general practitioner near me :: Article CreatorSex Doesn't Have To Be Intercourse
There are many reasons couples may not want to or be able to have penetrative sex. Sex is tied directly to individual mental health and can affect the quality of relationships. I also want to note that it may be assumed that only heterosexual couples or homosexual men have sex with penetration, but all genders and sexual orientations may engage in penetrative sex.
Some issues that may prohibit penetration could be:
Physical limitations; injuries or health conditions that decrease or inhibit mobility. Vaginismus; a disorder where the vagina has involuntary muscle spasms that can stop anything from being inserted. Erectile dysfunction is where a penis may have trouble becoming or staying erect. Dyspareunia causes painful intercourse for any gender due to an underlying condition or pelvic floor dysfunction. Trauma may also be a reason one might not want to have penetrative sex. Fear of pregnancy or a sexually transmitted infection. Many other disorders and issues are also affected. The psychological effects of these issues that affect intimacy can be vast. Individually people often struggle with depression or anxiety about their abilities to connect sexually with their partner. Feeling like sex has changed or you can't meet your partner's desire can bring up feelings of sadness, hopelessness, and avoidance. It can cause anxiety around sex and intimacy and make everything relating to it more stressful. Worrying about connecting with your partner and how your physical or emotional ability affects sex can even cause panic attacks. For some, they may even develop a specific sexual performance anxiety; SPA, (Pyke, 2020) which one study found to happen to up to 25% of men and 16% of women dealing with some form of sexual dysfunction. In general, those with sexual dysfunction or other health issues experience more depression about their situation. For those with issues stemming from trauma, that can even bring fear of sex as a response. Sexual issues definitely cause mental health symptoms to increase. Many clients seek therapy for these reasons alone.
For all genders having intercourse can define their role sexually. Some men may feel like they need to have penetration to feel masculine. Women may feel they need to be able to tolerate and enjoy it to fulfill their role with their partner. These beliefs stem from cultural and societal expectations and may cause gender dysphoria and gender identity incongruence. Due to stigmas and the vulnerable nature of sex people who experience this may not feel comfortable seeking therapy or even voicing this to their partner. That can lead to exacerbation of symptoms.
Something I enjoy teaching couples I work with is that there are many different ways to have sex, in fact anything you want to define as sex will work! People who engage in other forms of sex report no change in satisfaction when compared to penetrating sex. One study looked at older men with erectile disorders and found that engaging in non-penetrating sex actually improved not just sexual satisfaction but also relationship satisfaction (Ševčíková et al., 2023). This doesn't surprise me because having more sex that you feel comfortable with and enjoy would cause more satisfaction as opposed to causing stress or one partner not enjoying things. This can also lead to changes in other areas of a relationship, leading to more trust, safety, and connection overall.
Intimacy
Source: Ketut Subiyanto/Pexels
It's important that we change our view on heterosexual penetrative intercourse being the goal of sex. That view is founded on the belief that procreation is the only reason people choose to have sex. It may be rooted in religious beliefs that not everyone sees as their own personal beliefs.
Another research article I read highlighted the impact this has on intersex individuals (Cornwall, 2010). It discussed the impacts of this idea leading surgeons to perform more genital correcting surgeries on babies and young children based on the assumed sexual desires they may have in the future. This can cause depression, anxiety, or gender dysphoria later on in life and has led intersex individuals to seek therapy to address these complicated emotions. Everyone can benefit from placing less value on relationships only being consummated if there is intercourse.
They are pretty endless but I like to share ideas with my couples to spark some creativity. I also always remind couples that orgasms are also not necessary to have sex. They are great if you enjoy them but not everyone can have one or does enjoy them.
Hands, mouth, toys, etc. Kissing with touch. Rubbing or grinding; also known as outercourse. Mutual masturbation. Fantasy and roleplaying. The most important tip I like to give is that communication is very important. Talking about how sex makes you feel, what you like, and what you need will lead to the best and most satisfying sex with your partner. This also creates safety in the relationship which leads to having a stronger connection. Listening is also really great foreplay, feeling heard and understood can definitely get you in the mood. A study (Rancourt et al 2016) on treating vulvovaginal pain concluded that communication about sex was key for improving pain and satisfaction outcomes for both partners. That's a big deal to get positive outcomes without any medical intervention or treatment and speaks volumes to the power of communication in relationships.
If you are experiencing stress, depression, or anxiety relating to sex reach out to your doctor or a qualified individual or couples therapist. Other helpful resources include support groups and literature about specific issues you may be experiencing.
References
Ševčíková, A., Gottfried, J., Gocieková, V., Gore-Gorszewska, G., Blinka, L., & Kotík, J. (2023). The Role of Non-penetrative Partnered Sex Activities in the Associations Among Erectile Difficulties, Sex and Relationship Satisfaction in Men Aged 50+. International Journal of Sexual Health, 35(1), 30–40. Https://doi.Org/10.1080/19317611.2023.2169850
Cornwall, S. (2010). Ratum et Consummatum: Refiguring Non-Penetrative Sexual Activity Theologically, in Light of Intersex Conditions. Theology & Sexuality, 16(1), 77–93. Https://doi.Org/10.1558/tse.V16i1.77
Rancourt, K.M., Rosen, N.O., Bergeron, S. Et al. Talking About Sex When Sex Is Painful: Dyadic Sexual Communication Is Associated With Women's Pain, and Couples' Sexual and Psychological Outcomes in Provoked Vestibulodynia. Arch Sex Behav 45, 1933–1944 (2016). Https://doi.Org/10.1007/s10508-015-0670-6
Robert E. Pyke, Sexual Performance Anxiety, Sexual Medicine Reviews, Volume 8, Issue 2, April 2020, Pages 183–190, https://doi.Org/10.1016/j.Sxmr.2019.07.001
More references
2024 General Election: U.S. Congress, Second District
Mark Amodei
Mark E. Amodei
Republican
Occupation: U.S. Congressman
Age: 66
Contact: Amodeifornevada.Com
Record of service
• Congressman Amodei served with the U.S. Army Judge Advocate General Corps, from 1983 to 1987.
o Awards and honors: Army Achievement Medal, Army Commendation Medal, and Meritorious Service Medal.
• Upon receiving an honorable discharge, Congressman Amodei returned home to become an attorney with the law firms Allison MacKenzie in Carson City from 1987 to 2004 and Kummer Kaempfer Bonner Renshaw and Ferrario (now Kaempfer Crowell) in Reno, Nevada from 2004 to 2007.
• Served in the Nevada Assembly from 1996 to 1998 and in the Nevada State Senate from 1998 to 2010 representing the Capital District.
• Served as President of the Nevada Mining Association from 2007 to 2008.
• Served as Nevada Republican Party Chairman until May 2011, when he stepped down to pursue the Republican nomination for Congress.
• Congressman Amodei was the Republican candidate for Nevada's Second Congressional District in the September 13, 2011 special election.
• 118th Congress Committee Assignments: House Appropriations Committee.
o Subcommittee Assignments: Homeland Security (Chairman); Interior, Environment and Related Agencies; Financial Services and General Government.
• Caucuses: Congressional Western Caucus (Vice Chair), Army Caucus, Congressional Joint Strike Fighter Caucus, USO Caucus, Veterans Job Caucus, Public Broadcasting Caucus, Italian-American Caucus, Conservative Climate Caucus, Postal Preservation Caucus, ALS Caucus.
Education
Bachelors of Arts, University of Nevada, Reno, 1980,
Juris Doctor, University of Pacific, McGeorge School of Law, 1983
Briefly describe the core duties of the position you are running for.
A lot of people seem to think that being in Congress is just about voting on bills, but in reality, I spend a lot of time providing oversight of federal agencies and making sure they are complying with the law and treating Nevadans fairly. I'm also very proud of my office's constituent services operations, helping Nevadans every day in receiving the benefits and services they are entitled to.
A brief statement about your platform
My top priorities in Congress will continue to be specific to Nevadans, including helping foster economic growth in Nevada through the conveyance of federal lands surrounding our communities to local authorities so that they can actually be utilized, using my position as a chairman on the House Appropriations Committee to ensure that federal dollars continue to come to Northern Nevada, and providing oversight of federal agencies in how they carry out their duties in our state and how they treat Nevadans.
What is the biggest issue facing Northern Nevada residents and what can you do to solve it?
Inflation and the high cost of living continues to be the biggest problem facing Nevada and our country. Even after the pandemic ended, the Biden Administration still spent $4.2 trillion in stimulus packages, in which they pushed funding for a new army of 87,000 additional IRS agents, funding for climate justice and the Green New Deal, and the expansion of Obamacare. With Republicans retaking the House the last election cycle, we have been able to cap annual spending and ensure that there are better guardrails on how taxpayer dollars are being spent, and I will continue to make sure that we're not just frivolously throwing money at problems that really just require better oversight.
What makes you the most qualified candidate for this position
I've spent my whole life in Nevada, except for my time in law school and the U.S. Army. I've had a lifetime to learn about Nevada's issues and how best to serve my state. Throughout my time in Congress, I've also built the relationships and seniority in the House of Representatives that allows me to be a more effective representative of our state. As a chairman on the House Appropriations Committee, I am in the best position to make sure that Nevada gets its fair share of federal resources, and when I call in federal agencies to discuss issues impacting Nevadans, they actually listen. Most importantly though, I'm not and never have been in this for myself. While my opponent wants to use Congress to ease restrictions on his tech companies and the bank he owns, I wake up every day focused on delivering for Nevadans so our state can prosper.
Greg Kidd
Greg Kidd
Occupation: Entrepreneur, Investor, Business Leader
Age: 65
Contact: greg@kiddfornevada.Com; www.Kiddfornevada.Com
Record of service
I worked with Outward Bound and the National Outdoor Leadership School in New Hampshire, Wyoming, Alaska, and Latin America. I also joined the payments group of the Board of Governors of the Federal Reserve in Washington D.C. As a senior analyst.
Education
Greg was educated at Brown (B.A.), Yale (M.B.A.) and has a degree in public policy from Harvard's Kennedy School of Government.
Briefly describe the core duties of the position you are running for
To work hard and to fight for the people of Northern Nevada. To make our economy much more resilient by bringing in new jobs and new industries; by supporting the lithium loop and by creating a permanent fund for the state of Nevada.
A brief statement about your platform
I'm running as a nonpartisan because I want our democracy to function better, and I'm willing to work with both sides to get things done.
I believe strongly in a woman's right to reproductive care. A woman and her doctor should make this decision, not the government, whether it be Federal or state government.
I support the legislation providing $1 billion in Nevada to boost affordable housing. He sided with extremists against high-profile Nevadans in his own party, including Governor Lombardo and former Governor Sandoval, and then showed up for the ribbon cutting ceremony.
Our neighboring states of Arizona and New Mexico get way more Federal money than we do; I think that's a huge mistake and would put in the work to fix it.
I'm self-funded, so I'm beholden to no one. While ordinary citizens in our district are suffering, I don't think it's right to consistently vote for pay raises for politicians, including the largest pay increase for elected officials in Nevada history.
It's time for new leadership for our district.
What is the biggest issue facing Northern Nevada residents and what can you do to solve it?
The biggest issue facing Northern Nevada residents is the fact that Nevada's economy needs to offer more opportunity to its residents. People need a way to earn a good living wage, to live near where they work (affordable housing) and to a good education. For this to happen, we need to have an economy that is not seasonal: while we have a rich history of mining, gaming, and tourism, we need more.
What we need is a comprehensive plan to bring better jobs to Nevada. It begins with the lithium loop. We need to capture the benefit of our solar and mineral wealth from the sun to the socket and from the ground to the gigafactory. If we do, we'll be the richest state in the nation per capita rather than an also-ran. We need to plan for, and to create, an ecosystem of lithium mining, processing, manufacturing, and recycling — all in our state!
I am proposing a Nevada/District Permanent Fund to realize the value of our mineral resources rather than letting them slip out the door to non-Nevada and non-US entities. Let's invest in ourselves. The Alaska Permanent Fund has over $74 billion and has paid out an average of approximately $1,600 annually per resident. Norway has done the same thing with its oil and gas – if a dollar is coming out of their country, they add 25 cents, which they invest. It has about double the population of Nevada – and last year it earned $213 billion from that fund. Nevada has $0 because our fund doesn't yet exist. This is why we are near last place in educational achievement in our schools, and why we have chronic shortfalls in health, housing, roads, and other infrastructure in our 2nd District.
What makes you the most qualified candidate for this position
I'm a job creator, innovator, and pragmatist who's committed to getting things done. In 1990, I founded a courier dispatch company called Dispatch Management Services Corporation. I grew it from a small bike messenger firm to be the world's largest on-demand dispatch company, with revenues of $250M, a 5,000+ workforce, and a 1998 Nasdaq IPO.
I'm not a career politician. My opponent has shown himself to be low-energy, low-producing, and unwilling to reach across the aisle. He's out of touch with the challenges that everyday Nevadans deal with, and he has no solutions. I have fresh ideas, some of which I've detailed above, and the most important issues facing Nevadans are economic in nature. That is what I do. And that is why it's time for a change.
One American Physician's Long Journey To Becoming A Family Doctor In Canada
By Avis Favaro
Click here for updates on this story
TORONTO (CTV Network) — An American family doctor is frustrated with what she says has been a challenging two-year-and-counting bureaucratic journey to be accepted into Canada.
That's where she has a job waiting for her, tending to some 1,500 patients who don't have a physician.
"We assumed (the process) would be something around six months or so. But clearly, we were wrong…it's been two years," Dr. Ashleigh Duncan said with a laugh.
But it's no laughing matter for a country with 6.5 million Canadians without a family doctor, and where there are urgent recruitment programs to bring qualified physicians in to practice medicine.
Duncan graduated from Wayne State University School of Medicine in 2009. She's been a family physician at a clinic near Denver, Colo., where she lives with her husband, Matt, and their two children. She began looking for a job in Canada in 2022 to move closer to her parents in Michigan, and away from the gun violence that she says worries her as a young mother.
"We started doing some research about Canada, and my husband was looking at safety statistics and school safety, (and it) seemed much better in Canada versus the U.S.," said Duncan.
She quickly spotted an opening for a general physician in Morriston, Ont. It was posted by physicians Manu and Pooja Kaushik, a husband-and-wife team who runs the clinic in the small town south of Guelph.
"We're inundated with patient requests, meaning hundreds of patients asking, 'Can we have a family doctor?'" said Dr. Manu Kaushik. "I try my best to accept what I can, but we need help."
Duncan was one of just three doctors who applied for the position. One Canadian doctor, said Kaushik, turned it down. After meeting Duncan on Zoom and in person, the Kaushiks formally offered her the job in November of 2022.
With the severe shortage of doctors in their region, they expected it would be a quick process to get her certified and in place.
"Maximum, six, seven months," said Kaushik. "I was thinking Summer 2023 she should be here. And we're still waiting."
He showed CTV News a hefty pile of applications from residents waiting for a general practitioner, many of whom will become Duncan's patients. Some 1,500 come from another area GP who recently retired.
Two offices are ready for Duncan, and are sitting dark.
"Everything is done for her to start seeing patients," said Dr. Manu Kaushik.
"It's hard to imagine when someone who is fully qualified, ready to practice is not able to," said Dr. Pooja Kaushik.
"Despite what we hear, that they're trying to fast track people to come into Canada, (the Kaushiks) cannot get this person to come in. It's mind-boggling," said Gerald Tot, a patient at the clinic.
His wife, Daphne, said she worries the drawn-out process will put more stress on the clinic's other physicians, who are parents to young children and caregivers to an ailing mother. "We do not want to lose (the Kaushiks)" she said.
The Kaushiks admit they think about leaving family medicine "on a nightly basis" but say they are committed to their patients.
With too many Canadians without a family doctor, the situation is critical, said Dr. Nancy Fowler, executive director of academic family medicine at the College of Family Physicians of Canada.
While not commenting directly on Duncan's case, Fowler says it points to fixes needed in the pathway to physician approval, which involves several agencies, like medical governing boards and immigration.
"There's room for a lot of improvement and…breaking down some of the barriers to how we work together will be really critical," she said.
Long road to Canada
Duncan says she has spent nearly US$15,000 so far on her two-year journey through the bureaucratic maze. It has included criminal checks, financial reports, educational certification and two trips to Ontario.
There was a nine-month wait to be licensed by the Medical Council of Canada, the first step in applying to become a physician in Canada.
In contrast, her husband, who is a civil engineer, quickly received professional clearance to work in Canada.
"It was, within 24 to 48 hours that I got approved," said Matt Duncan.
Duncan received good news in July 2023 when she was registered to practice family medicine by the College of Physicians and Surgeons of Ontario.
Things slowed down again, she says, in the immigration system, says Duncan. She applied under the Express Entry profile with Immigration, Refugees and Citizenship Canada where she discovered a "points system" that would affect her application.
Candidates are given a "comprehensive ranking system" score and if it is above the CRS score required for the next draw of candidates, then they are "invited" to apply for permanent residence.
Duncan says that despite her 12 years as a physician and her other skills, she discovered her total score under the program was too low.
"We didn't work in Canada, so we lost points for that. We aren't currently living in Canada. We don't have first-degree relatives in Canada, so we lost points for that," she said.
Only when the Kaushiks asked for help from their local MP, Michael Chong, did a new option open. They applied for a note of "interest" from Ontario. That increased her score on the IRCC application and Duncan was eventually invited to apply for permanent residency.
Another delay she says came with the submission of a Labour Market Impact Assessment (LMIA) required by the IRCC under the Temporary Foreign Worker program in May of 2023.
It required the Kaushiks to show there was no Canadian worker or permanent resident available to do the job. They had received three applications to their job ad – only one of which was from a Canadian physician, who then declined to come to the clinic.
The initial LMIA submitted by the clinic's lawyer was rejected because the package needed a letter signed by whoever would be paying Duncan for her medical services. The application, says Duncan, assumed the clinic itself would be compensating her for her work, when doctors in Ontario are paid by Ontario Health Insurance Plan billings.
"We were told that, because the clinic is not paying me, they wouldn't approve the LMIA, because I'm going to be paid by the government, which just does not make any sense," said Duncan.
Eventually, her application was accepted, but remains "in progress," according to her file.
"I've no idea what's going on behind the scenes it would be nice if there was a tracker. We're 70 per cent here, you know? Just so we would know," said her husband, Matt.
Asked why she continues on this complex path to Canada, Dr. Duncan said, "We've definitely thought about pulling out our application and just staying here. But ultimately, it comes back to why we started this process in the first place, and nothing has changed."
CTV News asked the IRCC about whether physicians in demand are given expedited approval. An IRCC spokesperson responded with a statement, saying, "The IRCC continues to prioritize work permit applications from workers in 24 essential occupations in health care, where additional labour is needed to protect and promote the health of Canadians."
Meanwhile, Duncan's name is already on the College of Physicians and Surgeons of Ontario as a practising doctor and is on the call list to provide after-hours and weekend medical services for the local Guelph Health Team, where she is registered to work. But with her still located in the U.S., other physicians in the region including Manu and Pooja Kaushik have to cover her shifts atop their other work.
"If we don't get help, how long can we sustain this?" said Manu. "This is not sustainable," added Pooja.
Please note: This content carries a strict local market embargo. If you share the same market as the contributor of this article, you may not use it on any platform.
ctvnews.Caproducers@bellmedia.Ca
Comments
Post a Comment