You Can Probably Have Sex 6 Weeks After Giving Birth—But You Don’t Have To. And It Might Suck

No matter how prepared you are to have a baby—even if you attend all the childbirth classes and read piles of books on what to expect—pregnancy and new parenthood are full of surprises.

I, for one, was totally unprepared for the strange and sometimes alarming but benign grunting noises that came from my little one, all night long. And as much as I braced myself for stretch marks and a deflated postpartum belly, that first warm shower after giving birth was a bit of a shock. (I’ll never forget reaching down to wash and yelling in shock and awe at the swollen, stitched-up sight that reminded me of a balloon animal.)

Something else I was not anticipating: all of the issues that came along with postpartum sex.

Most of us have heard that you can have sex again roughly four to six weeks after childbirth. But you may not know where that advice stems from.

Traditionally, new parents in the U.S. have a comprehensive postpartum checkup around four to six weeks (but possibly sooner) after delivery, where the doctor will check whether the cervix has closed, examine vaginal tears and/or the C-section incision, check to see whether any areas that required stitches are healing properly, and examine the breasts. You also typically discuss birth control options and pregnancy spacing for parents who may want more biological children, as March of Dimes explains.

At a four- or six-week checkup, you may be cleared to have intercourse again. The cervix generally doesn’t close fully for around six weeks, so up until that point, there’s the risk of introducing bacteria into the uterus and ending up with an infection, Pari Ghodsi, M.D., a board-certified ob/gyn based in Los Angeles, tells SELF. In addition, stitches to repair vaginal tears could open up, and, if you had a C-section, “pressure of someone on top of you could lead to uterine rupture,” Dr. Ghodsi says. So, waiting this long to have penetrative sex helps to ensure you don’t experience these complications.

But it’s important to note that the postpartum checkup isn’t necessarily for the purpose of assessing sexual readiness, Sofia Jawed-Wessel, Ph.D., assistant professor in the School of Health and Kinesiology at the University of Nebraska-Omaha who studies the sexual health of women and couples as they transition into parenthood, tells SELF. “It is a follow-up appointment after a person’s body has experienced significant physical and hormonal changes,” she says. “A woman was pregnant and now she is not, and it is important for her medical team to see how she is doing after a vaginal or cesarean birth.”

Just because most people are cleared for sex by six weeks, that doesn’t mean that you should start having sex again, that it’s the norm, or that it’s even going to be enjoyable at first.

After giving birth to my first child, I got the go-ahead to have sex again at my six-week appointment. My body was still recovering from pregnancy and birth, and I was tired and sore, but I had this feeling that if six weeks was generally when people were doing it, it made sense for me and my partner to give it a shot. So we tried. Then, as I cringed in discomfort and pain, I was convinced that we would never try again.

The reality is that at six weeks (or even way later) post-birth, it may not go well, regardless of whether you had a vaginal delivery or a C-section, says Jawed-Wessel.

She explains that the cervix can remain sensitive even after it has returned to its typical dilation. Vaginal tears and abrasions may be healed and stitches may have dissolved, but the tear sites are usually still tender or sore, she adds, and fresh scar tissue can have difficulty stretching.

It also takes time for the body to adjust to hormonal changes after pregnancy, especially while breastfeeding, Dr. Ghodsi says. These hormone changes mainly affect lubrication and should be temporary, she explains, but dryness can last as long as you breastfeed.

So, ultimately, while some women may be surprised or bothered if and when the first few times are painful, that’s very normal, Dr. Ghodsi says. She’s “not recommending that new moms go through a lot of pain,” but she says it can actually be helpful to try to work through it if it’s tolerable, using a water-based lubricant, in order to help scar tissues stretch and ultimately make sex more comfortable again.

But even though on some level I understood that sex at six weeks was (of course) not a requirement by any means, why did that six-week mark still feel like it came with some amount of pressure or weightiness attached to it?

When I spoke with other new moms about this, I heard a lot of variations on the same theme: Some felt this pressure to be intimate again as soon as possible, but their bodies or minds weren’t quite there yet.

For Rosie, sex was painful even with lubricant, she tells SELF. “It wasn’t until about 11 months [postpartum] that all the pain finally disappeared, and now I wish I’d asked more questions and looked into physical therapy, as 11 months was a really long time to endure painful sex,” she says. “I would definitely approach recovery differently next time around if I had similar issues.”

Physical pain and discomfort aren’t the only factors that impact postpartum sex. New moms can have “fatigue, anxiety about penetration, and overall just need time to adjust to the new family member,” Jawed-Wessel says. “I think that we as a culture expect new parents to get right back into their pre-pregnancy routines, but there is no going back—a completely new routine must be figured out, and that routine is likely going to change from month to month when a newborn is changing so rapidly.”

I personally recall not being in the mood most of the time after both of my kids were born because I was exhausted, distracted by postpartum OCD, and spent so much time breastfeeding, rocking, and comforting my baby that additional physical contact wasn’t a priority for me.

This isn’t necessarily a bad thing, it’s just a new norm. “Life is just different now and it takes time to adapt to these changes,” Jawed-Wessel says. “When you throw in other common challenges like postpartum anxiety and postpartum depression, all of this can be quite a challenge, and sex is likely not a priority and that’s ok.”

The importance of having a considerate partner can’t be understated either. Cultural expectations can add to the pressure to have sex after birth, along with assumptions around how often “normal” couples have sex. But that pressure can also come from an eager partner, and that can be a tough situation even if they’re kind and supportive, let alone situations involving inconsiderate partners. “I think if partners of new mothers had a better understanding of what to expect and what was typical, many new mothers would feel less pressure to bounce back,” Jawed-Wessel says.

My spouse was supportive, as were partners of other moms I spoke with, but not everyone is so fortunate. So the six-week mark can cause added strife. Mary*, who describes her partner as coming off as impatient waiting to get back into their sex life, tells SELF that she felt as if she gave into pressure. “It was awful,” she says.

She recounts having “lost” herself in trying to be what she was supposed to be, due to her marriage being in a tough spot and her husband’s professional difficulties. Leading up to sex after baby, she didn’t want to say no, but she ended up having a panic attack. She wishes that she knew at the time that enthusiastic consent is as important as the go-ahead from an M.D. There’s a “great deal of pressure on women to be sexual, and this whole time frame guideline and physical go-ahead puts even more pressure on,” Mary says.

In cases like these, it doesn’t hurt to have an ally, someone who can help walk both you and your partner through the challenges of postpartum sex and explain how a mother might be feeling physically and emotionally even beyond six weeks—a doctor, nurse, doula, or family member who has been through it. “My midwife sat me down at my six-week [appointment] and said, ‘Tell your husband that he does not have the green light for anything, that it’s super common to have zero sex drive while breastfeeding, and if he has any issues with that he can talk to me,’” Emily, who says her husband had a hard time waiting, tells SELF. “I could have cried, I was so relieved to have someone on my side.”

Communication can go a long way between couples with a new baby when it comes to, well, everything—and it’s no different with sex.

“Both partners need to be open with each other about their fears, concerns, and desires in the face of a changing sexual relationship as to avoid any misunderstandings,” Dr. Conti says.

Most new parents want their partner to know they are attracted to and love them, and that they look forward to intimacy, Jawed-Wessel explains. “But sometimes in the chaos of new parenthood our wires get crossed and we forget to communicate these thoughts in a sensitive way,” she continues, meaning “without pressure to engage in sexual behaviors and while validating feelings of disappointment all at once.”

Don’t forget that “penetrative sex is not the only way for [couples] to be intimate, sexual, or show affection,” Jawed-Wessel says. “If penetration is causing pain [and/or] anxiety, take it off the table entirely and explore each other’s pleasure in different ways that don’t include penetration.” Removing the expectation of orgasm entirely may also help take the pressure off enough for couples to just enjoy touching one another for however long they want to, so long that it’s comfortable, she adds.

Keep in mind that postpartum care doesn’t boil down neatly into just one appointment, and it doesn’t hurt to reach out to your care provider if you have questions or if something doesn’t feel right, even after your checkup; I personally wish I had reached out when I thought the pain meant that we should just give up on sex.

The American College of Obstetricians and Gynecologists (ACOG) is actually pushing to transform the traditional six-week visit and replace it with an ongoing process that improves “communication across the transition from inpatient to outpatient settings” and improves postpartum care that’s currently “fragmented among maternal and pediatric health care providers,” according to an ACOG committee opinion published in May.

Even with all the expert advice in the world, I can tell you from experience that navigating these waters can be tiring, fraught, and messy (literally), even with a respectful partner and decent communication. And that’s OK.

That sink full of dishes, the baby crying in the next room, leaking breasts, and just trying your best to squeeze in a four-minute shower are hardly prime ingredients for passion. My spouse never turned his nose up at physical intimacy post-baby, but I’ll be frank—when we welcomed our second baby in 2013, we counted finishing a single episode of our favorite TV show within three bleary-eyed nights a big, romantic success.

But we got through it. It’s not easy, but, as Jawed-Wessel says, postpartum intimacy is “absolutely something couples can figure out with some old-fashioned vulnerable conversation and better resources.”

*Name has been changed.

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Nike Pegasus Turbo Review: A First-Time Marathoner Shares Her Thoughts

Before I get to my Nike Zoom Pegasus Turbo review, let’s talk about how scary it is to sign up for a marathon. I’ve always been a casual runner, the kind who runs in the same pair of shoes for years longer than I’d like to admit. But recently, I was given an incredible opportunity by Nike: a spot in the Chicago marathon, and a coach who would help me and a group of women in LA train for it. I thought about it for only a little bit, then excitedly accepted. And then I promptly started to freak out. I hadn’t even put foot to pavement and I was already very grateful that I had a coach and some built-in running partners to ask for advice. Stuff like: What are you supposed to eat? What shoes do I wear? Do I have to give up wine?

For now, let’s focus on that shoe part (although, for the record, you don’t have to give up wine). As part of my training experience, I joined Olympian and 2017 New York City marathon winner Shalane Flanagan in Tokyo for the launch of Nike’s new Zoom Pegasus Turbo shoe ($180). Within hours of getting off a plane, I was hitting the streets of Tokyo for a quick two-mile run in the shoes (trying to play it cool that Flanagan was also part of the pack). Since then, I’ve logged just over 70 miles in the Pegasus Turbos while I train for Chicago. Here’s what I’ve learned about the shoe, and my thoughts on how it holds up during marathon training.

Grace Chang

Meeting Shalane Flanagan in Tokyo.

The Pegasus Turbo incorporates design aspects of the Pegasus and Zoom Vaporfly shoes.

The new shoe is a version of Nike’s Pegasus 35, the latest iteration of the much-loved Pegasus shoe Nike has produced since 1983. Meant to be used as an everyday trainer, shoes in the Pegasus family have long been favorites of elite runners and athletes. For the Turbo model, the design team sought to make a shoe that incorporates technology used for elite runners; the design was developed from direct feedback of a team of elite athletes, including Flanagan and fellow Olympian Eliud Kipchoge. Kipchoge, who ran in Nike’s Zoom Vaporfly Elite during last year’s Breaking2 event—where elite runners attempted to run a marathon in under two hours—had asked for the light proprietary foam first used the Vaporfly to be available in an everyday trainer. Nike’s answer is the Pegasus Turbo, made with the same ZoomX foam used in the Vaporfly.

Flanagan credits ZoomX and the Vaporfly with helping her win the NYC Marathon; she also likes the Pegasus Turbos. “It’s a great shoe to use for long runs and tempo runs,” she told me in Tokyo. She might have had to say that—she’s a Nike-sponsored athlete, after all—but her enthusiasm seemed genuine. So after I got home from Tokyo, I couldn’t wait to test them out on my regular training runs.

One of the first things I noticed about the shoe was just how lightweight and, well, bouncy the foam feels.

When I first put on the shoe it felt super light and springy (a women’s size 8 weighs 6.9 ounces, according to press materials—while I don’t know how much my other shoes weigh, these ones do seem pretty light to me). They also felt comfortable as soon as I put them on, no breaking in required. The extended heel of the upper, similar to the Pegasus 35’s design, is meant to avoid any discomfort to your Achilles area. The back sole curves out a bit more, similar to the aerodynamic heel on the Vaporfly—it’s a little weird if you’re not used to your shoe sole sticking out that much, but it didn’t bother me.

Another thing I noticed is that the sizing seems a little different than other Nike shoes I’ve tried. When I first put on the Pegasus Turbos in my regular size they felt roomier than my Pegasus 35s in the same size, which I had been previously using on my runs. I have a narrow foot so I considered going down a half size but now, having logged some mileage, I am glad that I didn’t. As soon as I started running in the Pegasus Turbos the sizing felt perfect. If you’re wondering what size to buy, I recommend going to a Nike store to test them out or reading other reviews online to get a sense of how they fit.

Courtesy of Nike

On my first 10-mile trail run, at Will Rogers State Park in Pacific Palisades. That day, I felt like it was the hardest I’d ever pushed my body. That changed seven days later when I had to do my next long run.

Once I started logging miles in the Pegasus Turbo I knew it was the right shoe for me.

I have a normal pronation when running, despite having a slightly flat arch, and one thing I don’t like about some shoes I’ve run in, including the Pegasus 35, is that my arch sometimes hurts after a run. I’ve barely had any discomfort anywhere on my feet when wearing the Pegasus Turbos, even after my first 10-mile trail run (not one blister or sore area after that one!). I even felt great running the very next day in the same shoes. For my first speed run in the shoe, I felt like the ZoomX foam helped me stay quick on my feet.

I’ve gone on a couple more runs of similar mileage since that 10-mile trail run: another 10 miler and, most recently, a 13-mile one. The last one was a trail course just north of Malibu, which was was at a high elevation and had a good amount of hills. Read: super challenging for me. But the shoes held up pretty well; while the uneven terrain was hard on my ankles and I got a small blister on my left big toe, I had no foot or knee pain. I iced my ankles immediately after my run and was able to do a treadmill session the very next day in the same shoes.

It hasn’t been all smooth sailing (running?), however. One downside to the Pegasus Turbo is that the upper has a dual layer that makes it less breathable than other shoes I’ve been running in (like the Pegasus 35 and the Nike Epic React), something that I noticed immediately while first trying them out in the sweltering Tokyo heat. This decreased breathability has still been noticeable when I’m running in hot temperatures now that I’m back in LA, where I live; switching to a lightweight sock has helped, but it’s still a little annoying. In any case, the breathability issue is only a minor complaint—on my most recent long run, I had forgotten all about my hot feet by mile three and instead was grateful that the shoe felt supportive and comfortable enough to get me through several more miles of uneven terrain.

Courtesy of Nike

A post-run group shot at the Toyko Imperial Palace.

All in all, I definitely recommend grabbing a pair of the Pegasus Turbos if you’re in the market for a lightweight yet sturdy running shoe.

As Flanagan predicted, this shoe has been great for me on both semi-long and short runs (the longest I’ve run in these shoes so far has been just over 13 miles, while my short runs average around two or three miles), so I’d recommend it for either. I’ve yet to try them on anything longer than 13 miles, so I can’t say how well it’ll help me with leg or foot fatigue and pain as I ramp up my miles. But so far, it’s felt the same whether I’ve run on pavement or on a trail. The bounciness helps with speed in quicker paces and in my latest longer run it mentally and physically helped me stay light on my feet when I felt that I was hitting a wall. When my legs started to feel like bricks, my feet felt like they could still fly and keep tempo. And the aesthetics of the shoe, in my opinion, are great (hey, if you’re going to be logging hundreds of miles in a shoe, it helps if you like what they look like, right?): the laces are anchored by something called Flywire, which is meant to reduce the overall weight of the shoe but also just looks really cool, and the colorways (a grayish white with neon stripe, grayish green with green stripe, or black with white details) are just the right amount of flashy.

I know I’ve been given some incredible opportunities by Nike (an invite to a popular marathon and a dedicated coach! Running with famous elites! A trip to Tokyo!) and those experiences could seem like they’ve skewed my experiences with this shoe. But, look: it’s my marathon. Finding the right shoe to carry me through months of training is essential for me, and my personal performance and comfort are far more important than any (perceived) obligation. The fact is that in October, I’ll be in Chicago, running my first marathon. So this summer you’ll catch me running in the LA heat, logging miles in my new Pegasus Turbos. I’m happy I found a shoe that will help get me to the finish.

13 Best Wedding Guest Dresses to Buy from Rent the Runway for Under $70

For years, Rent the Runway has been my go-to source for finding stylish pieces for many of the important events in my life—from super fancy dinner parties to the most romantic weddings. Now that my friend circle has started to officially adult (more than half of my circle of friends is either married or engaged to be married), it’s important for me to keep a good number of dress options available in my closet, just in case (if you saw the number of invitations on my refrigerator door right now you’d understand).

Now through August 21, Rent the Runway is not only giving event-bound shoppers like me the option to rent pieces from brands like Milly, Carven and more, but also to full on buy them. That’s right, you can choose great pieces and not have to return them after four or eight days—which is especially helpful to me since I tend to get attached to my rentals.

If your wedding guest calendar looks anything like mine, you may want to scope out the abundance of dresses the brand has for sale (many for a fraction of the original price). To help make your outfit search even easier, I’ve rounded up some of my favorite dresses for sale for under $75 that will make figuring out what to wear so much easier.

7 Things That Inevitably Happen to Your Personal Life When You Get Sober

This year, I celebrated five years sober. It’s been over six years since I first started seriously questioning my relationship with alcohol and considered a life without it. That’s six hard, beautiful, glorious years during which I not only stopped drinking, but also finally moved on from all recreational drugs as well as a history of bulimia.

The life I had before I quit drinking was a lot like Groundhog Day; I was always waiting for it to begin and always reliving the same stuff, day after day, year after year. When I finally walked away from booze at 34, my life opened up. I can honestly say sobriety is the best thing I have ever done for myself. It was my jumping-off point into a life I knew I had buried inside of me. I got out of debt, started a company that provides digital recovery, launched a podcast, and am in the middle of writing a book.

While making the decision to be sober was the best thing I’ve ever done, it’s also one of the hardest. Not only because not drinking is hard, but also because we live in a society where most everyone around us drinks.

It’s seen as normal to drink, and quitting that drug can feel like breaking a social pact. So your bold, life-improving decision to not drink will mean changes almost everywhere you look. Here are some surprising (and not-so-surprising) occurrences that will inevitably happen to your relationships, your identity, even your free time, and how I’ve learned to deal with each one.

1. Your friendships will change.

If you’re like most drinkers, you’ve likely surrounded yourself at some point with a group of people who also drink. I’d argue that many of us gravitated to a group of friends who have drinking habits that align with our own, and we did this because we didn’t want sober friends.

Personally, I always thought drunk people were fun, and I didn’t want my own poop relationship with alcohol to stand out. I wanted to blend in nicely with a crowd who understood that sometimes you just want to drink your face off, or one that didn’t think anything was weird about a glass of noon wine.

So if all of your friends drink alongside you, then there’s no issue, right? Well, there’s a concept in psychology known as “confirmation bias,” and it means that we often look for evidence to support something that we already believe to be true. For instance, if you’ve convinced yourself that you don’t actually have a crappy relationship with drinking, you may constantly be trying to find reasons that support the argument that you don’t actually have a problematic drinking habit (like the fact that all of your friends do the same thing, so nothing seems wrong here).

When you share that you’re no longer drinking, people might be freaked out by your decision; you may have just thrown a wrench in their search for their own OK-ness, took away part of their own confirmation of their behavior and lifestyle. Some of your friends, or the ones who are threatened by your decision, will do things like pretend it’s not happening, pressure you to drink, question your choice, or say something like, “Oh, you’re still doing that not drinking thing?” Sometimes they stop talking to you altogether.

This isn’t to say that all of your friends will be threatened, or that all of your friendships will change. Some will certainly remain, but even those aren’t necessarily long-game friendships. Sobriety is kind of like the fast-pass line at Disneyland, except the ride is growing up. Even if your friends aren’t rocked by the not drinking thing, it’s possible that if they aren’t engaging in their own path of self-discovery, there may be tension at some point while you figure yourself out and evolve, and you may grow apart.

There is no one way to deal with this. It’s part of the sobriety package, and it’s not necessarily a bad thing. Sobriety can be an incredible way to shed relationships you’ve outgrown as well as find new ones that align with your new values. While it can be emotional and heartbreaking to watch some relationships veer off course, all you can do is trust that friendships will disintegrate or grow organically, and whichever direction they take is probably for a reason. Be patient and uphold your own standards.

2. Splitting checks becomes A Thing.

Before I quit drinking, I never really used to care about dividing the bill down the middle with a group. At some point after college, it just didn’t matter if someone had a meal that was four dollars more than mine, or if they ate more edamame, or even if they had one more drink than I did. Now that I’m sober, this is a bigger deal. Not only because my portion of the check is significantly smaller than anyone else at the table, but also because I refuse to invest in Big Alcohol. I am morally opposed.

Thankfully, there have only been a few times when someone at the table hasn’t pointed it out on my behalf and adjusted accordingly. However, when it has happened, I have to speak up to point out that I didn’t drink and I’m not subsidizing their drinking. If you’re like me, this can feel entirely terrifying. I have always hated the feeling that I’m putting people out or being difficult.

In these moments, I have to remind myself that recovery isn’t just about not drinking; it’s about remembering that I am first and foremost responsible for advocating for my own well-being and boundaries. While you may not wish for this scenario to happen, for there to not be attention drawn to you, or for you to potentially be seen as the difficult, high-maintenance sober chick, this is one of the best things that can happen! This is an opportunity to assert for your needs, and therefore assert your worth.

The simple way I handle these situations: I say, very matter-of-factly, that I didn’t consume any alcohol and I don’t want to pay for it. That’s it. I usually grab the check, count up what I ate, add tax and tip, and give that amount. I would never expect a sober person to pay for my booze if the situation was reversed. And if anyone has an issue with it or thinks I’m ridiculous, that’s their problem, and a sign that I’m going to dinner with the wrong people.

3. Seltzer, Netflix, and pajamas will all take on a new meaning.

When I was drinking, it never occurred to me that I was an introvert. I would have classified myself as someone who loved to be around people and go out with them at night. Thinking back to before I was sober, I usually had to drink to be around people. When I stopped drinking, not only did my recovery dictate that I needed lots of time to myself, lots of self-care, and lots of nights in, I discovered that I was, in fact, someone who relishes in alone time. I recharge when I’m by myself, and I deplete when I’m with others—especially big groups. Alcohol masked this truth about me.

I’m not alone in this. Ask any sober person whether they want to go to a cocktail party or stay in with a pack of La Croix, The Crown, and a bathrobe. I’d bet nine out of 10 of us won’t even answer, and we’ll just laugh because it’s such a ridiculous question. Sobriety doesn’t necessarily turn you into Liz Lemon, but it can give you the clarity to understand that you’ve been Liz Lemon your whole life.

4. People will ask you why you don’t drink or just say stupid things to you about not drinking.

You are a mirror now, a flashlight of sobriety in a society that is laced with the judgment that it’s abnormal to abstain from alcohol. People will assume you drink and will be very curious about why you don’t have a drink in your hand when they do.

In the early days, I felt that it was my responsibility to answer the question, “How come you aren’t drinking?” I didn’t understand I could decline to answer or that I didn’t have to make sense to everyone. My answer changed over time. For a period it was, “I’m an alcoholic,” and that tended to silence anyone (for clarification, I no longer identify as an alcoholic). These days, unless I’m feeling generous, I simply say, “I don’t drink,” and leave it at that.

If people press that response, I’ll either stare at them and hold an uncomfortable silence (this is enjoyable at some point), or just change the subject. There are exceptions to this, like if someone alludes to their own struggle with alcohol, and then I might offer up a bit more of my personal experience. This hasn’t happened often.

That being said, you might not be at a place where you want people to know you’re not drinking, and that’s OK. You still have options. You can provide an excuse, like that you’re on antibiotics, or you aren’t feeling great or want to feel fresh for something you have going on the next day. It’s important to remember that you never have to give yourself up to make other people comfortable—ever. Whether you’re stating a one-sentence response (“I don’t drink”) or using a small excuse, the only thing to consider is whether you are comfortable, and whether your boundaries are being upheld.

I should also warn you that people will offer you drinks, and you’ll have to turn them down. This is where you have to think like a vegan: A vegan doesn’t eat meat to make other people feel better, and we don’t do that with alcohol either. Politely decline and remember that just because they offered you a drink-gift doesn’t mean you owe them anything but a polite declination of it.

5. You’ll eventually have sober sex.

I don’t have that much sex, and that’s more like me saying, I no longer lower my standards and sleep with just anyone because of beer goggles. There’s no easy pass for me anymore, no more getting drunk and slipping past the part where you get to know each other. There’s no more not caring if they see your cellulite or whatever you’re hiding under there; and you will, once and for all, discover that sex is never like in the movies. It is an awkward, vulnerable dance between two awkward, vulnerable humans.

But this, I’ve learned, is a beautiful thing. I wish I had been only having sober sex my entire life, because nothing has pushed me to raise my standards, ask for what I want and need, or allowed me to fall more in love with my absolutely imperfect body more than being present for sex fully sober.

The only way to navigate your new sex life is to (of course) make sure that you are with someone who will be gentle and respectful of you and where you are at, whether that’s a significant other who is up to speed on the status of your recovery process or a new partner that you feel comfortable with and trust. It may also be helpful to get to know yourself on your own, first. Spending sober time becoming familiar with your body intimately can help you better communicate your needs to someone else when you feel ready for that step.

6. There will be people who don’t want to date you because you’re sober.

There are people for which sobriety is a deal-breaker. This might seem like a terrible thing; this is not a terrible thing. This is a JOYOUS and wonderful thing because it easily sorts out the ones that have a weird relationship with alcohol, or the ones that just aren’t for you. It will hurt (pretty bad at first), but in time you will come to see it as the gift it is—and you won’t waste time getting to know the wrong person. It’s like a super-charged filter.

Bonus tip: Sometimes sober people won’t want to date you either. These fringe cases are the ones that aren’t fully comfortable in their own sobriety, or aren’t ready to leave part of their old life behind. For a really long time this was me—dating not sober people was like a lifeline to a world I no longer belonged, and on some level I felt like it gave me an edge. In any case, this still isn’t about you, and this is still a way to filter out a waste of your time. People that don’t want to date you because you don’t drink aren’t your people.

7. You most likely discover you’re awkward.

I personally have this thing, let’s call it “Inevitably Awkward Somewhat Socially Inept Woman That Doesn’t Know How To Do Small Talk” crossed with a bit of “Woman That Doesn’t Feel Like She Belongs,” and also “Woman That Is Preternaturally Afraid of All People,” and maybe a bit of “Snowflake Empath Who Feels Everyone Else’s Everything.”

My biggest fears in life include being in large groups of strange people, standing at parties by myself, and really just people in general. Alcohol helped this. Alcohol helped me forget my awkwardness and not-belongingness and it helped me talk to and be with people without my neck muscles freezing up (this is a thing that happens to me, I literally lose my neck function in large groups of people). Drunk me didn’t have to worry if I was alone at a party because drunk me didn’t abide such things. Drunk me didn’t worry if she belonged, or said the right thing, or had to have small talk because drunk me just handled that. Drunk me had loose neck muscles.

So now I’m sober, and I have zero choice but to be me in all situations. There is no escape route, or greasing the wheels, or magic potion that makes people less terrifying, or me more “socially normal.” I can’t do anything about who I am, which is perfect because we should all be so lucky to be ourselves in public.

The beauty in feeling awkward and being sober is that you become who you are, because you can no longer use the thing you were using to hide who you are.

How you deal with this one is you use it and you own it and you live it, because there is nothing more beautiful than a human who has no other choice but to be themself.

Becoming sober isn’t just about abstaining from alcohol. It’s a subversive, hardcore choice to take your life into your own hands. It’s an invitation to stop playing small. It’s an opportunity to grow into your bones, and every single crap thing that happens to you on the way only makes you stronger.

Holly Glenn Whitaker is the founder and CEO of Hip Sobriety, a modern, feminist digital recovery solution, and the co-host of the Home Podcast. Follow her on Instagram at @hipsobriety.

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Mild Bloating After Eating Is Normal, But We’ve Become Obsessed With ‘Avoiding the Bloat’

As a nutritional psychologist, much of what I do looks at the overlap between food and mental health and the role of food and nutrition on brain function, disordered eating, and our psychological relationships with food. In the last few years, I’ve noticed a striking pattern in the descriptions of a particularly worrying thought about bloating after eating, that seems to occur in patients with a range of different disordered eating habits. Most of these patients are in their twenties, making them members of a generation that has had access to the internet from a young age.

Time and again my patients talk about the distress of feeling “bloated after eating.” When I ask them to explain, our conversation usually goes something like this:

Patient: After I ate my tummy got bloated.
Me: How long did that last?
Patient: A couple of hours.
Me: Was there any pain?
Patient: No.
Me: Did you feel nauseous?
Patient: No.
Me: How often does this happen?
Patient: Only after I eat.

I’ve had clients, in their frustration, stand up, lift their shirts, and show me the post-meal “bloating” that was making them feel so bad. I look. I don’t see any signs of bloating. Over time, I’ve come to suspect that what my clients find so troubling are the results of the process of eating and digesting food—you know, the mild distention from the presence of foods and liquids, gurgling, maybe some gas. I believe this is linked to the medicalization of food and the body, as well as strong social stigma around fat and fatness, but more on that shortly. First I want to talk a little about what healthy digestion looks and feels like.

A reminder: bloating is a normal part of the digestion process.

As Rudolph Bedford, M.D., director of gastroenterology at Providence Saint John’s Health Center in Santa Monica, California, explains, after you eat, your stomach breaks food down into digestible-sized pieces, so that the food can then start to flow through the small intestine, where most of the digestive action takes places. The breakdown of carbohydrates and the fermentation of dietary fiber may produce gas, which expands (think of balloon filling with air), which in turn causes bloating. This bloating generally passes after a bit of time or after gas is passed, and is often simply part of your body working effectively to turn food into fuel.

It’s important to note that there are certain conditions that are associated with uncomfortable, persistent, severe bloating after eating. Dr. Bedford says that the bloating that comes with conditions like irritable bowel syndrome, Celiac disease, or gluten sensitivity are accompanied by discomfort and cramping, and aren’t likely to be confused with mild post-meal bloating (that doesn’t come with any other symptoms or cause more than minor discomfort).

As a professional in the nutritional world, I’ve seen a worrisome increase in the amount of my patients who think any bloating at all is bad. I’m not alone.

I’ve asked colleagues (in nutrition and mental health) whether they have experience with clients who complain in particular about bloating, and many reported clients and patients asking for ways to “avoid the bloat.” Time and again—even after digestive disorders have been ruled out—clients remain convinced that if their stomachs are not flat at all times, there is something (or they had done something) wrong.

Are gastroenterologists noticing any similar trends? When asked about patients at his practice, Dr. Bedford said he experiences what I described above “all the time.” (Actually he put it more emphatically: “All. The. Time.”) He says that in the last decade he’s seen an increase in patients who come to his office complaining of bloating; patients who, most of the time, don’t have other symptoms that would indicate anything besides normal digestion.

A cursory look at the evidence seems to match up with Dr. Bedford’s observation. Not surprisingly, in roughly the same 10-year period that Dr. Bedford refers to, research that looks at gut health has risen dramatically. A PubMed search for the term “gut microbiota” for 2007 reveals just 67 papers. In 2017 that figure was 2,688, with 2018 on track to beat that total with 2011 so far. Google trends show a sharp rise in searches for “gut health” and “microbiome” over the last decade. FiveThirtyEight reports that funding on microbiome research rose from more than $200 million in 2012 to $450 million in 2014. The digestive health product industry was reportedly worth almost $70 billion in 2017. Clearly, people are interested in the health of their gut and reducing bloating.

But this only tells us part of the story. On image-based social media sites like Instagram, creating and consuming content about idealized bodies with #flatabs can be a huge part of the experience of using those apps, as evidenced by the popularity and wide reach of certain hashtags and posts, particularly by celebrities and influencers, featuring their bodies and their favorite body-related products. Eight years after its launch, Instagram has more than 800 million users, 68 percent of whom are women (the app reportedly is used by 31percent of U.S. women). More than half (59 percent) of internet users worldwide between the ages of 18 and 29 use Instagram. Basically, Instagram, the social network that is arguably all about how things look, is, in many ways, a young woman’s game.

Social media has also become a place to go for health and wellness tips and inspiration: In 2012, an industry survey found that 90 percent of respondents aged 18-24 would trust the health information they found on social media. There are more than a million posts on Instagram tagged “guthealth.” Invariably, it seems that a “healthy” gut is equated with a washboard flat abdomen, implying that, if your stomach isn’t, you are bloated and you need to do something to fix it. In 2017, England’s Royal Society for Public Health published a survey on the effect of social media networks on people’s mental health, ranking Instagram as the number one most detrimental to young people’s mental health and wellbeing. (Instagram, which is owned by Facebook, seems to know there’s room for improvement. The company has a Wellbeing Team charged, in large part, with making Instagram a safer, more positive online community.)

There are innumerable options that promise to address this bloating “problem.” High profile celebrities, influencers, and reality stars use Instagram to endorse flat tummy products (like detox teas, “flat tummy shakes,” and something called Boombod).

This is a potent, and problematic, combination: greater awareness of gut health and even greater access to idealized body images, both endorsing the idea that a perfectly flat stomach is the ideal for health and beauty. What it creates is a double whammy of bloating-related anxiety (often over natural and healthy occurance of digestion) for young women: if your stomach isn’t flat, either you have digestive issues and/or you’re unattractive.

That’s a problem. Exposure to idealized beauty standards can lead to body image issues and disordered eating. In addition, seeing bloating as undesirable further perpetuates the idea that fatness or bigness is inherently “bad.”

The culprit in all this is weight stigma. If thinness wasn’t so linked (if sometimes totally interchangeable) with attractiveness and even a person’s values, it’s unlikely that routine, mild stomach distention would seem worthy of a “fix” or an intervention by a doctor.

We know that exposure to images of the “thin ideal” is associated with increased body dissatisfaction, body dysmorphia, symptoms of disordered eating, and lower self-esteem. A recent UK youth survey of more than 1,000 people (ages 11-16) on body image expectations found that 62 percent of the 15-16 year-olds felt increased pressure around their physical appearance due to social media, and 58 percent of them attributing this to celebrity influence.

As someone who treats patients with disordered eating, I believe that together these factors contribute to the development of disordered eating behaviors. It is common for me to meet people who have embarked on “detoxes” or elimination diets (which, by the way should only be done under the supervision of physician and for the purpose of identifying an intolerance or allergy) in order to combat their “bloating.” Some people deliberately undereat in order to minimize any of the normal distention associated with digestion, putting them at risk for health problems and increasing their chances of developing a long-term eating disorder.

There probably isn’t that much we can do to change how companies take advantage of our collective fear of bloating, but we can demand better from ourselves and our social media communities.

As I mentioned, there are times when bloating is a sign of something to be concerned about. If you are worried, and have symptoms beyond a bigger belly immediately following food consumption, you should see your physician or a registered dietitian to rule out a gastrointestinal problem, food allergy, or intolerance—the idea shouldn’t be to “avoid the bloat,” but to understand that bloating is one symptom of a larger medical issue that needs to be addressed. But for most people who feel bloated and show no other signs of gastrointestinal distress, the distention they experience after eating is simply the gut’s response to food, which we have been encouraged to view as unattractive and undesirable through a combination of a culture obsessed with thinness and dieting, the use of vague terminology in product marketing, greater public interest in gut issues, and scaremongering social media symptom checklists.

How do we get out? We reassure ourselves that a degree of distention or bloating after eating is absolutely to be expected. We tell ourselves that we don’t need to avoid the bloat. We accept that daily shifts in the appearance of our bodies is absolutely natural. We remind each other that our bodies are our own and support each other to take care of them without comparing ourselves to a generic and irrelevant body standard. We speak out against weight bias and fat stigma. And we should stop perpetuating the myth that not having a flat stomach—whether from bloating, body composition, or anything else—is something that needs to be fixed.

Kimberley Wilson is a Chartered Psychologist working in private practice in London, UK. Her work and writing addresses the interplay between food, psychology and mental health, including Nutritional Psychiatry, disordered eating, and our social and psychological relationships with food. Listen to her podcast Food and Psych, here, and follow her on Twitter @FoodAndPsych here, and on Instagram here.

5 Foundations Dark-Skinned Beauty Bloggers Love

It’s no secret that it can be difficult to find the right foundation, but it can be even more difficult to find the right foundation when you have a darker skin tone. Prior to my days as a market editor, I would scan drugstore aisles and department stores searching for a foundation that truly matched my café au lait skin color and didn’t make me look like I was wearing a mask. There have been countless times where my face didn’t match my neck because I was wearing a foundation color that was way too light for me.

Even now in 2018, many makeup brands still aren’t creating shades that cater to everyone. Luckily, there are many mainstream brands that carry shades for the majority of skin tones—and have excellent formulas and color payoff to boot. To help narrow down some of the best inclusive foundations on the market, I got the scoop from a few dark-skinned beauty bloggers who told me their holy grail foundation favorites.

1. Fenty Beauty by Rihanna Pro Filt’r Soft Matte Long-Wear Foundation, $34

Courtesy of Yuki Edogun/Sephora

“I love the Fenty Beauty foundation because of its long-lasting, beautiful finish and its ability to sustain that finish throughout the day. It is one of few foundation lines that offer a shade option that matches my skin perfectly, and its expansive shade range with varying undertones makes this line incredibly appealing to women of color. In this photo I am wearing shade 420 which is a near perfect match, but I recently discovered that shade 410 is my absolute perfect match.” —Yuki Edogun, @youkeyy_

Courtesy of Armanda Tounghui

“I use Fenty Beauty Pro Filt’r Foundation and love it—it’s literally the best. Fenty’s foundation sets on my face so well, and it also gives my skin a natural look because it matches so well.” —Armanda Tounghui, @glowprincess

Get it: $34, sephora.com

2. Flesh Firm Flesh Thickstick Foundation, $18

Courtesy of Cydnee Black/Ulta

“My favorite foundation at the moment is Tiramisu from Flesh Beauty. I like this foundation because of its lightweight, medium coverage and natural finish. The foundation also comes in a wide range of shades for darker skin complexions with all undertones. Most foundations for darker skin complexions only include golden or red undertones, but Flesh carries both of those as well as neutral and olive undertones for darker skin complexions, which is amazing!” —Cydnee Black, @cydbee

Get it: $18, ulta.com

3. Born This Way Foundation, $39

Courtesy of Andrea Marklew/Too Faced

“I literally created a skin graft of my shade in Chai. It’s the most perfect match that I have—it’s freakin’ amazing. It’s just a really good, all around, everyday foundation. If I were to wear makeup every day, it would be Born This Way.” —Jackie Aina, @jackieaina

Get it: $39, toofaced.com

4. Bobbi Brown Skin Long-Wear Weightless Foundation, $46

Courtesy of Shahd Batal

“My favorite foundation of the moment is the Bobbi Brown Skin Long-Wear Weightless Foundation—the shade range is incredible. It keeps me from getting shiny but isn’t drying at all (feels like skin) and it’s easy to blend.” —Shahd Batal, @shahdbatal

Get it: $46, bobbibrowncosmetics.com

5. Cover FX Power Play Foundation, $44

Courtesy of Shanygne Maurice/Cover FX

“I love it. The formula is amazing for my combo/oily skin type, and Cover FX Power Play Foundation is ideal for women of color. Not only has Cover FX always prioritized making shades for many different skin tones, but they also take into account the importance of undertone, which is often overlooked!” —Shanygne Maurice, @yagirltoomuch

Get it: $44, coverfx.com

16 going on 66: Will you be the same person 50 years from now?

How much do you change between high school and retirement? The answer depends on whether you’re comparing yourself to others or to your younger self.

The results of a new study, the first to test how personality might change over 50 years and relying on the same data source at both time points, finds that broad patterns of thoughts, feelings and behaviors — personality — do change, and this change appears to accumulate with time. But don’t compare yourself to others; those who are the most emotionally stable when young are probably going to continue being the most stable as they age.

“The rankings (of personality traits) remain fairly consistent. People who are more conscientious than others their age at 16 are likely to be more conscientious than others at 66,” said Rodica Damian, assistant professor of psychology at the University of Houston and lead author of a new study on the subject. “But, on average, everyone becomes more conscientious, more emotionally stable, and more agreeable.

Still, she said, researchers did find individual differences in change across time, with some people changing more than others and some changing in more maladaptive or harmful ways.

The work, “Sixteen Going on Sixty-Six: A Longitudinal Study of Personality Stability and Change across 50 Years,” was published Aug. 16 in the Journal of Personality and Social Psychology.

Social scientists have long debated whether personality is stable — unchanged over time — or malleable. Recent studies have indicated it might be both, but longitudinal studies covering very long timespans and relying on the same data source at both time points are rare.

The new research supports the idea that personality is influenced by both genetics and environment.

Personality is described as patterns of thoughts, feelings and behaviors, consisting of five major traits: conscientiousness, agreeableness, openness to experiences, extraversion, and emotional stability. Damian said those five traits have been found across ages and cultures.

The combination of those traits — how dominant each trait is in a given individual relative to the other traits -makes up the personality profile.

With co-authors Marion Spengler of the University of Tuebingen in Germany, Brent W. Roberts of the University of Illinois at Urbana-Champaign, and Andreea Sutu, a graduate student working with Damian at UH, Damian used a dataset of U.S. high school students who answered a series of questions to assess personality in 1960 and again 50 years later.

Data from the Project Talent Personality Inventory allowed the researchers to answer several questions, including:

  • To what extent do people maintain their relative standing on personality traits compared with other people — for example, do people who are more impulsive than most of their peers at age 16 remain more impulsive than their peers at age 60?
  • To what extent do average levels of personality traits change? Are people, on average, more conscientious at 66 than at 16?
  • Does everyone change in the same way?
  • Are there gender differences in patterns of personality stability and change across time?

“Our findings suggest that personality has a stable component across the lifespan, both at the trait level and at the profile level, and that personality is also malleable and people mature as they age,” the researchers wrote. They found gender differences in personality at any given time, Damian said, but, overall, men and women changed at the same rates across the lifespan.

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Materials provided by University of Houston. Note: Content may be edited for style and length.

Witch Hunts: Meet the Activists Fighting Witch Hunting in Rural India

Samta* was cleaning rice inside her home when the men attacked. She had known they would come. Samta’s offerings of free health advice and medicinal herbs had angered a holy man in her village in the rural Dang district in Gujarat, a state in western India. The holy man made his living providing ritual sacrifices and herbal medicines for a hefty price and Samta’s generosity towards her villagers was damaging his business.

Before she was attacked, Samta had already experienced violence in her village. After her siblings died, Samta’s nephews had demanded she hand over her land. “They said a woman shouldn’t have it, that it belonged to them,” she tells SELF during an interview. “They wouldn’t even let me go on to my land to farm it. They would pick up big rocks when I walked there and they would throw the rocks at me.” She gestures with her hands to show the rocks were twice the size of her head.

First came the violence about the land. Then Samta started offering health advice, posing a threat to the holy man’s business. And then came the men.

Villagers gathered outside Samta’s home to watch the attack. A group of men called her dakan, the Gujarati word for witch—a slur that can cost a woman her life in some regions of the country. They beat her with fists and feet and iron rods until Samta’s mouth was bloodied, her head pressed into the sand. She is lucky to have survived.

Samta’s story is unfortunately not unique. Maahi*, who appears to be in her sixties, lives in a village close to where Samta lives. She, too, was accused of being a witch, and attacked. She believes she was accused of witchcraft because she owned a parcel of fertile land that was bequeathed to her by her father.

One day, Maahi’s nephews beat her so badly that she lost her two front teeth. She cries, pressing her finger to lower her bottom lip to show the empty space. “They said I had to give them my land. They said my mother had an affair and I wasn’t even my father’s daughter,” she says, crying harder.

More than 2,500 people have been assaulted and killed in witch hunts across India since 2000, according to estimates by the National Crime Records Bureau. The vast majority of them are believed to be women. Most states in India don’t record witch hunting as a specific type of crime; instead the attacks against women are logged as physical assault or murder with no mention of the woman being branded a witch, which makes it difficult to comprehend the true extent of the problem.

Those who survive say they were accused of sorcery to explain the death of a child, a sickness spreading through a village, or even bad weather. Sometimes, an accusation of witchcraft is made by men seeking to force a woman out of her home so they can claim her land. In other cases, a woman is asked to pay a hefty fine to a local leader or holy man as punishment for being a witch.

“All it takes is for someone to say there is an illness spreading and it must be this lady; then people go to her and ask questions and if the astrologer has said she’s a witch she will be taken on a donkey with a shaven head and then she’ll be thrown in the house and the house is burned,” Sanal Edamaruku, an activist fighting witch hunts and president of the India Rationalist Association, tells SELF. In Samta’s village, for instance, a local practice to determine if a woman is a witch involves placing lentils in a bowl of water. If the lentils float, the woman is said to be a witch.

The men rarely attack alone. Experts and activists say that the attacks often unfold as mob violence, involving torture in various forms. Neighbors, even family members, watch as women are strung up on trees or trapped in burning houses, their faces covered in crushed chili peppers, their limbs cut off with axes by a vengeful mob.

Seema Yasmin

Samta* was attacked in a witch hunt in Gujarat, India. She says she was accused of witchcraft for offering free herbal medicines to villagers.

Witch hunts are not an exclusively Indian phenomenon, of course. They have occurred across the world and throughout history, from medieval witch hunts in Europe, to the Salem witch trials in colonial Massachusetts, where thousands of women were killed in the late 1600s. Most recently, witch hunts have been documented in China, Tanzania, India, and other countries. A 2018 Nature study of witch hunts in modern China deduced that women were branded witches by fellow villagers who considered them rivals, and that the designation gets passed down the female line. Damaging a woman’s reputation and social standing was one way of outcompeting her for resources. In Tanzania, nearly 400 people were killed in witch hunts in the first half of 2016, according to police.

The reasons driving witch hunts vary across region and time period, but the underlying factors have always been misogyny, as well as a desire to punish women who don’t obey cultural norms, Soma Chaudhuri, a sociologist at Michigan State University, tells SELF. Chaudhuri studies gender violence; she finds witch hunts, though triggered by different factors in different places, tend to have one thing on common. “Even within India it’s very context-based and the reasons vary from region to region,” she says. “But always there’s this need to overpower women and take what little they have.”

The context in some regions of rural India today is that women’s bodies and their lands are treacherously intertwined, particularly for tribal, or Adivasi, women. Witch hunts often begin with disputes over property—like in the case of Samta and Maahi. Men who are jealous about a woman’s crops or a home she inherited will accuse her of witchcraft to oust her from her property. Meanwhile, the very earth they’re fighting for is in jeopardy. The Indian government is taking tribal land from the Adivasi communities to build hydroelectric dams.

Experts of gender violence in India say older women are more vulnerable to accusations of witchcraft. “Most of the women accused of witchcraft are old widows, lonely ladies,” Edamaruku says. Widowed, divorced, or living alone, they are perceived as wild, free and threatening. Some older women have inherited land from husbands or fathers that others seek to own. Killing a woman makes the land attainable and calling a woman a dakan makes her murder acceptable.

Seema Yasmin

Maahi* was accused of witchcraft and beaten by men who wanted her land.

Local activists are working to address the problem in a variety of ways, from helping women protect their land from the government, as well as seeking justice for women injured and killed by witch hunts. Organizations like the Centre for Social Justice use the legal system to fight for the rights of women and marginalized people, such as Adivasi women who are attacked in witch hunts in Gujarat. They also use the law to protect women’s assets. Another organization, ANANDI, an Indian non-profit, builds solidarity among those who are the victims of witch hunts or living in areas where women are targeted. The women support one another and help survivors of violence navigate the complex legal system.

Besides a number of NGOs in India fighting the practice, individual activists such as Birubala Rabha from the far-eastern state of Assam, where witch hunting is rife, are speaking up against the violence in an effort to raise awareness and change laws through popular support. Raised believing superstitions about witches, Rabha has spent the last 15 years in a crusade against witch hunting across India and is credited with spurring the Assam government to enact one of the country’s strictest anti-witch hunting laws. More than half a dozen states in India have such laws; Gujurat, where Samta lives, is not one of them.

Another way that activists work to combat witch-hunting is through education. Edamaruku, for instance, has been fighting the practice of witch hunting in India since the ’90s, traveling through villages and explaining that fevers and diarrheal illnesses are caused by infections such as cholera, not by witchcraft. His organization, the India Rationalist Association, uses science to explain what many believe to be miracles, such as a statue of Jesus, that, because of a leaking pipe, appeared to be weeping. Edamaruku lives in exile in Finland because of his work fighting superstition. He stands to go to prison for blasphemy if he returns to India because his relentless myth-busting has angered religious leaders who have cited a 90-year-old law from the British colonial era that could land him behind bars.

“My work is to protect women’s bodies and their land,” says Nikita Sonavane, a 25-year-old lawyer from Mumbai. Sonavane left behind friends who work in corporate law offices in the city and moved to Dang to work in the regional office of the Centre for Social Justice in September 2017. “Law school doesn’t establish a link between how the law can be used as a tool for social change,” she says. “That’s why this work was appealing… for people here, the law is extremely relevant.”

Sonavane gave up city living and moved to the village, a six hour drive from Mumbai along highways and country roads. She lives in a one room apartment with a small kitchenette near the center of Dang. A few days before she arrived at her new home, Sonavane learned a woman was murdered in a witch hunt in a village nearby. She grew even more determined to use her training to fight for women’s rights.

Seema Yasmin

Nikita Sonavane, 25, moved to Dang in Gujarat, a state in western India, a few days after a woman was accused of witchcraft and murdered.

I meet Sonavane at her apartment on a December afternoon in 2017, with a plan to accompany her and her coworkers as they go about their work. On the day we meet, she is gathering information about a woman who had been murdered in a witch hunt in September, several months prior. Her goal is to help improve government records.

The woman, believed to be in her 60s, was attacked by a group of five men, among them accountants and religious leaders. They accused her of sorcery and stealing a statue from a temple and beat her to death.

Sonavane would have liked to visit the village within days of the murder, but it was unsafe, she says. “The men who killed her were powerful men,” she says. “They hold a lot of sway. Even though we needed to get access to compare witness information with the [first information report], which we got from the police, it was too dangerous for us to go.”

Sonavane speaks energetically, using her hands for emphasis as we drive through rural farming communities toward the village where the woman was murdered. “All of this land you see,” she says, stretching out her arms and gesturing at the lush vegetation flying by, “all of it will be underwater by the next time you come back. People’s farms, homes, everything will be gone.” It’s another terror being perpetrated against the women, she explains. As well as campaigning to end the violence against their bodies, Sonavane finds ways to use her legal training to protect their homes and livelihoods. She treks from home to home in the villages and explains to women that she can use a law, the Forest Rights Act of 2006, to try and preserve the lands where they live and farm. Back in her office, Sonavane files paperwork for each woman, hoping to thwart the government’s dam expansion attempts.

When we reach the village where the woman was murdered, Sonavane walks through brush with her male co-worker, Rameshbhai Dhoom, the pair exchanging notes about the murder and what they had read in the crime report. Most villagers have left to sell sugarcane in the market, so Sonavane and Dhoom clear bushes out of their way and walk to the small, empty hut that had belonged to the murdered woman.

They are looking for people who saw the murder to compare eyewitness reports with information recorded by the police. A key first step is getting the police to add the word dakan to the official report. “Here in Dang they don’t always say the woman was killed in a witch hunt but it’s important they write that so we can get an accurate picture of the prevalence of witch hunting,” Sonavane says.

Dhoom talks with a neighbor while Sonavane sits on the stoop of the murdered woman’s home. Behind her lay two flat discs made of stone that the woman would have used to grind grain into flour. She looks out onto the small patch of land where the woman used to grow crops. “We try and gather facts and get justice,” she says, biting her lip. “But like with Samta’s case, the men you are up against are powerful and so you take the case to court but you lose.”

Samta had pursued her case through the courts, but all of the men who attacked her had been acquitted.

After a day gathering information, Sonavane and Dhoom return from visiting surrounding villages and sit on the floor in their office. A map of Gujarat hanging on the wall outlines the dam expansion project. It will inundate much of the land surrounding their office.

Sonavane invites local women into her office, sits with them on the floor and listens to their stories over cups of tea. “We have to keep pushing for a law that punishes men for defaming and murdering women,” she says.

*Names have been changed

This story was reported with support from the Pulitzer Center on Crisis Reporting.

Moderate carbohydrate intake may be best for health, study suggests

Eating carbohydrates in moderation seems to be optimal for health and longevity, suggests new research published in The Lancet Public Health journal.

The observational study of more than 15,400 people from the Atherosclerosis Risk in Communities Study (ARIC) in the USA found that diets both low (< 40% energy) and high (>70% energy) in carbohydrates were linked with an increase in mortality, while moderate consumers of carbohydrates (50-55% of energy) had the lowest risk of mortality.

The primary findings, confirmed in a meta-analysis of studies on carbohydrate intake including more than 432,000 people from over 20 countries, also suggest that not all low-carbohydrate diets appear equal — eating more animal-based proteins and fats from foods like beef, lamb, pork, chicken and cheese instead of carbohydrate was associated with a greater risk of mortality. Alternatively, eating more plant-based proteins and fats from foods such as vegetables, legumes, and nuts was linked to lower mortality.

“We need to look really carefully at what are the healthy compounds in diets that provide protection,” says Dr Sara Seidelmann, Clinical and Research Fellow in Cardiovascular Medicine from Brigham and Women’s Hospital, Boston, USA who led the research.

“Low-carb diets that replace carbohydrates with protein or fat are gaining widespread popularity as a health and weight loss strategy. However, our data suggests that animal-based low carbohydrate diets, which are prevalent in North America and Europe, might be associated with shorter overall life span and should be discouraged. Instead, if one chooses to follow a low carbohydrate diet, then exchanging carbohydrates for more plant-based fats and proteins might actually promote healthy aging in the long term.”

Previous randomised trials have shown low carbohydrate diets are beneficial for short-term weight loss and improve cardiometabolic risk. However, the long-term impact of carbohydrate restriction on mortality is controversial with prospective research so far producing conflicting results. What’s more, earlier studies have not addressed the source or quality of proteins and fats consumed in low-carb diets.

To address this uncertainty, researchers began by studying 15,428 adults aged 45-64 years from diverse socioeconomic backgrounds from four US communities (Forsyth County, NC; Jackson, MS; Minneapolis, MN; and Washington County, MD) enrolled in the ARIC cohort between 1987 and 1989. All participants reported consuming 600-4200 kcal per day for men and 500-3600 kcal per day for women, and participants with extreme (high or low) caloric intake were excluded from the analysis.

At the start of the study and again 6 years later, participants completed a dietary questionnaire on the types of food and beverages they consumed, what portion size and how often, which the researchers used to estimate the cumulative average of calories they derived from carbohydrates, fats, and protein.

The researchers assessed the association between overall carbohydrate intake (categorised by quantiles) and all cause-mortality after adjusting for age, sex, race, total energy intake, education, exercise, income level, smoking, and diabetes. During a median follow-up of 25 years, 6283 people died.

Results showed a U-shape association between overall carbohydrate intake and life expectancy, with low (less than 40% of calories from carbohydrates) and high (more than 70%) intake of carbohydrates associated with a higher risk of mortality compared with moderate intake (50-55% of calories).

The researchers estimated that from age 50, the average life expectancy was an additional 33 years for those with moderate carbohydrate intake — 4 years longer than those with very low carbohydrate consumption (29 years), and 1 year longer compared to those with high carbohydrate consumption (32 years). However, the authors highlight that since diets were only measured at the start of the trial and 6 years later, dietary patterns could change over 25 years, which might make the reported effect of carbohydrate consumption on lifespan less certain.

In the next step of the study, the authors performed a meta-analysis of data from eight prospective cohorts (including ARIC) involving data from 432,179 people in North American, European, and Asian countries. This revealed similar trends, with participants whose overall diets were high and low in carbohydrates having a shorter life expectancy than those with moderate consumption.

As Seidelmann explains, “A midrange of carbohydrate intake might be considered moderate in North America and Europe where average consumption is about 50% but low in other regions, such as Asia, where the average diet consists of over 60% carbohydrates.”

In further analyses examining whether the source of proteins and fats favoured in low-carbohydrate diets — plant-based or animal-based — was associated with length of life, researchers found that replacing carbohydrates with protein and fat from animal sources was associated with a higher risk of mortality than moderate carbohydrate intake. In contrast, replacing carbohydrates with plant-based foods was linked to a lower risk of mortality (table 3).

“These findings bring together several strands that have been controversial. Too much and too little carbohydrate can be harmful but what counts most is the type of fat, protein, and carbohydrate,” says Walter Willett, Professor of Epidemiology and Nutrition at Harvard T. H. Chan School of Public Health and co-author of the study.

The findings show observational associations rather than cause and effect. Considering evidence from other studies, the authors speculate that Western-type diets that heavily restrict carbohydrates often result in lower intake of vegetables, fruit, and grains and lead to greater consumption of animal proteins and fats — some of which have been implicated in stimulating inflammatory pathways, biological aging, and oxidative stress — and could be a contributing factor to the increased risk of mortality. Whilst high carbohydrate diets (common in Asian and less economically advantaged nations) tend to be high in refined carbohydrates such as white rice, may also contribute to a chronically high glycaemic load and worse metabolic outcomes.

“This work provides the most comprehensive study of carbohydrate intake that has been done to date, and helps us better understand the relationship between the specific components of diet and long term health,” says Dr Scott Solomon, The Edward D Frohlich Distinguished Chair at Brigham and Women’s Hospital and Professor of Medicine at Harvard Medical School, and senior author on the paper. “While a randomized trial has not been performed to compare the longer term effects of different types of low carbohydrate diets, these data suggest that shifting towards a more plant-based consumption is likely to help attenuate major morbid disease.”

The authors note some limitations including that dietary patterns were based on self-reported data, which might not accurately represent participants’ food consumption; and that their conclusions about animal-based sources of fat and protein might have less generalisability to Asian populations which tend to have diets high in carbohydrates, but often consume fish rather than meat. Finally, given the relatively small number of individuals following plant-based low-carb diets, further research is needed.

Writing in a linked Comment, Dr Andrew Mente and Dr Salim Yusuf from McMaster University, Hamilton, Canada say, “Such differences in risk associated with extreme differences in intake of a nutrient are plausible, but observational studies cannot completely exclude residual confounders when the apparent differences are so modest. Based on first principles, a U-shaped association is logical between most essential nutrients versus health outcomes. Essential nutrients should be consumed above a minimal level to avoid deficiency and below a maximal level to avoid toxicity. This approach maintains physiological processes and health (ie, a so-called sweet spot). Although carbohydrates are technically not an essential nutrient (unlike protein and fats), a certain amount is probably required to meet short-term energy demands during physical activity and to maintain fat and protein intakes within their respective sweet spots. On the basis of these principles, moderate intake of carbohydrate (eg, roughly 50% of energy) is likely to be more appropriate for the general population than are very low or very high intakes.”

Spotting on Birth Control? Here’s Why (and When to See a Doctor)

Your birth control should be like a bodyguard, keeping threats such as unintended pregnancy, heavy bleeding, and painful periods as far from you as possible. But sometimes that very birth control is the cause of vaginal bleeding that happens outside of your period, which can completely take you (and your underwear) by surprise. Here’s what it means if you’re spotting on birth control, plus when to do something about it.

Spotting can be a fact of life when you begin a new form of contraception because your body is getting used to the medication or device.

“It’s really common when someone is just starting birth control,” Lauren Streicher, M.D., a professor of clinical obstetrics and gynecology at Northwestern University Feinberg School of Medicine, tells SELF, adding that she always warns patients that this can happen.

Quick refresher: If you’re not on birth control, the lining of your uterus builds up every month and then comes out as a period when you don’t get pregnant. But if you’re taking hormonal birth control, that process is a little different. The estrogen in combined forms of birth control prevents your ovaries from releasing eggs each month, while the progestin in BC thins out the lining of your uterus and thickens your cervical mucus to make it hard for sperm to swim to and fertilize an egg.

You’d think that the whole thinner-uterine-lining thing would mean you should start bleeding less during your period (or not have one at all), not that you should start spotting randomly. But your body doesn’t immediately get the thin-lining memo and spring into action. It can take some time to adjust to the influx of hormones that dictate its new normal. “Until you get to that point, you’re dealing with the lining that’s already there,” Dr. Streicher says, and that lining may shed before you expect. Also, as you grow a thinner uterine lining, it may be more liable to break off when it’s not supposed to due to its less stable structure.

Spotting may take around three months to recede when you’re on a new form of hormonal birth control, Dr. Streicher says, but that can vary.

Spotting can happen with many forms of birth control, but a few, like low-dose pills, are especially likely to cause it.

“In general, the lower the estrogen dose, the more breakthrough bleeding,” Mary Jane Minkin, M.D., a clinical professor of obstetrics and gynecology and reproductive sciences at Yale Medical School, tells SELF. Experts aren’t totally sure why higher levels of estrogen may help with breakthrough bleeding, but one theory is that the hormone may help blood to clot better.

Spotting can also happen if you’re on extended-cycle birth control pills to get fewer periods every year, according to the Mayo Clinic. These come in packs with active pills you’re supposed to take for around three months at a time. Even with the progestin to thin your uterine lining, it can build up in those intervals, Dr. Minkin says, leading to spotting in between your period.

Before you blame it all on hormones, know that breakthrough bleeding can also happen when you’re using a hormone-free method of birth control that goes inside the uterus, like the copper IUD, Aparna Sridhar, M.D., M.P.H., an ob/gyn at UCLA Health and an assistant professor at the David Geffen School of Medicine at University of California Los Angeles, tells SELF. Imagine if you were a uterus and someone inserted a device into you, even if for a good cause. You might experience some irritation and bleeding due to the foreign body, too.

If you’re using the copper IUD, you might bleed between periods and experience heavier, more painful periods for around a year, according to the American College of Obstetricians and Gynecologists.

You can also get spotting on birth control if you messed up the way you take it.

Spotting on methods like the pill, the patch, or the ring can happen because you miss a pill dose or put your ring or patch on outside of the time frame you’re supposed to, Dr. Sridhar says.

Although the spotting is annoying, the biggest reason to avoid this is because you have to use birth control perfectly every time to have maximum protection. If you’re continuously messing up, it might be a sign you need to talk to a doctor about a form of birth control that better fits your needs. Which brings us to…

If your spotting lasts longer than three months, happens because you tend to use birth control incorrectly, or is coming with other concerning symptoms, see a doctor.

If you recently started birth control and think your spotting may come down to that, it’s OK to just ride it out a bit, Dr. Streicher says. Once you hit that three-month mark and things aren’t better, it’s smart to see a doctor. But if you just started a new birth control method and the spotting is pissing you off (fair) or worrying you (ditto), you should absolutely check in with your doctor no matter how long it’s been, Dr. Minkin says. “We can do something about it most of the time,” she says, which usually means trying out a different method of birth control if you really are not a fan of the spotting.

If the spotting happens because you’re constantly forgetting to take your pill, or making some other birth control error, you should talk to your doctor as well. That’s a clear sign that whichever method you’re using may not be the best fit. Your doctor should be able to counsel you on better options, like a vaginal ring you can keep inserted for three weeks instead of a pill you have to take every day or a method you can keep inside of you for years, like the arm implant or an IUD.

Another reason to see a doctor due to spotting on birth control: You’ve been on your method for so long it can’t be an adjustment thing, and you use it correctly, to boot. “If I had someone who had been taking the pill for year, never had an issue, and now has spotting, that’s a problem,” Dr. Streicher says. On a related note, if you’re not taking birth control at all but are dealing with spotting, get yourself to a doctor post-haste.

Seeing a doctor for mysterious spotting is essential because it can be a sign of several health conditions, including a sexually transmitted infection such as gonorrhea or chlamydia, a miscarriage, and growths like ovarian cysts, uterine fibroids, or little lumps called polyps that can grow from your cervix or uterus, according to the Mayo Clinic. Spotting can also be a sign of pregnancy or a gynecological cancer, but “the vast majority of the time, spotting is not harmful,” Dr. Minkin says. No matter what the specifics may be, bleeding from your vagina when you don’t expect it can feel worrisome. If you’re freaked out, it’s perfectly OK to see a doctor for some reassurance.

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