 or HSV-2 antibodies (ASHA). IgM typed tests, another available herpes testing method, are not recommended based on false positives, cross-reactions, and inability/inaccurate typing. STDcheck.com offers type-specific enzyme-linked immunosorbent assays (ELISA) that seek out IgG antibodies to the herpes simplex virus, the most accurate testing method. After submitting payment for your test, you will be prompted to enter your zip code to find and choose a convenient testing center. STDcheck.com will send a lab requisition form and test code for you to bring along to your appointment. Your results will be available to you within two business days and you will have the option to consult with a physician to explain your results, offer guidance, answer questions, and offer potential treatment.

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Accessibility
STDcheck.com offers multiple payment methods which include credit cards, cashiers checks, flexible spending accounts, health savings accounts, and cryptocurrency. Health insurance is not accepted in order to ensure patient privacy.

STDcheck.com: A Solution?

While I believe that advertising a private environment for screening and diagnosing sexually transmitted infections further promotes the idea of shame and perceived stigma (i.e. something secretive), I do believe that there is great purpose in the ability to advocate on behalf of our sexual health. This certainly is not the only solution for screening, but it is comforting to know that additional options are available to us at our discretion if they are within our means.

Additional Resources
How to Advocate for Your Sexual Health at the Doctor’s Office
Herpes Testing (ASHA)

[This is a sponsored post for STDcheck.com]

Herpes: The Truth Behind the Health-Related Stigma

Herpes activists, including myself, talk extensively about the existing stereotypes and stigmas associated with carrying genital herpes. These associated slights and slurs could accumulate in perpetuity, but exist without a tangible definition. When I think of herpes stigma, I immediately move towards words and phrases like: dirty, diseased, disgusting, “deserved it,” slut, whore, unworthy, unloveable, at fault, gross. When I looked in the mirror after my diagnosis, I did not feel that my identity reflected any of those words, but I still felt an innate sense of shame and sorrow towards myself and my future.

What Is Stigma?
For those of us who have received a positive genital herpes diagnosis, we know what stigma feels like. We know the extra weight that we feel burdened to carry. The uncertainty of how to disclose to current and potential partners. The insecurity and lack of love we hold for ourselves. Stigma exists, as “an attribute that is deeply discrediting” and reduces one “from a whole and usual person to a tainted and discounted one” (Goffman, 1963, p. 3). Stigma, to some degree, affects everyone. I often find myself comparing my herpes diagnosis as another chapter in my story. Stories are a mark of the human experience. Some we publicize on social media, like new jobs and outings with friends—the happier moments. Other chapters remain more closeted from public view. Current culture dictates a consistently positive social media presence and attitude which is neither realistic to maintain nor reflective of our identities.

Before I publicized my herpes diagnosis in December 2015, I lived within the shadow of perceived genital herpes stigma. Perceived stigma, the experience of shame and embarrassment, is not exclusive to those who test seropositive for genital herpes. Maybe your shadow is the loss of a loved one, depression or anxiety, bullying, in an identity, or another story’s unspoken truth. People struggle with the impact of stigma each day and may live in fear of encountering the stigma in real life. Enacted stigma includes overt rejection, social rejection, or in some cases, physical assaults. Both perceived and enacted stigmas are relatable experiences. Although my friends and family may not be able to relate to my experience with genital herpes, we can certainly find common ground and understanding in the root of our emotions.

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Health-Related Stigma
In order to deconstruct herpes stigma, it is essential to narrow its definition and define examples of perceived and enacted stigma as it relates to herpes simplex. According to Stringer & Baker (2018), “health-related stigma is defined as status lost and discrimination informed by negative attitudes and stereotypes based on health related conditions” (p. 5). The perceived genital herpes stigma includes the laundry list of words provided at the beginning of this post. The innate feeling of being dirty, diseased, and unworthy of love. The fear of rejection from potential partners because of their positive status. Enacted genital herpes stigma includes the movie lines and jokes that poke fun at herpes, the individuals and groups that enjoin perceived stigma in conversation with friends and comments on social media, those that reject and shame potential partners because of genital herpes without consideration, knowledge, or research of what the virus is and its risks, and the medical and educational environments that do not offer an appropriate, inclusive, or realistic learning space for comprehensive sex education. These systems work together to perpetuate this health-related stigma, which unfortunately does not stop here.

Genital herpes stigma is considered to be discreditable, meaning that it cannot be readily observed from someone through appearance alone (which reflects the herpes virus itself, as one cannot tell that someone has or does not have herpes just by looking at their genitals) without disclosure. Stringer & Baker assert that those with such a discreditable stigma, like genital herpes stigma, typically fear disclosure and develop defense mechanisms in order to avoid perceived and enacted stigmas. Those with genital herpes may (and often do) avoid sexual encounters, conversations about safe sex and sexual histories, and even avoid treatment from professionals as a means to avoid stigma.

How Do We Combat This?
Conversations
Despite how perceived and enacted genital herpes stigma represent genital herpes as an isolating infection, we all likely know someone with at least one strain of herpes simplex virus (HSV). Everyone is capable of standing up to genital herpes stigma, especially if we each make an effort to educate ourselves about the basics. Here are a few broad examples of how to confront enacted stigma:

Enactor: [At lunch room] Don’t sleep with her, I hear that she’s got the gift that
keeps on giving...

Confronter: Are you talking about herpes? Actually, it’s really not that funny. A lot of
people have it. Herpes is also the same virus that is responsible for cold sores and is
in the same virus family as chicken pox and mono. Roughly two-thirds of the world
has some strain of herpes simplex, it’s more common than you think. Someone at our
table likely has one strain of it.

Enactor: My STD test results came back. Clean! Thank God I don’t have herpes.
Confronter: I’m happy to hear that you are practicing safe sex and taking
responsibility for your health, but fun fact! Did you know that herpes is not included
in a standard STD panel?
Enactor: What? I asked to be tested for everything?! This is bullshit!
Confronter: Yeah, I know. I didn’t know either until I did some research. Current
guidelines do not recommend testing for herpes unless there are symptoms present.
If you still want to be tested for herpes, you can request an IGG blood test from your
doctor, but they may be hesitant if you don’t have symptoms.

Confronter: I have something that I want to tell you before things get heated…
Enactor: Go ahead. It’s not like you have herpes or something, LOL.
Confronter: Actually, I do. I was diagnosed last year.
Enactor: Oh my God. I’m so sorry. I don’t know what to say…
Confronter: Not many know how to respond. It’s a lot more common than people
realize. When I found out I felt really alone, but after some research, I learned just
how common it is. I feel a lot better about it now.
Enactor: Really? So can you still have sex with people?
Confronter: Yep! I am on prescription antivirals. I avoid engaging in sexual acts
when I have an outbreak to protect my partners. Antivirals along with condoms
decrease the potential for transmission, but herpes is spread through skin-to-skin
contact, so there is still a possibility that my partners may contract it. I understand
you might need time to think about it, so if you want to know of additional
resources let me know.
Enactor: You actually seem like you know your stuff. You know more about herpes
than my sex ed teacher did, ha!
Confronter: Thanks! So, now it's your turn. When was your last STD test?

In a perfect world, these confrontations end in our favor—one small step towards dismantling the stigma! Unfortunately, it’s best to be prepared that not everyone will be open to having their beliefs challenged—even sex educators and medical professionals.

Inclusivity of Care
There is, sadly, little research or guidance on how to care for transgender individuals who contract genital herpes. Though disappointing, this does not come as much of a surprise given that most sex education and medical programs focus on the basis of heterosexual relationships, cisgender identities, and penis-in-vagina (PIV) penetration. The Center for Excellence for Transgender Health dedicates a page to STI guidelines for transgender people. The Centers for Disease Control and Prevention (CDC) does include transgender men and women as special populations, but does not give specific guidelines or interventions for STD panels, instead relying on physicians’ knowledge of behavior and anatomy, which may or may not be well-informed about transgender care. Further research and education is necessary to better care for this population and create a safe space for their sexual health care and understanding.

Sex Education
It’s easy to say that we want more comprehensive sex education in America, but what does that look like when it comes to sexually transmitted infections like genital herpes? Whether at speaking engagements, or during class presentations, I always include an overview of the stigma prior to delving into what the virus is and how it functions. I poll my audience for what they know or have heard about herpes (which typically results in the laundry list of terms). When structuring my presentations, acknowledging genital herpes stigma head-on is one way to both address and combat it. After discussing the labels of perceived stigma, I transition into the reality of how those words impacted me and my identity when I was diagnosed, and how they impact so many others, too. My disclosure in these scenarios also works to address enacted genital herpes stigma. These students and classmates share what they know (or think they know) about herpes, and may be sharing their internal belief systems. I have yet to receive a negative confrontation in-person, but I do prepare myself for it.

A slide from my recent reproductive biology presentation.

A slide from my recent reproductive biology presentation.

What Can You Do to Help?
Stories gain traction through being told. While public disclosure may not be for everyone, there is a story to tell about genital herpes stigma—the truth.

References
Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice Hall.
Stringer, K. L. & Baker, E. H. (2018). Stigma as a barrier to substance abuse treatment among those with unmet need: An analysis of parenthood and marital status. Journal of Family Issues, 39(1), 3-27.

The Overlap Between Herpes, Mental Health, and Addiction

One week ago, I stood by as my boyfriend buried his best friend of twenty years. I buried my friend of almost two.  Friendships that had not yet reached their expiration. Friendships that weren’t supposed to end this way. Addiction.

After losing a friend to addiction, it’s difficult for me to make sense of wanting to drink anytime soon. Over the past year, I experimented with multiple periods of sobriety. I embarked on the journey through Dry January, and even continued beyond it. I began to feel what living sober meant, as if, since my first drink, I somehow lost that sense of life along the way.

 The bottle of wine will stare at you from across the counter and you won’t even need to pour a glass because you know it will disappear by the end of the night. You’ll wake up in the morning in the same clothes, with lipstick smeared across your cheeks and a puddle of drool on your pillow. You won’t know how you got there. This becomes routine.
— July 2016
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Alcohol. Defined as a substance I used as a mask to face the world with my newly condemned identity. I would argue that I used alcohol as a coping mechanism even before that diagnosis, but society’s continued approval, encouragement, and promotion of binge-drinking behaviors constituted its normalcy. It still does.

Herpes is not just a viral diagnosis. Feelings of fear, self-hatred, inadequacy, sadness, and grief all filled my mind at one point or another. Enough to manifest themselves through my mask. The thought of therapy crossed my mind, but I concluded that it was a waste of time. No one would understand me. People will judge me. They won’t know or understand what I’m going through—how could they?

Part of this anxiety was rational. Therapists might not understand what you’re going through. And there may be initial, internal judgments—we are human. While my graduate program advises not to “yuck someone’s yum,” it also acknowledges the human condition and feelings and thoughts that may arise in the presence of the unfamiliar, and how best to prepare oneself.

While I appreciate community efforts to destigmatize herpes, I am also disheartened by the oversight made on the relationship between herpes and mental health. I am not (yet) a mental health professional. I am a sex and relationship therapist-in-training in a combined MSW/MEd graduate program, but am in no way qualified or equipped to navigate someone through a herpes diagnosis at this time. I can only offer words of personal experience and resources that provide comfort in times of distress. Over the past several years, I have been offered monetary funds in exchange for guiding individuals through their herpes diagnoses—all of which I have politely declined. Making a profit off individuals healing process is unethical, inconsiderate to mental health professionals’ credentials and training, and is doing a disservice to those hoping for a solution to one problem that ultimately may be the root of others.
   
Herpes is a mental health issue. There are no shortcuts to healing. There are layers. There are emotions. There are stigmas and stereotypes. There may be pre-existing, clinical diagnoses and intersections with anxiety, depression, and trauma. There are multi-faceted systems in place. Offering a safe space to those who struggle is a beautiful and necessary presence to provide, but treating those who struggle with a diagnosis should be left to qualified professionals who are equipped to navigate mental health and trauma.

My career path to sex therapy began before my herpes diagnosis, but this journey gave my life’s mission new meaning. As does my friend’s passing. I am 31 days into my most recent period of sobriety, and it doesn’t feel like something that I want to end anytime soon.

This week offered me an opportunity into how the world views addiction. Eye rolls. Abruptly ending conversations. Perpetuating stereotypes of worthlessness and faulted-ness. In these moments, it is especially important to realize that coping mechanisms do not always present themselves as alcohol or drug abuse; We can be addicted to the mundane. Work, social media, exercise, food, people—the list continues. Addiction can kill us—all of us. Some deaths end a life too soon, others lose out on the quality time and the freedom of truly living.

 


In memory one of my most compassionate and loving friends, Elliot. Someone who breathed in more depth and emotion than most. Someone who wanted to share his love enough to move the world. Elliot, you are forever a “real one” in my eyes.

Elliot Guitar .jpg

Where In the World Can I Get Tested for Herpes?

Does it present orally, or genitally? Do I have HSV-1 or HSV-2? Is a cold sore the same as herpes? Discussions about the herpes simplex virus (HSV) and geography usually intersect at the virus’ chosen locale within the human body. Our curiosity for which type it is, where it occurs, and why it matters is closely intertwined with well-known herpes stereotypes and stigmas.

While cold sores can be embarrassing, they do not carry the same negative connotation as genital outbreaks. Under a microscope, the herpes simplex viruses are nearly identical (you can read more about their differences here). In fact, the two strains belong to a family of viruses known as herpesviridae, and share common ties with chickenpox, shingles, and mononucleosis (“mono”). Although these viruses collectively fall under the same family tree, only one is stigmatized. Herpes, whether HSV-1 or HSV-2, whether it presents orally or genitally, whether you got it from someone you love or someone in the moment, does not pick a “type” of person to infect; Herpes does not happen to certain “types” of people. It is society that constructs the idea of difference, value, and worth. It is not only the virus that is demonized, but also, the area on the body in which it resides.

Aside from body parts, herpes and geography converge in conversations about available and accessible testing. Despite the amount of people who carry the infection worldwide, herpes is not included on a standard STD panel. In the United States, the Center for Disease Control and Prevention (CDC) does not currently recommend testing unless a patient shows symptoms of a herpes outbreak. When asking a healthcare professional to be, “tested for everything,” there is typically a failure to mention that herpes is not included in these panels. Some doctors may even decline or discourage a patient’s request to be tested for genital herpes due to lack of symptoms, as prescribed by current CDC guidance.

Many of my blog inquiries this week have centered around the question of testing:

My doctor told me that testing is illegal. How do I know if I have herpes?

I just ended a relationship with a partner who was diagnosed with genital herpes, how do I know if I have it since I can’t be tested?

My doctor, whom I trust, refuses to test me for herpes. He says testing is not available where I live and to just practice safe sex when I have an outbreak. I’m just tired of living in the prison of mystery.


 


The STD Project offers an overview of private global testing locations, however, I am still curious about testing parameters and healthcare treatment recommendations in these countries. What is included in other countries’ STD panels? How much education do medical professionals receive about STDs/STIs? Are doctors informed about the LGBTQ+ community needs and testing parameters? Is there a significant difference in testing recommendations for herpes around the globe?

John Cruice Photography

John Cruice Photography

Australia: The Australian STI Management guidelines offer serological testing as a “special consideration” and are only to be used “where results will provide meaningful clinical information.”

Canada: According to the Canadian Guidelines on Sexually Transmitted Infections, “culture is the most common method used in public health laboratories in Canada to confirm the diagnosis of HSV.” The guidelines discuss the reliability of cultures, PCR, Tzanck smears, and blood testing. Although “PCR is four times more sensitive than HSV culture and is 100% specific, PCR assays have not yet replaced culture testing in Canada.” The guidelines seem to suggest a recommendation and movement toward type-specific antibody tests, but according to an update of the guidelines, there is “no indication” of screening for asymptomatic patients.

India: The Ministry of Health and Family Welfare, Government of India reports that its major methods of diagnosis is the herpes culture and PCR testing. Blood testing is mentioned, but appears to be secondary to cultures.

New Zealand: The Ministry of Health and New Zealand Sexual Health Society Incorporated (NZSHS) supported NZ Herpes Foundation guidelines for best practice note that “genital herpes is under-recognized and under-treated.” Serological testing is, unfortunately, recommended in limited clinical settings. The guidelines offer recommendations and explanations as to why serological testing is not recommended: 1) indicate past infection, 2) not accurate enough to be offered as “routine,” and 3) does not distinguish the anatomical site of infection. New Zealand seemed to be the most LGBTQ inclusive of all the investigated public sexual health sources.

South Africa: According to the National Department of Health, South Africa 2015 guidelines, do not have specific testing for genital herpes unless a patient presents with a genital ulcer.

UK
: The National Health Service (NHS) reiterates the CDC’s guidance, noting that testing for herpes is “not usually done unless you have sores on your genitals or anus.”

WHO Recommendation: Since 2016, 88% of countries have updated their STI guidelines.

Aside from surprise and discouragement, this research brought about an awareness of what resources are lacking and the gaps that need to be filled. I feel confident enough to address testing parameters in the United States, but truthfully, have done little research (until now) as to foreign requirements and guidelines for testing. Sexual rights are human rights, and it saddens me that even though we are encouraged to advocate for our sexual health, available testing does not always translate to accessible testing.

Additional Resources
Herpes Testing
How to Advocate for Your Sexual Health at the Doctor’s Office
Why Your Doctor May Not Want to Test You For STD’s


What's In A (Sur)name?: To Change, Or Not To Change

An email in which the sender addressed me as “E” recently landed in my inbox. I’ve never expressed a divergence from “Emily,” other than an occasional “Em” with friends and family members. What about the letter “E” being synonymous with my name inflicted such a reaction?

As a pre-teen, I remember wanting everything engraved with my initials: initial pillows, initial chokers, initial key chains, and of course, initial lettering on my backpack. As a young adult, I still wear necklaces that dawn my name and initials, but the engraved jewelry carries more meaning than it did when I was a child. These initials have carried me though my young adult life—through relationships, hardships, first jobs, an undergraduate degree, and future graduate degrees—but not everyone shares that same perspective or tie to identity.

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The earliest known woman to retain her surname was Lucy Stone, an antislavery and female suffrage crusader (Goldin & Shim, 2004). After her marriage in 1855, Lucy still embraced the term “Miss,” which was exclusively reserved for unmarried women (Goldin & Shim, 2004). “Ms.” did not gain popular or accepted connotation in language until the appearance of ‘Ms.’ magazine in 1972 (Goldin & Shim, 2004). The usage of “Ms.” was still so controversial that the New York Times dedicated an editorial announcement to its terms of use in June of 1986: the New York Times “will use “Ms.” as an honorific in its news and editorial columns…The Times will continue to use “Miss” or “Mrs.” when it knows the marital status of a woman in the news, unless she prefers “Ms.” “Ms.” will also be used when marital status is unknown.” This dedication admits not only the importance of marital status in the United States, but also its privilege.

When it comes to heterosexual marriage, it is an assumed tradition that a woman will take her fiancé’s last name—which is considered by scholars to be one of the most gendered aspects of such a union (Fitzgibbons Shafer & Christensen, 2018). In fact, 50 percent of Americans believe that women should be required by law to take their husband’s name. This belief system reinforces both the patriarchal structure of the United States and the rights of property and inheritance passed to and from males (also symbolized by a father “giving” his daughter away during wedding ceremonies) (Stoiko & Strough, 2017). Although earlier feminist movements pushed women to renegotiate marital terms of identity, only 22% of women married in 2010 reported retaining their surnames (Fitzgibbons Schafer & Christensen, 2018; Stoiko & Strough, 2017). Women are more likely to keep their last names if they have an established professional identity or graduate from advanced degree programs. Women considered as more “traditional” and concerned with familial and societal expectations are more likely to change their names (Goldin & Shim, 2004).

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Heterosexual women are still found in the shadows of their husband’s name, even if they choose not to adopt it. Women’s surname change is linked to level of spousal devotion and commitment to familial bonding (Robnett et al., 2016). Of those women that decide to retain their surnames, or even hyphenate, there is patriarchal backlash to pay. These women are seen as more masculine, more selfish, and worse mothers than those who adopt a name change at marriage (Fitzgibbons Shafer & Christensen, 2018). In rationalizing the adoption of a new naming convention, most women cite tradition and putting their families first as primary reasons.

Despite the majority decision for women to adopt a new surname upon marriage, the process of legally changing one’s name is not as simple as one might think. Similar to planning a wedding, this process has become heavily commodified with bride name change kits and apps and Pinterest’s multiple how-to guides for changing one’s last name as part of traditional wedding planning (Goldin & Shim, 2004).

Similar to other heterosexual marital traditions, a name change isn’t simply just a name change; It’s a subscription to a gender belief system. It’s an expectation. It’s a reinforcement of privilege and resistance to change. It was unacceptable for a woman in 1855 to retain her surname post-ceremony, and 163 years later, despite all of the movements and advancements for equality and independence, the view of surname retention remains the same.

Questions for Readers
What do you believe in?
Did you change your name? Why/Why not?
Do you plan to change your name? Why/Why not?

References
Boxer, D. & Gritsenko, E. Women and surnames across cultures: reconstituting identity in marriage*. Women and Language, 28(2), 1-8.
Fitzgibbons Shafer, E. & Christensen, M.A. (2018). Flipping the (surname) script: men’s nontraditional surname choice at marriage. Journal of Family Issues, 39(11), 3055-3074.
Goldin, C. & Shim, M. (2004). Making a name: women’s surnames at marriage and beyond. Journal of Economic Perspectives, 18(2), 143-160.
Kay, L. (n.d.). 7 things no one tells you about changing your name. Retrieved from https://www.theknot.com/content/7-things-no-one-tells-you-about-changing-your-name
Piquant, N. (n.d.). How much does it cost to change your name after the wedding? Retrieved from https://www.theknot.com/content/name-change-cost
Robnett, R.D., Underwood, C. R., Nelson, P.A., Anderson, K.J. (2016). “She might be afraid of commitment”: perceptions of women who retain their surname after marriage. Sex Roles, 75, 500-513.
Stoiko, R. R. & Strough, J. (2017). ‘Choosing’ the patriarchal norm: emerging adults’ marital last name change attitudes, plans, and rationales. Gender Issues, 34, 295-315.

HE Said Yes: The Unspoken History Behind Engagement Rings and Wedding Bands

After an engagement becomes Facebook official, family members and friends of the newly betrothed couple participate in ring ogling that is so common, it seems like its own tradition. Rumor insists that diamonds are a girls’ best friend, but history has another tale to tell about its significance.

When I was a little girl, I have a distinct memory of my father mentioning that you could tell a lot about a person by the presence of a ring on their finger. He told me that the ring symbolized commitment to another person, and that commitment could transcend to other pieces of that person’s life—a similar presentation of Jack Byrnes’ “Circle of Trust” in Meet the Parents.  In Western society, many believe that the engagement ring is the utmost symbol of commitment to another, and although there are some links to ancient practices, rituals, and the rumored vein to the heart, the diamond ring did not become a symbol of marital promise in the United States until after the Great Depression (Ogletree, 2010).

Once upon a time, betrothed women were protected by the Breach of Promise of Action (Brinig, 1990). This law entitled a woman whose fiancé had broken the engagement to sue him for damages, which included embarrassment, humiliation, and potential future marriage prospects—all important to women at the time since marriage was considered one of a woman’s only career opportunities (Brinig, 1990, p. 204).  Most states repealed this law in 1935, which some scholars argue created a need for “a bonding device” within society, while others simply thought that the Depression created a need for tangible assets (Brinig, 1990, p. 209). It is difficult to know for certain considering that there are little-to-no records of engagement sales from this time period. Four years later, De Beers, a diamond importing company, partnered with Ayers, a New York advertising agency, on a campaign that promised a “diamond is forever” (Brinig, 1990). Hollywood starlets were given diamonds to wear and movie scenes were scripted to include marriage proposals.

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By 1965, 80% of brides chose diamond engagement rings. Today, popular wedding planning website (and a world completely unfamiliar to me),  The Knot, has pages upon pages of engagement rings organized by style (vintage, classic, elegant, glamorous, and unique) and cut (princess, asscher, cushion, emerald, heart, marquise, pear, radiant, round, and oval). These rings, exclusively advertised to women, were once a failed advertisement to men in the 1920s--well before De Beers' campaign even ran (Howard, 2003). In 1926, jewelers across the country participated in a campaign to popularize male engagement rings--advertised as symbolic associations of masculinity situated in heterosexual tradition. Jewelers knew that in order to create a new tradition, they would have to defy the social norm that jewelry was strictly a feminine accessory (Howard, 2003). These advertisements used masculine language and symbols of cultural prowess to assert male dominance and reinforce masculinity:

A ring like “The Major,” a carved green gold ring with a blue-white diamond, was advertised as something ‘for the he-man’ who appreciates true value. Men’s rings that were not wedding-specific signaled their associate with power or positions of authority through style names like the Pilot, the Advocate, the Master, the Executive, and the Stag. Men who wore them had sexual prowess; they were in leadership positions or were in control.
— Howard, 2003, p. 840

The male engagement ring campaign failed to attract enough consumers to survive, however, masculine dominance was, and still is, present in the cultural engagement ritual. Historically, men prove their ability to care for and commit to their prospective wives through the purchase of an engagement ring--something considered "almost a rite of passage" for males (Howard, 2003, p. 843). An engagement is something that happened to a woman, while a man took action by initiating the proposal, signaling "male prerogative" (Howard, 2003, p. 843). 

After the Depression, a new marital trend started making its way around jewelers' windows: wedding bands for women and men. Before World War II, most marriages took place with only one wedding band--this is largely thought because Roman Catholics only required that the bride's ring be blessed (Howard, 2003). By 1937, etiquette books began to suggest that double-banded wedding ceremonies were more common, however, the trend did not solidify in America as a tradition until the late 1940s and early 1950s, when double ring marriages increased from 15 to 80% (Howard, 2003, p. 845).  So why did male wedding bands catch on, but male engagement rings are an often unspoken aspect of marital history? Timing.

During and after the war, marriage became a patriotic act: "The groom's ring became tradition when marriage, weddings, and masculine domesticity became synonymous with prosperity, capitalism, and national stability" (Howard, 2003, p. 846).  Thus, jewelers could cater advertisements to men at war abroad, fighting to protect the families they left behind at home.

Today, engagement advertisements, although somewhat evolved, still reflect De Beers' original ideology that a diamond is forever, but when 40-50% of marriages result in divorce, I am left wondering what piece of forever today's couples are fighting to preserve (APA).

To my surprise, I found a piece of myself in The Knot--research. The Knot performs a study every two years on wedding jewelry and engagement rings entitled, "The Knot Engagement Ring Trends & Insight Report." The most recent report released in November 2017 reveals several important takeaways:

  • Engagement ring spending is at an all time high;
  • People are spending more time researching, but looking at fewer rings;
  • Women are increasingly more involved in the selection of the ring and proposal;
  • Men care more about price, while women care more about size; 
  • Couples desire the proposal to be filmed; and
  • Wedding bands rarely match.

The Knot caters its data to wedding industry providers, as opposed to those exchanging vows. The report suggests that jewelers, photographers, caterers, and wedding planners should centralize their businesses based upon data trends in order to successfully market their services to modern couples. From a marketing perspective, this rationale makes sense. As a researcher, I am left wanting more.

Historically, wedding traditions evolve and establish themselves over time. Some (the diamond ring and double wedding band) survive generations, while others (the male engagement ring) fade away into an unspoken history. It seems that most (but not all) couples embrace such traditions in a way that fulfills a marital obligation or expectation, rather than a choice. A marriage is as distinctive as the personalities of its partners. Couples not only have the prerogative to choose a style of ring, but also the power to forego tradition. A diamond ring may represent forever to America, but the success of a marriage is not dependent on the presence of a piece of jewelry.   

Questions for Readers: I want to hear from you! 
Did you know the history of engagement rings and wedding bands? 
Why did/do you want an engagement ring/wedding band? Why/why not?
How do you feel about those who choose forego rings? Why? 
Have you received judgement for your engagement ring/wedding band choice (or lack thereof)?  
 

References
American Psychological Association. (2018). Marriage and divorce. Retrieved from http://www.apa.org/topics/divorce/
Brinig, M.F. (1990). Rings and promises. Journal of Law, Economics, and Organization, 6(1), 203-215.
Howard, V. A “real man’s ring:” gender and the invention of tradition. Journal of Social History, 36(4), 837-856. 
Ogletree, S. M. (2010). With this ring, I thee wed: relating gender roles and love styles to attitudes towards engagement rings and weddings. Gender Issues 27, 67-77.
The KnotPro. (2017, November 11). The Knot engagement ring trends & insights reports 2017 is here. Retrieved from https://partners.theknotpro.com/wedding-business-blog/2017/11/16/the-knot-engagement-ring-trends-insights-report-2017-is-here

The Marriage Myth: An Introduction

Twenty-five is the cusp of wedded bliss for many, but for me, twenty-five has been defined as the year that my vacation days succumb to friends’ marriage nuptials. Summer, otherwise known as wedding season, is well underway. Another wedding to attend means another wedding website, perfectly organized with the couple’s bridesmaids, groomsmen, details of the wedding, and of course, their love story. With each passing ceremony, I find myself increasingly bored over cliché love poems, quotes, and readings. At first, I asked myself some tough questions: “Am I being too harsh?  Am I too judgmental of wedding ceremonies? Am I anti-romance? Anti-marriage?”

Upon further reflection, I realized that I think much more critically than most about marriage and its related rituals simply because of my background in gender and sexuality studies. My opinions and feelings about marriage are rooted in historical critiques of societal expectations and traditions associated with heteronormative, defined coupling--things that seem so obvious when they're brought to our attention, but are far from thought when we're wrapped up in our day-to-day lives.

When I first began my research, I considered engagement rings, proposals, and ceremonies to be 'traditions,' however, after familiarizing myself with the literature, it is clear that these are referred to as 'rituals' throughout academia. Although closely related, a ritual is defined as "a religious or solemn ceremony consisting of actions performed to a prescribed order" while a tradition is defined as "the transmission of customs or beliefs from generation to generation, or the fact of being passed on in this way." In consideration of these definitions, I believe that weddings do serve as an intersection for rituals and tradition, but the actions classified as 'traditions' by most (i.e. the ring, the proposal, the engagement party, etc.) are a part of the ritualistic performance of marriage. The groom-to-be "pops the question," even though he likely knows the answer. The bride-to-be happily flaunts her engagement ring to friends and family as proof of the couple's deeper commitment to one another.

Gender is not something that one is, it is something one does, an act... a “doing” rather than a “being”....Our notions of what a human being is problematically depend on there being two coherent genders. And if someone doesn’t comply with either the masculine norm or the feminine norm, their very humaness is called into question.
— Judith Butler

We live in a world of defined roles, typically thought of in absolutes of masculine and feminine, male and female, husband and wife, and so forth.  The performance of wedding rituals requires associated gender roles, and these roles reflect a reproduction of, typically white, heteronormativity (Fetner & Heath, 2016). Although room is being made for same-sex couples, there is still a long battle for a more gender-inclusive society. Some same-sex couples feel liberated to legally participate in a performance that was once reserved for heterosexual partners, while others feel no obligation to sanctify their commitment through reproducing the heteronormative institution of marriage (Fetner & Heath, 2016).

Through my preliminary research, it became clear that definitions of what 'traditional' translates to in the wedding world are non-exclusive. From the ring, to the procession, vows, and even the location, there may be new takes on these rituals, but research indicates that these elements, no matter how manipulated, are still included in the marital performance. Although some brides mentioned a desire to stray from the norm, most concede to their family and friends' desires in order to maintain what I label as 'the happiness status quo.' Other women admit to not giving traditions and rituals much thought simply because they felt these rituals were things that they were 'supposed to do.'

Each holiday season, you make your great-grandmother's famous chocolate chip cookie recipe, but it isn't as meaningful without the memory or familial history that is attached to it. Tradition is often cited as the primary reasoning for participation in marital rituals, but what about tradition? What good is the preservation of rituals if we cannot trace them, or understand their complex histories and origins? I think it is perfectly acceptable to want your partner to propose, to have an engagement ring, and to plan the wedding of your dreams. I also believe that there should be a deeper understanding as to where the traditions arose from besides simply stating, "it's tradition." It is so easy to get wrapped up in the conventional simply because we believe that we "should," rather than reflecting upon how tradition and rituals fit into our interpretation and definition of deeper commitment.

References
Fetner, T. & Heath, M. (2016). Do same-sex and straight weddings aspire to the fairytale? Women's conformity and resistance to traditional weddings. Sociological Perspectives, 59(4), 721-741.
Schweingruber, D., Anahita, S., & Berns, N. (2004). "Popping the question" when the answer is known: the engagement proposal as performance. Sociological Focus, 37(2), 143-161.

The Painted Bride by Isaiah Zagar, Philadelphia, PA --  Read about its past, present, and future

The Painted Bride by Isaiah Zagar, Philadelphia, PA -- Read about its past, present, and future

 

 

 

Dating with Herpes & How to Overcome the Fear of Disclosure

Last week I launched my Ask Emily platform, a safe space for readers to submit questions related to herpes and sexual health that they would like to see covered on my blog. Surprisingly, most questions I received this week revolved around dating and disclosure to potential partners, but one in particular stood out:  

I’ve been trying to get back out there in the dating scene, but I’m nervous because a few years ago I was diagnosed with HSV-1 genital. I’ve been with two guys since and they were cool about it, but they were one night stands. There’s this guy I really like and I am nervous to have sex with him because I couldn’t take the guilt of him getting it. I take precautions like Valtrex daily and always use condoms. So I guess my question is, How do you not let the fear of a partner contracting HSV hold you back? I know it’s their decision, but I would still feel super crappy if he were to acquire it.

Disclosure
One of the most common questions that people ask me is, “How do you tell someone that you have herpes?” As picture perfect as the idea of herpes disclosure templates may be, I don’t think there is a one-size-fits-all answer to this question. It is dependent upon variable factors, such as preferred communication style, type of relationship, knowledge about and comfort in discussing herpes simplex and its associated risks—the list continues.  

A disclosure to a close friend or family member can be just as daunting as a disclosure to a potential sexual partner. Common reflective questions are centered around the idea of acceptance within social groups. “Will this person still treat me the same after revealing my diagnosis? Will my family still love me? Will this person still be my friend? Will I find acceptance” The root of these questions stems from the social stigma and the perception of placement in the realm of socially ascribed normalcy.

I like to think we disclose on a daily basis. We disclose our identities through our language, our style and clothes, our hairstyles. The way we walk, talk, and carry ourselves.  Disclosure is relevant to our preferences and comfort levels, and as many of us know from adolescence, we may not always be widely accepted by the larger “in” group. Of course, there are pieces of ourselves and our experiences which we reveal to select communities (friends, families, partners, classmates, etc.), and herpes likely falls under this category.

My parents were the first to know. As an only child, I am fortunate to have loving and supportive relationships with both of my parents. My Dad actually accompanied me to the appointment at the urgent care center. Nearly all my friends’ responses immediately began with, “Oh my God, Em. Are you ok?” I never questioned their love for me, however, I did question how potential partners would perceive me.

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After my then-partner (the person whom I contracted herpes from) ended things between us, I began to reiterate those initial self-inflicting questions of acceptance. Shortly after making the decision to go public with my diagnosis on social media and my blog,
I was faced with dating disclosure. This person was not new to me, as we had been friends for some time, and consequentially, friends on social media, too. Therefore, it was loosely known before conversations about sexual involvement that I was herpes-positive.

Although I do not recall a formal disclosure, per se, I do remember conversations about navigating safe sex between us. I remember him asking how he could best protect himself, and an expression of wanting to learn more. He never made me feel like any less of a person. This unspoken acceptance and desire to educate was an integral part of my healing process, and I am grateful to have such a positive disclosure experience.

While it is my hope that STI+ individuals would have similarly positive experiences across the board, the unfortunate reality is, not everyone will be so receptive or responsive to these sensitive conversations, and I think that this reality is something to consider when disclosing. I did a bit of anthropological research on the herpes Reddit boards, curious as to current perspectives from those who were recently diagnosed. Despite (what seems to be) increasing numbers of “out” STI+ resources, the content and questions asked were similar to those from my own diagnosis nearly three years ago. To counter the negative disclosures, there were, however, several individuals who shared their experiences of receptive partners and so-called happy endings, which I do not remember seeing as much of. It may seem counterintuitive, but I think STIs and their disclosures have given space for conversations that we should have been having a long time ago with regard to our sexual health and histories.  

Overcoming Fear of Disclosure   
The potential rejection that we fear from others may result in a lesser number of individuals sharing their diagnosis with partners, further increasing chances for herpes transmission.  Fear has the potential to shape our daily lives; think back to the example of daily disclosures. Are we incorporating trends into our wardrobes for the sake of being considered trendy? Are we shielding some part of our culture or heritage for fear that we may be judged by our peers? Do we feel that we’re at our fullest expression of self, or are we living under a cloak of fear?

Of course, some aspects of our identities are more malleable than others, just as some pieces of our stories are easier to share, while some we would rather keep to ourselves. We all have a story that has yet to be told, and it is only up to us to share at our discretion. For many of us, herpes becomes interwoven into our stories, or is a story all on its own. Just as we may fear sharing our herpes+ status, someone may equally be afraid to share their lack of sexual experience. This goes beyond the realm of sexuality, too. Maybe we’re afraid to share our fear of heights, or our preference for meat in a room full of vegetarians. These may seem like silly examples, but fear is relative. We all know what it is like to fear revealing a part of ourselves that has the potential to be ill-received; and in that shared fear is immense power in finding similarity within human connection.

Overcoming Fear of Fault
So you’re herpes+ and your partner is not (a discordant couple). You have informed your partner of his/her/their chances of contracting the virus and associated risks. Both of you are probably wondering how to navigate your sexual experiences in a way that still allows for pleasure and fulfillment. While suppressive antiviral therapy and condoms are a great starting point, it is imperative to acknowledge that condoms are not 100% effective at preventing the transmission of herpes since the virus is spread through skin-to-skin contact. 

A 2010 NY Times article notes that it is difficult to determine the exact risk and transmission rates of contracting HSV-1 and HSV-2 in discordant couples. The World Health Organization (WHO) asserts that more women are infected with HSV-2 than men because the virus is more transmissible from male-to-female rather than female-to-male (based on biological body parts). Increasing studies are including same-sex couples in their research, however, to date, I have not found representative data for the transgender population.

So you've educated your partner about the realities of herpes, and have said your ABC's of the CDC and WHO. You are practicing safe HSV+/HSV- sex, but you still fear that your partner will contract the virus. Just the thought of a partner contracting herpes from you fuels impending guilt. Although a herpes+ status can often make you feel like one in a million, the American Sexual Health Association (ASHA) states that 1 in 2 sexually active adults will contract an STI by the age of 25. Further, 1 in 8 people in the United States has genital herpes. And these are only considering those who have been diagnosed. An estimated 87% of HSV-2 positive people have yet to receive a clinical diagnosis, according to the Center for Disease Control and Prevention (CDC). I have found enormous solace in these statistics; Sharing in sexual experiences with someone who is aware of his/her/their herpes+ is less likely to result in a transmission because they will more than likely know how to navigate their outbreaks. Of course, this is not inclusive of everyone, but when you take the facts into consideration, it makes logical sense.

Regardless of the facts, the numbers of new infections each year, and endless posts on just how common herpes really is, we still convince ourselves otherwise. I have always been someone who struggled with feeling as though events were my fault--even when they weren't, I would still acknowledge some kind of responsibility; I've always been "too nice." As someone in a discordant relationship, I have mulled over the idea of guilt. What If my partner contracted herpes? What if it came from me? What would I do? How would I feel?

Despite his acknowledgement and acceptance, I think that I would be lying if I said that I wouldn't feel bad, at least for a period of time. I know that I am not personally or emotionally responsible for the potential transmission between shared cells, but I would be reminded of my own initial experience. I think it is of importance to investigate the true meaning of safe sex. Is sex ever safe?

Most sexuality education programs in the US stress the importance of risk-prevention and do little to explore pleasure and consent (although this is starting to change!). Generally, sex is taught as something that is sacred and can result in serious consequences. I was never taught the value of consent or healthy relationships, and was instead taught about the horrors of abortion and STIs. Feelings of impending guilt may naturally arise during those "what if" moments. While I am unsure if it can be eliminated, I do believe we can cultivate a shift in our mindset about how we approach safe sex and the realities of engaging in any type of sexual play.


Although the changes since my diagnosis seem micro, I do believe the increasing amounts of out herpes+ individuals seen on social media is proving helpful for those recently diagnosed. I see increasing coverage from popular magazines about navigating relationships and sex with STIs. It is much more normalized than when I was first scouring the internet in the wee hours of the night. I am hopeful that one day in my lifetime, STI disclosures will be seen less as an act of bravery and more as a cumulative part of life as a sexual being.  

Additional Resources
Giving Your Partner Herpes  (NY Times, 2010) 
Can We Gene-Edit Herpes Away? (Smithsonian Magazine, 2018)

We Need to Talk: When Your Gynecologist Doesn't Listen


Seven months and five doctors later, I finally had an explanation of my symptoms. In the early months of summer 2017, I experienced deep hip pain with certain movements. After one hip intensive yoga practice, I noticed abnormal vaginal bleeding. Over time, the bleeding occurred whenever I performed any type of lower body movement.

June, 2017: “It’s just abnormal bleeding between periods.”
July, 2017: “Yup, weak pelvic floor. I am sending you to pelvic floor therapy. I doubt you have any fibroids or cysts, but I’ll still order the transvaginal ultrasounds.”

The physician’s assistant seemed impressed with my knowledge of the term “menarche,” the technical term for a woman’s first menstrual period. She felt around my pelvic floor and I immediately cringed in pain. I thought it was odd, but when I rose from the examination table, I knew for certain that something was awry. I gazed at a puddle of bright red blood. I know that some women bleed during PAP smears and pelvic exams, but I know my body, and this was an abnormal response for me. I was still bleeding three days later, and my calls to the gynecologists’ office were met with dismissals of normalcy.

August, 2017: “Since you brought up your previous eating disorder, I have significant reason to believe your bones may be the culprit for your hip pain. We’ll take an x-ray of your pelvis and order a round of physical therapy. I don’t do gynecology. You’ll have to see a gynecologist for bleeding. I don’t see a correlation.” 
August, 2017: “As active as you are? There’s no way you have a weak pelvic floor.”

One urgent care practitioner, three gynecologists, and one female athletic specialist. Two PAP smears, two ultrasounds, and an x-ray. I found myself on a journey from one doctor to another, and I was fortunate enough to carry health insurance to support me. With nearly three months’ rest from weightlifting and yoga, I allowed my body time to heal. And it did. I never received a formal diagnosis for my hip pain, but despite the apparent setback, I was able to learn the value of rest, and just how much of it my body needed. As pain and recurrences of bleeding subsided, I began to work my way back into an exercise routine.

From September through November, things seemed relatively “normal.” Pain was absent, but bleeding reappeared around the holiday season. I downloaded a period tracker app, so that I could better differentiate what was happening when, to decipher the puzzle pieces of my body’s symptoms. This time, much of the bleeding occurred post intercourse. There was no associated pain, but when I got up, the sheets were shades of red and pink. I looked down and we both had smears of blood on our skin.  The first time it happened, I was embarrassed. The second time, concerned.  When the bleeding persisted into the New Year, I knew that I needed to make a visit to yet another gynecologist.

January, 2018: “You have cervicitis. It is very common, and can easily be alleviated through cryotherapy, if you choose to pursue that treatment route.”

I searched patient reviews on Google, Yelp, and ZocDoc, and finally settled on a gynecologist who patients reported as a great listener; someone who spent as much time as necessary with patients . While the previous doctors heard my immediate concerns and scanned the history disclosed on my intake sheet, this particular doctor was the only one who guided me into his office, took out a pen and paper, and wrote persistently while I recounted my body’s story. He picked up on my type-A tendencies, and how that trait potentially affects other habits, such as taking a birth control pill at the same time each day. He noticed how I knew the exact date that I was diagnosed with herpes, and how deeply that must have impacted me. He took time to get to know me, and most importantly, listen


Seven months and five doctors later. Although I now had a more definitive diagnosis than I did seven months prior, I remained frustrated by the medical field. Why did it take so long for a diagnosis? Why did no one else take me seriously? Why did some doctors focus on only one part of my medical history? Why were my concerns of abnormality within my body brushed aside by practitioners? If this is so common, why did no one else investigate further?

 Gynecology and Sexuality: A Dynamic Duo?
Membership in the human sexuality field includes stereotypes that are present across various disciplines and spheres. At first glance, sexuality and gynecology seem to couple well together, but as conversations progress, a power struggle is revealed. I typically preface my gynecologist visits by revealing my identity as a sexuality student and researcher, and my specified knowledge in herpes simplex. Although this disclosure creates space for a more specialized level of communication between patient and practitioner, it may be difficult for clinicians to navigate between their knowledge and mine. Perhaps doctors feel particularly threatened by my intellect on subject matter that is supposed to be their specialty. Thus, the relationship may feel imbalanced and becomes a battle for validity rather than a conversation of care.

In sharing my experience with women outside the field, I learned that I was not alone in my feelings. Women who felt their concerns were ignored and invalidated by their gynecologists. Women who were denied testing. Women who felt that their doctors did not address their concerns. Women who did not feel accepted. Women who did not feel valued as patients. Women who felt shame. Women who left the office with more questions than answers. I needed to dig deeper.  

 What Defines Gynecologists’ Training?
To preface, my research thus far is broad. I started with The American College of Obstetricians and Gynecologists (ACOG), and The American Board of Obstetrics and Gynecology (ABOG). ACOG has resourceful fact sheets and guidelines for patients with specific gynecological inquiries. ABOG defines obstetricians and gynecologists as “…physicians who, by virtue of satisfactory completion of an accredited program of graduate medical education, possess special knowledge, skills and professional capability in the medical and surgical care of women related to pregnancy and disorders of the female reproductive system.  Obstetricians and Gynecologists provide primary and preventive care for women and serve as consultants to other health care professionals.”

From there, I learned that there are six gynecologic sub-specialties: (1) critical care medicine, (2) female pelvic medicine and reconstructive surgery, (3) gynecologic oncology, (4) hospice and palliative medicine, (5) maternal/fetal medicine, and (6) reproductive endocrinology/infertility. To become certified in one of these specialties, physicians must be Board Certified by ABOG and complete additional training beyond the basic ABOG certification. According to the ABOG website, Board Certified obstetricians/gynecologists’ training consists of:

  • four years of residency training in preconception health, pregnancy, labor and delivery, postpartum care, genetics, genetic counseling and prenatal diagnosis; 
  • women’s general health (reproductive organs, breasts and sexual function); 
  • screening for cancer;
  • hormonal disorders, infections, surgery to correct or treat pelvic organ and urinary tract problems; and
  • preventative health care.

Although reproductive health and sexual functions are addressed, from my research, sexual wellness appears absent from the gynecological education experience. The American Sexual Health Association (ASHA) defines sexual health as “…the ability to embrace and enjoy our sexuality throughout our lives. Being “sexually healthy” means:

  • understanding that sexuality is a natural part of life and involves more than sexual behavior;
  • recognizing and respecting shared sexual rights;
  • having access to sexual health information, education, and care;
  • making an effort to prevent unintended pregnancies and STDs and seek care and treatment when needed;
  • being able to experience sexual pleasure, satisfaction, and intimacy when desired; and
  • being able to communicate about sexual health with others including sexual partners and healthcare providers.

A 2009 study by Kershnar, R., Hooper, C., Gold, M., Norwitz, E.R., and Illuzzi, J.L. sought to investigate the attitudes, training, and experience of pediatric, family medicine, and obstetric-gynecology residents with regard to adolescents. “Of 87 respondents (31 OB/GYN, 29 FM, and 27 Pediatric), most residents from all three fields felt that the full range of adolescent preventative and clinical services…fell under their scope of practice.” The study concluded that residents are not “optimally prepared to provide the full range” of care and services to adolescents that their disciplines expect of them.  Interestingly, over 90 percent of residents in the study felt well-prepared to counsel STI risk and prevention, but are practitioners just as prepared to discuss living with an STI? 

J. Dennis Fortenberry, MD, an ASHA Board member and professor of pediatrics at Indian University believes that “sex is still primarily seen as a set of risk factors that [physicians] counsel against.” He is “convinced that this perspective on sex and sexuality as “risk” legitimates the stigma associated with sexually transmitted infections and contributes to our society’s poisonous intolerance of sexual diversity.” Considering Dr. Fortenberry’s words in relation to gynecological standards set by ACOG and ABOG, much of the guidelines prescribed for gynecologists to counsel is risk prevention-based. Prestigious gynecological boards are advocating for STI prevention, rather than validating their inevitability. According to The World Health Organization (WHO), more than one million STIs are acquired every day across the globe. This is not a matter of “if,” it’s a matter of “when.” 

Disclosing STIs to Professionals  
Testing for herpes simplex virus (HSV) can be challenging. When I encountered a false-positive IGM result in 2013, the notification of results was not carried out well. I received a phone call while I was on vacation. The doctor simply said, “Your test yielded positive results for genital herpes.” Her delivery lacked resources, emotional compassion, and understanding. Given the materials referenced above, it is unsurprising that the doctor’s counsel was negligent—her training taught her how to counsel prevention, not how to live life with an STI.

Additional IGG serological testing by my primary care provider showed that I was indeed, negative for herpes in 2013, and had a false-positive IGM read. My 2015 diagnostic visit was met with concern, heartache, and reassurance by the nurses. Since then, my herpes disclosure at introductory gynecological check-ups have been brushed aside as, “Oh almost everyone has that. It’s more common than you think.” Although true, not everyone knows that, or has completed enough research to be satisfied with that statement. People want to know how to move forward from an STI diagnosis. How to tell their current and future partner(s). How to find love. How to feel normal (whatever that is!). How to navigate sexuality with something that is so demonized by our society.

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The Price of Honesty
Although my most recent gynecological concerns were not herpes-related, I view my abnormal bleeding experience as a gateway into expanding my research into gynecology and working to better the patient/practitioner relationship. I learned just how little doctors listened to me, or valued my knowledge and experience of my body.  How easily I was dismissed when presenting my own scholarly research.  How different sub-specialties of gynecology could structure how doctors shaped their diagnosis. Considering that I am a white, straight, cisgender woman, I can only begin to imagine the experiences that other races, ethnicities, and gender identities encounter. ACOG has several LGBT fact sheets dedicated to adolescents and women, but I am curious to know how extensive gynecologists' training is in these populations.

People want honesty from their doctors. People want real answers. People want to be heard and valued. I doubt that the gynecology field is equipped to provide that level of transparency and acceptance. There is an apparent disconnection between the patient and gynecologist relationship that warrants further deconstruction and analysis. We are more than our body parts, more than another pair of feet in the stirrups. It is difficult enough to strip down for an annual appointment, but to share vulnerable parts of our identities and health stories only to be dismissed and chastised makes us question, "Is it worth being honest?"

Additional Resources
ABOG Certification - American Board of Obstetrics and Gynecology
ACOG - The American College of Obstetricians and Gynecologists
ASHA - American Sexual Health Association
WHO - Sexual Health

 

 

Asymptomatic Herpes: Do I Really Have It?

It wasn’t said with malicious or demeaning intent, but it is a phrase that keeps echoing in my head. “Sometimes I don’t believe you have herpes, because I don’t have it.” I have been a carrier of the herpes simplex virus (HSV) for nearly three years, and yet, I have only had one visible outbreak. Just one; that’s it. One that I didn’t even look at because I was too afraid, too ashamed. But one was enough to make a lifelong difference for me.

Statistically, recurrences of genital herpes occur more frequently in those with HSV-2 than HSV-1, especially within the first year. I experienced an initial outbreak and, as of yet, never had another lesion surface. Sometimes it begs me to question if I am some form of genetic anomaly. Sometimes I wonder if I really do have herpes because I don’t have recurring, visible outbreaks. I feel wrong for even processing and posing those questions in my head. Questions based off difference and doused in what many would label as luck.

“Sometimes I don’t believe you have herpes, because I don’t have it.” After being with the same partner for roughly two years, one might expect that person would have contracted the virus by now. Despite a daily regimen of Valacyclovir, commonly known as Valtrex, the HSV-2 transmission rate is only lowered by 50%. Herpes can be spread through skin-to-skin contact, even when there are no visible outbreaks, which is why additional barriers are especially important if one partner is herpes-positive. Anatomically speaking, it is easier for a male to transmit genital herpes to a female than it is for a female to transmit to a male based on mucous membrane preferences. A combination of anti-viral therapy as well as some type of barrier is the most sound preventative decision in relationships where only one partner is infected. Realistically, the majority of couples ditch traditional barrier methods of protection as their relationships evolve. A Dutch study found that heterosexual couples in long-term relationships only use condoms 14% of the time, compared to those involved in casual relationships--who use condoms just 33.5% of the time. The study also found that the more similar and familiar partners were with one another, the more likely inconsistent condom use became. Even through long-term commitments, couples can unknowingly transmit the virus to one another. For example, a husband could go down on his wife when he has a cold sore and could transmit genital HSV-1 to her unintentionally. As casual and committed relationships evolve, is it possible for someone herpes-positive and herpes-negative to have an explorative and meaningful discussion of sexuality without transmission? 

The majority of herpes is spread by those who are unaware that they have the virus, most commonly through asymptomatic viral shedding, which accounts for approximately 80% of transmissions. Asymptomatic shedding is the shedding of the virus that occurs without symptoms or lesions present. A 2011 study explored the differences between asymptomatic and symptomatic carriers of HSV-2. Those classified with asymptomatic HSV-2 had a shedding rate of 10.2% compared to those with symptomatic HSV-2 infections, who shed at 20.1%. The study concluded that genital shedding is "likely universal" in seropositive persons but clinical manifestations differ widely, and that further research is needed with regard to clinically seropositive, asymptomatic HSV-2 infections. 

The so-called silent spread of herpes is a large piece of why the CDC does not recommend testing for individuals who do not present symptoms, a guideline that I disagree with. Even the CDC itself seems somewhat wary of its guidelines, stating that they “do not know" if testing everyone would stop the spread of genital herpes. Their website continues, "...without knowing the benefits of testing, the risk of shaming and stigmatizing people outweighs the potential benefits. For these reasons, testing everyone for herpes is not recommended at this time." I believe this statement calls for a shift in perspective and call to action. I do not think the focus should be so much on stopping the spread of herpes as removing the stigma associated with it. After all, over half of the world population aged 14-49 will contract HSV-1, and 11% will contract HSV-2 in their lifetimes--it is time that we stop talking around it. If the stigma of herpes were not as overshadowing and destructive, a herpes diagnosis would be much more navigable.  The thing about herpes, as common as it is, is that its complex, as that 2011 study suggested. If infected, it is likely that you’ll never know who exactly gave it to you, or when you acquired it. Serological testing can indicate which strain of the virus you have, but without a prior testing history, it is nearly impossible to determine when it was transmitted to you or how long you've had it. You may have recurring outbreaks, and you may have none. There is no "norm", no clear black and white, which makes things even more frustrating for those just diagnosed--but isn't that the nature of the human experience? 

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Although my blood test yields a positive HSV-2 result, nearly three years later, not much physically has changed. But here’s the thing, so much has changed because of that seropositive result. I felt somewhat lost that summer after graduating college, and strangely, my journey with herpes brought me back to, not only my academic roots, but my purpose. A purpose that I had not expected nor anticipated, or even wanted, but here I am nearly three years later in the midst of a dual degree masters program. I feel lucky at almost 25 to have a general idea of what I feel my purpose to be, but that doesn’t mean that I don’t question it. I think it would be wrong to assume my passion is static. It started as an undergraduate interest that I didn’t even know I could major in. I found solace in a field that analyzed my personal experiences with an academic lens, and it allowed for a significant amount of healing through fact-based knowledge. Even through my current research and writing, I am still healing to an extent, but my lens has an expanded audience and goal to provide resources that I did not have access to during the most difficult period of my young adult life. 

My experience of my primary outbreak is not invalidated by the shape or form my body decides to take since acquiring the virus. I lead a remarkably “normal” sex life filled with much more embarrassing moments than sharing that I am a carrier of the herpes virus. Generally speaking, no one is going to have my exact genetic makeup, and that is the beauty of being me--inside and out. No one’s body moves quite like mine, in its beauty and its faults. That is why it is so important to me to preserve its integrity, its strength, and its scars. 

RESOURCES
https://www.cdc.gov/std/herpes/screening.htm
http://dx.doi.org/10.1136/sextrans-2013-051087
https://jamanetwork.com/journals/jama/fullarticle/896698
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1871807/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4006256/pdf/rsif20140160.pdf
https://www.reuters.com/article/us-couples-condom/couples-characteristics-may-predict-condom-use-idUSBREA2A18920140311

 

 

Why We Should Be Having More Awkward Conversations

All too often I overhear complaints about dissatisfaction with relationship partners, both in and outside of the bedroom. Rather than dedicating time to discuss unmet desires and needs with our partners, the complaints seem to grow outside of the relationship—in our heads and amongst peers. On an unconscious level, we somehow expect our partners to telepathically interpret and cater to our thoughts without addressing them. At least, that’s our hope; because let’s face it—no matter how sex positive we may be, talking about sex, especially within our own relationships, is never as easy as we’d like it to be.

As a student, writer, and researcher of human sexuality, I am more comfortable than most in engaging in such discussions. Despite my openness in previous relationships, the depth of honesty required for true intimacy was never cultivated until recent years. I credit this newfound vulnerability to my initial herpes diagnosis in July 2015. Although that period of my life was filled with more questions than answers, I eventually found solace through honest disclosures to those around me. From these conversations stemmed an awareness of the power and profound effect that my honesty held within my interpersonal relationships.

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Despite my comfort in discussing my experience with herpes and growing knowledge in the field of human sexuality, it remains difficult for me to muster enough confidence to address my relationship concerns head-on. My natural inclination is to write through my emotions in the form of a letter, rather than initiate a discussion.  Verbalizing my emotions is a work-in-progress; there is still some inherent sense of awkwardness to these types of conversations. Yet I am dedicated to making them happen because I know that these communications solidify foundations for positive relationships. It is unfair of me to expect any partner or friend to know my thoughts, needs, and desires. It is also unfair of me to assume that I am the only one with dissatisfaction in relationships. Initiating a discussion of one’s own desires could turn into a fruitful conversation for both partners in the relationship, and typically, it is one that often happens much later than it should (Wong, 2017).   

“I believe in the power of vulnerability to create change,” has held truth as my personal mantra since 2016, but its validity is surprisingly challenged by researchers. Researcher, Kory Floyd, is one supporter of said mantra. Floyd (2006) developed the Affection Exchange Theory (AET) which “argues that affectionate messages enhance relational bonds, affectionate communicators are better able to respond to stress, and that affectionate communication physiologically benefits sources.” In health class, we are taught to use some combination of birth control methods and practice safe sex, but honest communication is rarely a topic that instructors include in that discussion. Horan (2016) found that “honesty surrounding sexual history conversations” is considered as a preventative method for Sextually Transmitted Infections (STIs) (451). Countering that finding, multiple studies have found that this honesty is filtered through deception, and may cause more harm than good, insisting that “a risk of affection is deception” (Horan, 2016, 459).

Instead of having a conversation with one’s partner about what is needed to achieve an orgasm, an individual may resort to faking it (Which, from my perspective, is not fair to either party). Horan (2016) noted that a recent study found that “50% of women and 25% of men reported previously pretending to orgasm” (451). It is often easier for some to engage in okay-ish sex than state what will assist them in improving pleasure during sexual activity, or achieving orgasm. Additionally, communication topics surrounding sexuality, such as birth control and sexual history (60% of participants in Horan’s study were untruthful when revealing their number of intimate partners) may be considered taboo dependent upon commitment levels of the partners involved (Horan, 2016, 464). A study by Lehmiller, VanderDrift, and Kelly (2014) found that “friends with benefits relationships were more likely to use condoms than committed romantic relationships.” I am fascinated as to how we, as a society, draw the line between sharing our physical and emotional selves  and making determinations as to safe spaces (read: persons) for each.

No matter which side of research you stand by, it is important to consider our differences—not only our physical bodies and racial ethnicities, but the depth of our internal emotional bases. There are those who have been abused, assaulted, and are just now learning to vocalize what they want, and feel that they deserve. There are some who feel utmost shame and guilt due to their past, or present. There are those who refuse to acknowledge trauma because it is easier to deny its existence than to confront it. Some of us like sex a lot, whereas some of us can receive enough intimacy from a hug or make-out session on the couch to satiate our need. Maybe you’ve been married for 30 years and the spark just isn’t there.

Behind these examples are levels of human experiences and emotions that only we as individuals are privy to.  Affectionate disclosures may put us at risk for deception, but remaining bound eternally by fear puts us against an even greater risk. It is not our obligation to tell the world every ounce of our story, but I do believe there is power in sharing  honest conversation with those who matter. 

References:

Floyd, K. (2006). Communicating affection: Interpersonal behavior and social context. Cambridge, England: Cambridge University Press.

Horan, Sean M. (2016). Further understanding sexual communication: Honesty, deception, safety, and risk. Journal of Social and Personal Relationships 33(4), 449-468.

Lehmiller, J.L., VanderDrift, L. E., & Kelly, J.R. (2014. Sexual communication, satisfaction, and condom use behavior in friends with benefits and romantic partners. Journal of Sex Research, 5, 74-85.

Wong, B. (2017, March 10). By the time you show up to my office, your marriage may be over [Blog post]. Retrieved from https://www.huffingtonpost.com/entry/by-the-time-you-show-up-to-my-office-your-marriage-may-beover_us_58c2de1de4b054a0ea6a5cad?ncid=engmodushpmg00000004

 

Here's What It's Like to Hold Your Pet During Its Final Moments

I knew it was coming. My dad called me Friday night after he and my mom took our family pup, Buddy, to the vet. My mom was in tears, and my dad did his best to complete her mumbled sentences. “We’re putting Buddy down next Thursday. The vet offered to do it tonight, but we wanted to make sure you had an opportunity to say goodbye.” Several minutes of silence and tears followed that statement. I had a lot of thinking to do.

I knew that I wanted to say goodbye to Buddy, but I didn’t know if I wanted to be in the room when he passed. The last several weeks have easily been the most challenging of 2017, and the addition of Buddy’s impending death made them that much harder. I only got three hours of sleep the night my parents told me the news.

In contrast to my gloomy mood, I won a ticket to Wanderlust Festival in Philadelphia. Wanderlust is comprised of a 5K, 90 minutes of yoga, and meditation. After three hours of sleep, I intended to walk the 5K around the Navy Yard. I have never been much of a runner, but that morning, my legs had other ideas. I ran my first 5K, the whole way through. I needed that release. By the end of the weekend, and after two solid nights of rest and significant research on the euthanasia process, I knew that I wanted to be there for Buddy.

I departed Philly Wednesday night and met my parents for a glass of wine at one of our local wine bars. One glass turned into two as we chatted over Buddy's 18 years of life. When we arrived home, I looked into my furry friend's face. His eyes were clouded, his nose wasn't wet, and he couldn't walk without his hind legs shaking. My poor, Buddy.

I went to bed Wednesday night with a heavy heart, and woke up Thursday morning with an even more uncertain one. We took Buddy on his final stroll around the park behind our house, a park he wandered through and protected for 18 years, one last time. It was bittersweet for me. When I was younger and still lived at home, I used to take him on some of those walks. He'd chase squirrels, and sniff the world around him, and bark at anything and everything that moved. Thursday morning, we placed him in a puppy stroller, borrowed from my mom's generous friend, and gave him one final view of his favorite walk.

7:45 rolled around as soon as the stroller cleared the corner of our yard, which meant that it was time to leave for our 8AM appointment. We grabbed Buddy’s green blanket, a stuffed animal that looked just like him, and placed him in my lap. He was shaking, and his poor teeth were chattering. This was the most emotion I had seen from Bud in a while. He made a bit of an effort to hold me, but I knew he just wanted to get down. I whispered to him in my puppy voice that everything would be okay, and he'd always be my Buddy. I didn't want to let him go.

We were guided to Room 6, and awaited the vet, who loved Buddy just as much, if not more, than we did. I could feel Buddy's heartrate increase as he was still snuggled tightly in my arms. The doctor explained the process, and tears started to fall from each of us. She took Buddy away to place an IV catheter in him, and soon returned. "It's purple," I muttered, "my favorite color," and somehow managed to find a smile. I asked her to clip some of Buddy's fur, just because.    

She asked if we were ready, and we all nodded in agreement, wiping our tears. "There's my Buddy-son," the vet whispered as Buddy took one last nip at her. As soon as the vet let go, so did Buddy, so did I. I felt his shivers cease, his chattering teeth no longer echoed. I felt his muscles go limp, I no longer felt his beating heart. The doctor asked me to move my hands as she placed the stethoscope over his heart. "He's no longer with us," she whispered through tears. I cried, "I love you, Buddy," more times than I'd like to admit. Even after his spirit left. My childhood dog of 18 years took his final breaths in my arms, and I felt so lucky to be that person.

I didn’t know if I was strong enough to watch something I love die. I have never faced death. I didn't come home with the intention of being the one holding him in his last moments, but looking back on his life, it makes sense that I was. Buddy used to hate thunderstorms. He was so terrified. He never liked being cuddled, or snuggling in bed, but when he heard thunder in the distance, he begged for me to hold him. It was always me he ran to in times of fear. And even though he could no longer run to me in his last few years of life, I knew he was meant to be in my arms yesterday.

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Buddy's death brought up a lot of buried feelings about my first puppy, Lily. She passed away on the operating room table while we were on vacation. Doctors investigated removing a brain tumor between her eyes, but said that she would have no sense of sight, smell, or hearing, and suggested putting her down. My parents agreed. I never officially had a chance to say my goodbyes to Lily, which is another reason why it was so important for me to be with Buddy. Today, a stargazer lily stands in her honor, and it remains my favorite flower.  

I’ve been thinking of ways to memorialize Buddy. I was on my way back to Philly last night, and I saw a field of dead sunflowers. The day was coming to a close, and the sun was shining on them in such a way that there was no other word to describe their death other than 'beautiful.' I wanted to turn around and stop to take a picture, but I knew that it was one of those moments that needed to be felt rather than captured. How could death be so beautiful? That’s the thing about October, “autumn is so beautiful, yet everything is dying.”  Sunflowers symbolize adoration, loyalty, and longevity, and I couldn’t think of a better symbol to represent Buddy’s 18 years with us. I plan to plant a row of sunflowers along my parents' fence line in Buddy's honor. The same fence that Buddy used to run in his youth. The one that Buddy will still run in spirit. I love you, Buddy. Thanks for letting me be your human sister.

 

Five Tips in Five Weeks: How to Navigate Graduate School While Working Full-Time

Five weeks ago I became the proud owner of a graduate student ID. During my undergraduate years, I was a full-time student, so learning an effective balance between work and school work has been challenging to navigate.  Not to mention making time for friends, writing, and my physical activities. For me, this chapter of my life is not about having the time, it is about making the time (within reason). Many of my peers have commented on how well I manage my work, school, and extracurricular endeavors, so I figured that I would share what I have learned on my journey thus far:

1. Make a commitment to yourself and the things you love. There is one yoga class that means more to the success of my mental and physical well-being than any other, hot yinyasa taught by Justine Bacon. I describe it as “yummy” to my friends because it is tailored to the energy in the room and the students' desires. The perfect combination of work and release. Although originally designed for cyclists and runners, anyone is welcome.  One of my online classes requires that I meet with my partner and small group once during the week. Tuesday at 5:45 PM at Priya Hot Yoga is my non-negotiable meeting time with myself and my mat. I schedule it like a meeting because it is one. I believe that the meetings we hold with ourselves are just as important as the meetings we attend at work and school.    

2. Plan to keep your diet and nutrition in check. I love the limited edition Oreos as much as the next Instagram foodie, but they are not the foundation of my food pyramid. Normally, I prepare my meals on Sunday for the week ahead, however, I knew that after seventeen hours of class, coming home to cook on a Sunday night would be the last thing I wanted to do (Hint: I was right). So on weeks when I have been in class, or have had heavy workloads, I order my meals ahead of time through a meal prep company. There is no substitute for cooking for yourself,  but I would rather spend a little extra cash to earn a little extra time. Not necessary by any means, nor is it financially sound for all, but my current chaos of a schedule interrupts my preparation of healthy choices, which is essential to my success.   

3. There is no such thing as dead time; Make the most of it. Lately I have been doing laundry at 5AM, or 9PM, there has been little in-between or consistency where my clothes are concerned. I find that my school reading often accompanies my loads of laundry. My goal is to complete my coursework one week before its intended deadline (to an extent). Clearly I cannot have my Week 5 group meeting during Week 4, but I can complete readings, papers, and research ahead of schedule. By creating false deadlines for myself, I have grown an appreciation for, and even added to, my free time. For a previous procrastinator, and someone who began this semester procrastinating, this is a significant change, and one that I hope to maintain throughout the duration of my graduate studies.

4. Know that you’re going to fall off track. Be flexible, have a back-up plan. This summer I experienced an injury that threw me out of the activities I love—yoga, weight lifting, spinning, and hiking—for roughly two months. I slowly managed to get back into pieces of my routine, but much of it is still interrupted. A late night hiking adventure led to a longer night’s sleep, a long weekend of class between workdays left me needing more me-time. Some days I will set an alarm at 4:30 with the intent of waking up and walking to the gym, but most of those days I end up pressing snooze. My injury showed me that my body needed and deserved more rest. Instead of looking at these moments as failures, I honor my body and its needs, but I still make an effort to accomplish what I can. Whether that's a quick workout in my apartment or a walk across the Ben Franklin Bridge, I make sure that something gets done before my workday begins.   

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5. Write things down. At present, I have about five floating to-do lists. One on my work desk, one in my planner, some on my phone, and several others in notebooks. Although my planning has much improved, I am still trying to find one organizational method to keep track of my projects, deadlines, and personal goals. I find that I am more likely to complete a task if it is written down, but I also know that I rely on my phone's calendar for most life events.

Considering that this is my first semester balancing work and school, Ithink I am doing the best that I can. Time management and prioritizing varies for each person, and what may work for me might not work for you. I need time alone to recharge. I work well in routine. I am someone who accomplishes more when I am busy, versus when I have all of the time in the world. Although I thrive in busy, there are still some skills that need improvement, and I hope that my current place in life will offer the opportunities needed to teach me.

 

My First Day of 17th Grade

Remember the children who always brought their lunch in grade school?  No matter the occasion? Even on special lunch days? That child was me, and apparently still is, as last weekend I found myself in constant search of a microwave while the majority of my peers flocked to Moe's, Uno's, or the campus dining hall.

Somewhere between a search for a microwave and a parking spot began my graduate education. I am currently studying Social Work (online) and Human Sexuality. My Interpersonal Communication course began three weeks ago, but last weekend was the first in-person meeting with my Human Sexuality colleagues.

As per usual first day agendas, my Concepts in Human Sexuality course was no different, other than the fact that we would be meeting for 17 hours in one weekend. My classmates and I circuled up to introduce ourselves, our interests, and accomplishments.  From my undergraduate research in female sexuality and archival research of LGBTQ history on campus, to the writing I have published, interviews I have been fortunate enough to have my voice included in, and the opportunity to co-design and teach a human sexuality course, I realized I have accomplished a fair amount in my field for someone of my age.

After sharing my academic background and career goals/accomplishments aloud, I delved deeper. There was a point in my life when I failed to see my academic intelligence as a key-piece of my identity. A point when "I can't" and "I could never achieve that" were common vernacular. My undergraduate advisor’s support of my research, and ultimately, her belief in me as an individual, shifted that perspective.  This weekend, I experienced a similar realization with regard to my future.

In an off-the-whim database search at a library workshop, I found a gap. A research interest of mine that needs to be filled. There is no research, there is no voice, and I have an overwhelming desire to be there. I need to make myself present in that space. In translation, that means I am planning to pursue my PhD. I entered graduate school with the mindset that this journey would likely not be the conclusion of my education, but was unsure of which direction I needed to take. After this search, I at least have narrowed my path.

Not only does this program require its students to critically think and analyze content, but also feel. During our exercises, my classmates and I were given a sheet of "Feeling Words." We would go back and forth with one another describing how we felt after watching videos--using only words, as opposed to what we thought. Candidly, I began to apply some of those words to my personal life. 

Uncomfortable. I have been heavily weighted by things that I need to let go of. Mostly people, or more accurately, associated feelings I have held onto, raw emotion, blockages, attachments--all accumulated negative energy.  Indifferent. I am in a position in which I can say I have moved forward about 85%, but there is still lingering tension in thought. These thoughts find me on my yoga mat and occasionally wake me from sleep. Uneasy.

Quotes about healing have been populating my social media feeds lately. How healing is a process, and that it is never truly finished. The idea of healing as a continuum is new to me, but I feel as though its applications are integral for understanding how our minds work, especially in terms of trauma. I can forgive, move forward, and direct my energy into positive platforms, but I am still affected, I still feel, I've just evolved.

The same little girl who brought her lunch day, the one who wanted to be a teacher, is now a young woman who treks along campus with a different meal, and a more defined purpose. Evolve. Some habits may never change, but our experiences will shift our perspectives if we allow them the opportunity.    

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Dear Lush Spa, I'm Not An Untouchable: On Two Years With Herpes

Alarm bells buzz as I reach for my glasses on the nightstand, and somehow manage to unroll myself from tangled sheets. I slowly shuffle myself downstairs to brew my first cup of coffee. Somewhere between my first and second cup, I take my daily vitamins and medications. Omega-3, Multi-Vitamin, Super-B Complex, Valtrex. Valtrex, an oblong blue pill that stands out from the rest, and shapes a meaningful part of my identity.

Two years ago, almost to the day, I walked out of a Patient First mourning the woman I once was. I climbed into the passenger side of my Dad's truck and cried on my his shoulder asking him, "Who will ever love me?" Since that moment, I've come to realize that a lot of people hold significant amounts of love for me, including myself (something that wasn't always present). On the flip side of the support given by family, friends, and strangers, is the reality of how weighted the stigma of carrying a sexually transmitted infection (STI) really is.

No matter how many CDC statistics or "real life" experiences that myself and others who share in this educational pursuit present to the world, there are going to be those who don't get it, choose not to get it, and never will support it. I have felt shame online, but for the first time experienced it in person at the Lush Spa in Philadelphia.

After I take that not-so-little blue pill in the morning, you'll most likely find me hitting the gym, or on the pier for a yoga session.  Coaches and yoga instructors have never had a problem touching me. There has never been hesitation, or lack of love in adjustments given to improve a posture or encourage the engagement of different muscle groups in my body.

Friends and family members have never held back hugs, in fact, they hold me tighter. Sexual intimacy has improved, thanks to a partner with open ears and an understanding heart. There has never been a moment where I have felt "disgusting" or "unworthy" of pleasure in bed in that relationship because of the virus I carry. There is still meaningful touch, there is still pleasure and I'm more comfortable with expressing my sexual desires, needs, and emotions because of that honesty. My sexuality is so well-nurtured in this environment that I often forget I even carry the herpes virus. I just feel like me.

From a young age, many of us learn to differentiate "good" from "bad" touch. When I was first diagnosed with herpes, I remember dragging myself to the gym, and the simple brush of a shoulder by a fitness instructor was enough to bring me to tears. No, it was not an inherently 'bad' touch, but I was sensitive due to a negative experience that happened in my life. So many people are unaware of the invisible boundaries that exist due to the past weights we carry. As much as there is a healing power in touch, there is one that can ruin an entire day. This power of touch is one of the main reasons I sought my RYT 200 certification, to provide that love and care that others have shown me. To offer a safe space and sense of healing, if others are open to receiving it.

The overwhelming sense of judgement that I felt from across the table at Lush Spa Philadelphia when I disclosed my medications was enough for me to determine that it was not a safe space.  When disclosing to medical professionals and even my bikini waxer, no one has inquired further about Valtrex or herpes. I am open with my diagnosis, and usually, there are no further questions, nor should there be. In my research, I found a helpful guide entitled, "Basic Pharmacology for Massage Therapists." A brief description of Valtrex, an anti-viral, can be found on page 44. Although accurate, I do not feel that this guide gives enough background for navigating real-life scenarios like the one I encountered. Collectively, we need to do better.

I am not pushing this issue for free spa treatments, or Lush products. What I am advocating for is further education and understanding in the spa and beauty industry about sexual health, stigmas, and the value in creating a safe space. Lush presents itself as a holistic organization in support of "fresh" and "organic" products that have an "honest meaning beyond marketing." Additionally, Lush gives back through a variety of means (charity pots, limited edition products, etc.) to "advocate for the environment, animals and people in need." This company presents itself to the public as one who cares about its customers.

The support received from Lush Cosmetics North America has been honest and receptive to my comments and concerns, however, the as-promised response from Lush Philadelphia is so far, non-existent. As a company that appears to be so dedicated to the value of natural products and supportive of the good of the world around us, I am a bit disappointed in the way this situation was handled. I've made a list of reasons in my head as to why Lush's promise was left unfulfilled: The manager hasn't had a chance to talk with the masseuse. I'm at the bottom of the manager's 'to-do' list, especially after a return from vacation. The manager doesn't know what to say, or how to respond. Or maybe Lush is just hoping I fade away. If I were in the manager's shoes, I'm not sure I would know what to say, either, except maybe, "I'm sorry."

On it's Charitable Giving page, Lush claims that it focuses "...on campaigning and education efforts to make societal change." Although I have been assured multiple times through Lush's Twitter that my situation is being taken seriously, actions are beginning to speak louder than words. I can only hope that my correspondence and writing efforts hold true with Lush's mission. I've spent two years fighting this stigma in my own mind, and in the world around me, and it's not something I plan to back away from.

I pour my coffee just like everyone else. I say "shit" one too many times when I realize that I'm late for work. I may take one more pill in the morning than some, but that one blue pill is not the standard for who I am and how I should be treated.

How Herpes Unexpectedly Defined My LUSH Spa Experience

"Is it up here, or...down there?" the masseuse nervously inquired. While I applaud her knowledge of the differentiation of HSV-1 and HSV-2, the situation was not dealt with in a professional manner. 

One of my greatest fears is failure--that I won't do something 'just right,' or that I will disappoint myself in my execution of a project, or lack thereof.  I've been having a lot of fun lately, and seeing that this is my first summer in a new city--my first summer living in any city--I don't think that there is anything 'wrong' with that mindset. What I do see fault in is my avoidance of housekeeping, grocery shopping, and the mundane things that seemed to be so easily accomplished months ago. Things that kept me successful in running my active lifestyle, have somehow loosened their seems. Underneath the beer gardens and poolside mimosas, there is also an element of fear that I've kept from myself. School. 

When I submitted my deposit just a few months ago, I saw a box that said, "defer to Fall 2018." In hindsight, I wish I had checked it. I do not believe my original six-month plan was adequate time for me to adjust and explore my new city, and develop a new routine for what success means to me.  One of my best friends summed it up well in his advice to me, "It's not that you're incapable of completing the work now. But you have a lot on your plate and mind, and I'm not sure if you can give it the attention you want at the current time."

Since that conversation, there have been moments of weakness and uncertainty, and I'm still unsure as to what my next move is. What's right, what's wrong--it's overwhelming to me. Believe what you may about the power of the full moon and it's effects, but this past one was no different, at least for me. A feeling of strangulation by my innermost thoughts, a constant stream of intuitive analysis- to the point of physical manifestation of symptoms that don't add up. It's enough to make me want to lock myself in my apartment during the next cycle.

My stress management has improved with age, and typically, yoga does the trick. This time around, I dug deeper into my practice of self-care and booked a massage. After an already shitty Wednesday, I was looking forward to the time to decompress and let go--of school, people, injuries-- and just be. Originally, I was seeking a deep tissue massage, but when I learned that one of the two LUSH Spas in North America was in Center City, I quickly changed my mind.

I booked an appointment for "The Good Hour," a seventy minute deep tissue, ship-themed massage. After pre-paying for my services, I was greeted with lemon water and whisked away into the chic county kitchen. I was greeted by my masseuse, who handed me a paper that I thought nothing of. A usual list of any known allergies and medications I'm currently taking. I filled out the paperwork in a little under two minutes as she gave me a background story of the LUSH Spa. I knew something was wrong when her brows furrowed over my paper.

"...You take Valtrex? How long have you taken that?"Just about two years now.
"...Why are you taking that?"I have herpes.

I'm not sure what the usual spa standards are when it comes to disclosure forms, but I have written Valtrex on a variety of treatment forms, and this is the first instance when someone inquired how long and the reason it was prescribed to me. She scribbled something on the paper, shuffled it under the cabinet, and asked me to follow her upstairs. At this point, perhaps I was as nervous as she was.

Before leading me into the treatment room, I was given a chance to explore the LUSH bathroom--complete with a shower and almost any LUSH product you could think of. I did not care so much about experiencing the free LUSH products as much as I cared about my massage, so I quickly retreated into my supposed oasis. There were two chairs in the room, and I was asked to take a seat in one. After dropping the Big Blue bath bomb underneath the table, she joined me on the opposite side of the room. Before she sat down, she drew her hand to her face, and asked where I was infected. She couldn't even say the word, "herpes." It reminded me of a child describing his or her genitals for the first time: Awkwardness. Nervousness. Accompanied by a side of shame and slight embarrassment.

It's been almost two years to the day when I found out I had herpes, which is also why I think I was especially sensitive to this conversation. Herpes has become a common word in my vernacular, and for me is virtually just another part of who I am. I've done the crying. I've felt the shame and experienced the stigma. I know it exists in this world. And yet this conversation caused an internal breakdown. I bit my lip and shared my truth, "

I have genital herpes. I was diagnosed two years ago and have only had one visible, physical outbreak. If you are uncomfortable touching me, or providing me this service, I'd be happy to leave."

I knew I should have, and I wish I had. She insisted it was fine since I was on medication, but her attitudes, mannerisms, and questioning told me otherwise.  I felt like a leper.

I cried through half of my massage. Something I booked in an effort to show myself a little more love and de-stress, caused the opposite effect. I spent seventy minutes in my head trying to come up with a few sentences to share with my massage therapist. There was nothing wrong with the massage itself, even my therapist's touch, but the experience that LUSH intended to create was ruined by the lack of education, care, and sensitivity leading up to the main event.

I couldn't wait to escape after those seventy minutes. I was led to that little bathroom again and was faced with only my reflection. It reminded me of the girl I was two years ago, when I couldn't even face myself in the mirror because I was so disgusted. Mascara and eyeliner led a trail down my cheeks. As much as I tried to hide my tears, there was no way my therapist turned a blind eye. Tea and biscuits awaited my arrival downstairs, as did the massage therapist who I'd rather not be faced with again. She seemed over-friendly and energetic. I felt that we both wanted to say something to the other, but neither of us did.      

That night, I made a decision to contact LUSH*. I did not reach out to complain about my therapist, or the massage itself, but offer an opportunity for education. I have told chiropractors and other skin-care and holistic health enthusiasts about my medical health and diagnosis, and not once have they turned me away as a customer, or made me feel uncomfortable. This experience showed me that despite my efforts to educate, the stigma is very present, and very real. And no matter how much of a brave face I put on, I'm still affected by it.

As unpleasant as this experience was, it taught me something. There is still work to be done, and this is why I'm here. This is why I'm seeking to further my own education so I can create change, or at least a wave of it. Perhaps this is the universe's strange way of telling me to push forward with graduate school this semester. 

We are all afraid of something. Some people, like myself, are afraid of failure. Some people are afraid of spiders. For some, it's death. And some are afraid of being infected by an STI--likely because they are uneducated about STIs and only 'know' what society presents (which is usually not the best source of information). In her years of experience, I am sure this woman has touched many people with herpes, but I can guarantee you that not all of them disclosed--likely in fear of what unfolded during my experience: unnecessary shame, stigma, and lack of a safe space. I strive to change just that... 

*I have been in touch with LUSH North America since the incident and they assure me my comments and concerns are being taken seriously. The communication I have exchanged with them has been open, and very much a safe space for discussion (Thanks, LUSH!). I am supposed to hear from the store manager this Monday and will update this post accordingly. 

UPDATE- Lush Philadelphia remains silent

Escaping Emily


I’d liken my introspective nature to a paralysis at times; I am my own worst enemy. The last few weeks has caused a deeper reflection and repetition of my young adult life in my head. Fragments. Memories. Words. Years. Things I wish I said, or phrased differently, or didn't say at all. Things I’d rather forget. Things I wish I wrote down, or wish I savored longer. Although I cannot change the past, I can appreciate where I am now and the moments, lessons, and people that led me to present. In an attempt to maintain my usual positive mentality, and not collapse into an oblivion of Emily thought, I created this Gratitude List to remind me of just how lucky I am, how far I have come, and what still needs some fine tuning-- and maybe inspire a few others to do the same.



Written Expression. Words are one of my gifts. An extension of my voice, my heart, best articulated by putting pen to paper. I’m not the best at translating those thoughts into a solid vocalization, at least, not yet. I have little trouble talking to people, but when it comes to verbalizing exactly what I wish to say, it's not easy for me. I think it has something to do with my perfectionism and a pressure to find the exact words to relay my emotions. Because of this, I allow thoughts to bubble in my head longer than they should, and even though writing serves as a form of release, the words still linger.



 I am always thankful of those who appreciate my writing, whether through this blog, letters, or other form of written communication. Those in my life who accept me where I am, who are open to reading my voice and my thoughts, even in times of disagreement, misunderstanding, and uncertainty. I wish verbal communication came naturally to me. I reflect, and things have left my tongue with the wrong words or intention, or a chip of attitude, and are just subpar to things that could have been better expressed with patience. I have taken steps of honest and transparent communication through my writing, and have been working for the past year to create an improved verbal application, but it is still very much a work in progress. I am always thankful of those who appreciate my writing, whether through this blog, letters, or other form of written communication. Those in my life who accept me where I am, who are open to reading my voice and my thoughts, even in times of disagreement, misunderstanding, and uncertainty. I wish verbal communication came naturally to me. I reflect, and things have left my tongue with the wrong words or intention, or a chip of attitude, and are just subpar to things that could have been better expressed with patience. I have taken steps of honest and transparent communication through my writing, and have been working for the past year to create an improved verbal application, but it is still very much a work in progress.



Healthy Friendships. It's taken me most of my adult life to identify with a strong friend group, or even open myself to the idea of what society defines as a "best friend."  In childhood, someone you supposedly spend every moment with, never fought with, exchanged friendship bracelets and had sleepovers with each weekend. As a child (an only child at that), I was likely unaware of my introverted nature and need to recharge, and therefore, failed to identify with sharing that space, or conceptualize myself having, needing, or wanting a "best friend."


There was never an absence of friends, but maybe I was in scrutiny of the ones I did have--searching for this supposed "best friend" that never really identified with my needs. Friends have entered my life, they have left, and some have even reappeared. For better or worse, with the few friendships that have fallen apart, some of those whom I now consider to be my best friends have emerged from that rubble. And perhaps that was the purpose in those individuals' roles all along. That is not to say I was a perfect friend, I'm still not a perfect friend, but I have friends that love me, and who appreciate my presence, even if I make them take a picture everywhere we go.

 
We might not talk on a daily basis, but I know in the end, they always have my back. I know they're there, just as I am there for them. It goes both ways. We learn and grow from one another, laugh with each other, support each other, and listen with honesty and integrity, furthering each other to our best selves, even when we feel we are at our worst. That depth matters to me, and my friendships were not always at that level. I have finally reached a place in my life when I am happy with the energy surrounding me, and am receptive to finding that energy in a new locale.    


Forgiveness. Necessary to my healing, but something that does not come as easily to me as it once did. Last year, I wrote a controversial post about how "I am Most Grateful to the Guy Who Gave Me Herpes," and really, I am. That experience forced me to grow in every area of my life. In my romantic relationships, friendships, career, and educational pursuits. Things I had ignored for years, or brushed to the side. I was forced to look in the mirror and reevaluate my existence and what I am seeking within myself and my life. It was a transformative year for me--I'm not the same person I once was, I think it would be a problem if I were still the same person in terms of personal growth.

I have loved. I have lost. I have forgiven, over, and over, and over again. Cyclical, my own toxicity. Even when people highlight the negative aspects of someone, I will seek the good. I've always held a healing presence. There were times when I acted from that place too quickly. I never gave either party time to reflect, I simply pursued a quick fix, a temporary bandage for larger problems at hand.

Some of these people are no longer in my life, but their absences are not indicative of a lack of effort or forgiveness. Continued attempts and failures to heal and begin anew do not equate to healthy friendships or relationships. Not everyone will lift you up. Not everyone wants to see you achieve success. Not everyone is as positive, caring, and genuine as we wish them to be, or know they could be.  People can enter your life, and fail to hold a permanent place, and sometimes, this person can be you. I'm sure it was me at some juncture. There is no ill will to those who I have separated from, but I think it is important to achieve an awareness of how you affect others, and the effects they have on you. Like oil and water, some relationships just don't work, no matter how much effort you put into them, or how often you start over, not everyone is meant to stay in your life. Although there were better ways of navigating my separations, for me, these people served as teachers of pivotal growth points within myself that were necessary to my healing and maturity.    


 Passion. I see failure. I see mistakes made. But I see persistence, and someone who seeks growth, even though sometimes--most of the time, she has to learn the hard way.
But at the root of this list, I see passion. I see dreams realized. I love hard. I put every ounce of myself into my goals, interests, career, vision, and those who matter most to me. At times, probably a little too much. In my teens, I often lost my identity in others. It took several rounds of playing hide and seek with myself for me to learn, accept, and understand my value, need for space and independence, and appreciation for that in others.

I know some practice daily gratitude journals, but for me, these are current life themes that jump off my page. They offer a more complete picture of what I have realized, and what my current self-work is dedicated to.