TIME Sex/Relationships

Fewer Teens Are Having Sex Than in the Past

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New data shows the number of teenagers who have sex continues to drop

The number of teenagers who have had sex has significantly dropped over the last quarter century, new federal data shows.

The number of teens from ages 15 to 19 who have had sex dropped 14% for females and 22% for males over the past 25 years, revealed new data published by the U.S. Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics. According to the new report, which uses national survey data from 2011-2013, 44% of female teens reported having sex at least one time and 47% of men reported the same.

MORE: The Teen Birth Rate Is Now At an All-Time Low

The report shows that in the early teenage years, male teens were more likely than female teens to report having had sex, but by age 17, the rates were similar. Most teenagers said they used contraceptives. From 2011-2013, 79% of females and 84% of males said they used a contraceptive when they had sex for the first time and condoms were used most often. The data also shows that 60% of female teens said they had used withdrawal as a contraceptive method and 54% had used the pill. The CDC also reports that teenage women who did not use a contraceptive during their first sexual intercourse were twice as likely to become teen mothers compared to their peers who did use birth control.

Over the last 10 years of available data, the number of teenage girls who have used emergency contraception has also increased from 8% in 2002 to 22% in 2011–2013.

MORE: U.S. Teen Trends In Sex, Bullying, Booze and More

The new findings fall in line with other recent federal data showing the U.S. teen pregnancy and birth rate is on the decline, possibly due to a drop in sexual activity and an increased use of contraceptives. Why teenagers are reporting less sexual activity is not fully understood, but public health experts have credited the increase in contraceptive use to more education and lower costs for methods thanks to the Affordable Care Act. Still, the CDC notes in the new report that America’s rates remain higher than other developed countries.

TIME Research

5 Weird Ways Ovulation Can Affect Your Body

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Your senses might seem heightened

Once a month, women of reproductive age go through ovulation—the process in which an egg is released from an ovary into the fallopian tubes, which can then be fertilized by sperm. At the same time, our hormones begin to fluctuate and our brain chemistry shifts, which may be an attempt to help the baby-making along. These changes are thought to increase chances of conception, with research in recent years revealing that ovulation may affect your brain, body, and behavior in surprising ways.

“Hormones affect the entire body, not just the reproductive organs, so it makes sense that our thinking, our behavior, even our appearance can change throughout our cycles,” says Carol Gnatuk, MD, assistant professor of obstetrics and gynecology at Penn State Milton S. Hershey Medical Center. Here are some of the more surprising, even mysterious, symptoms you may notice during your most fertile time of the month.

Your face may get (ever so slightly) redder

First, a new study published in the journal PLoS One found that women’s faces become slightly more flushed in the days leading up to and during ovulation. This makes sense, Dr. Gnatuk says, since hormones affect blood flow throughout the body. “Higher estrogen levels during ovulation can cause blood vessels to dilate, and when vessels dilate close to the skin you get more of a glow,” she says.

The study authors had assumed this affect might be noticeable to men, and might begin to solve the mystery of how and why men seem to find women who are ovulating more sexually attractive. But the slight increase in redness was only detectable via very sensitive cameras—not to the naked eye, which means the jury’s still out.

You might feel more frisky (and express it in interesting ways)

Evolutionarily, it makes sense that a woman’s libido goes up during the time of the month she’s most fertile. But ovulating women don’t just consciously think more about sex; it’s on their mind in sneakier ways as well. According to a 2010 study in the Journal of Consumer Research, during ovulation women may be more likely to unconsciously buy and wear sexier clothing.

Research has also suggested that women dream more about sex in the first half of the menstrual cycle, when the body is gearing up for ovulation, compared to the second half, when your body prepares for your period. One small study found women may even have more erotic interpretations of abstract artwork (think Georgia O’Keeffe flower paintings) when they’re ovulating versus later in their menstrual cycles.

“Libido isn’t totally driven by hormones—if it were, sex would only be about when and not where or with who,” Dr. Gnatuk says. “But certainly, estrogen and testosterone, both of which are higher during ovulation, can increase a woman’s desire.”

You may be more attracted to a certain type of guy

Not only might you feel more “in the mood” during ovulation, but you may also be more interested in some guys over others. Studies have shown that women tend to prefer men with sterotypically masculine traits and pay more attention to traditionally attractive guys during fertile times of the month, especially if their current partners lack manly facial features, like a square jaw.

“When we’re in reproductive mode, we look for traits that we associate with good health,” Dr. Gnatuk explains—and that includes healthy testosterone levels, she says, which suggest that a man is well able to produce and protect offspring.

Another 2011 study from the journal Psychological Science suggests women are better at judging men’s sexual orientation when they are ovulating, perhaps since, from an evolutionary perspective, there’s no sense in going after a guy who isn’t interested.

Your senses might seem heightened

Ovulating women seem to be better able to detect musky odors and male pheromones than those taking oral contraceptives (which prevent ovulation), according to a small 2013 study in the journal Hormones and Behavior; another study that same year found that women may have a heightened sense of smell in general during ovulation than during other times of the month.

You may even be better at detecting potential threats to yourself and your future offspring: A preliminary 2012 study by Kyoto University researchers found that women in the luteal phase of their cycles (which begins with ovulation) were better at finding snakes hidden in photographs of flowers.

You could avoid male relatives

And finally, here’s perhaps one of the most bizarre side effects of ovulation found in the research: According to a 2010 UCLA study, women avoid talking to their fathers on the phone during their most fertile times of the month. (Those who were ovulating or about to ovulate were half as likely to chat with Dad, on average.)

The researchers speculated that historically, it was in a woman’s (and her offspring’s) best interest to avoid male relatives—and potentially incestuous couplings—while they were fertile. Dr. Gnatuk has an alternate interpretation: “You might also argue that you don’t want to talk to Dad right now because he always told you you couldn’t go out with guys, and now’s the time you want to do that.”

This article originally appeared on Health.com

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TIME Sex/Relationships

Being Multiracial May Give You An Advantage In Online Dating

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But that's hardly the whole story, recent research suggests

In the otherwise newfangled world of online dating, an old secret remains: All is not fair in love.

This ugly truth was revealed in the book Dataclysm by OkCupid co-founder Christian Rudder, released last year, which used data collected from OkCupid users. It found that while we’d like to claim we have advanced as a society beyond judging people by the color of their skin, our habits show otherwise. Regardless of gender, according to the book, whites are most preferred, while blacks are least preferred. Asians and Hispanics fall somewhere in between. Toss gender into the quotient, and the facts get even more uncomfortable: Asian men, black women, and black and Latino men are considered the least desirable in the dating market, but Asian and Latina women are seen as the most desirable—perhaps because of fetishization, Rudder suggested.

But Rudder’s theory does not include a key, growing part of the American population: individuals who identify as multiracial. In a country where the number of people who identify as multiracial has grown substantially and 93% of multiracial people identify as white and black, what does dating data show about them?

A forthcoming study from the Council on Contemporary Families, to be published in August by the American Sociological Review, looks at this very question. Researchers analyzed data collected between 2003 and 2010 from a major online dating website and combed through 6.7 million messages exchanged between heterosexual men and women. The researchers were looking for how often Asian-white, black-white, and Hispanic-white multiracial people received responses to messages, compared to people of one race.

The three groups were the most common multiracial identifications on the site. Reciprocation, or response messages, were key to figuring out where multiracial people fell in perceived attractiveness because they were more “honest,” explains Celeste Curington from the University of Massachusetts Amherst and one of the authors of the study.

“We look at response rate versus attractive rate because of social desirability bias,” she says, noting that being multiracial often carries an added unspoken benefit of being “exotic.” “People will be less likely to claim what they will view. The response rates are more accurate [as a measurement] since we can actually see what they do.”

At first glance, there seems to be a remarkable advantage to being multiracial on the online dating scene.

“The most surprising finding from our study is that some white-minority multiracial daters are, in fact, preferred over white daters,” the authors write in a press release. Called the “dividend effect,” the authors found that three specific combinations were heavily favored in online dating: Asian-white women, Asian-white men, and Hispanic-white men.

But beneath the superficial results that being of mixed race is advantageous remains a more complicated, race-tinged story, write the authors, who note that the study’s results do not suggest a totally even playing field.

“White men and women are still less likely to respond to an individual who identifies as part black and part white than they are to a fellow white,” the authors write. And when they do respond, skin color still plays a role. “In some cases they [the preferences for the three multiracial groups] seem to be closely linked to a continuing partiality for lightness or whiteness,” the study notes.

But being lighter skinned is not the whole story. Virginia Rutter, professor of sociology at Framingham State University, and Stephanie Coontz, professor of history and family studies at Evergreen State College, reviewed the results. The two warn against the takeaway that multiracial people are considered more attractive along skin color lines—a far too simple conclusion, they say.

It’s not as simple as societal preference for lighter-skinned people, and future consequences have yet to be measured, according to Rutter, who says that it helps to consider the results through “the arc of time.” Only 48 years ago, the ban on marrying a person of a different race was lifted nationally, and Rutter thinks societal acceptance of mixed race couples might indicate more acceptance—or, very possibly, less. Curington, one of the study’s authors, points to the multicultural movement of the 1990s that popularized identification of a person beyond being black, white, Asian or Hispanic as a key factor, too. “After those changes came about, there was an increased representation of mixed people in general,” Curington says.

“As these changes lead to a growing multiracial population, is it possible that the multiracial dividend will be extended, or at least begin to counter some of the racial penalties that have existed in the dating and marriage market?” ask Rutter and Coontz in their review. “Or will individuals perceived as mono-racial blacks fall even further behind?”

What further complicates these findings more is the exoticizing of multiracial people. Pop culture tends to mark “the ethnically ambiguous” person to be attractive to either sex for their enigma and lack of clear origin, Curington says. “If you look at cultural representations of multiracial people, going back to the early 1900s, they are often portrayed as exotic and sexually wanton,” she says.

But being multiracial might also act as a marker of progressiveness, particularly for Asian-American women. As Asian-American generations ground themselves in American culture and seek mates who can transcend their cultural tradition while also being able to understand their American upbringing, Asian-American women might prefer multiracial men for two reasons: First, they offer a dual upbringing that blatantly signals to Asian-American women the ability for the potential date to transcend both cultures; and second, they offer a “middle ground” of sorts for Asian parents—not quite white, and therefore more acceptable for older generations seeking to keep Asian culture intact in their offspring’s mating choice, but not quite Asian either, or having the “exotic” factor to come into play.

TIME Marriage

Your Spouse Is Likelier to Cheat if They Are Financially Dependent on You, Study Finds

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"People like feeling relatively equal in their relationships"

A new study published in the June issue of the American Sociological Review found both men and women are more likely to cheat on their spouse when they become financially dependent on their significant other.

By analyzing data from 2,750 couples between the ages of 18 to 32 years old, study author Christin Munsch found that there was a 5% chance that women financially dependent on their spouse would cheat at any given time, and a 15% chance that men in a similar position of dependency would stray.

When the household financial contribution evened out between the spouses, however, the odds of committing adultery decreased.

“You would think that people would not want to ‘bite the hand that feeds them’ so to speak, but that is not what my research shows. Instead, the findings indicate people like feeling relatively equal in their relationships. People don’t like to feel dependent on another person,” said Munsch, whose work was reported on in Science Daily.

The research also found that when men begin to earn 70% or more of a household income, they once again are more likely to be unfaithful. “These men are aware that their wives are truly dependent and may think that, as a result, their wives will not leave them even if they cheat,” said Munsch.

On the flip side, because women who outearn their husbands challenge the status quo, Munsch says they are more likely to engage in what sociologists call “deviance-neutralizing behaviors,” and, in order to buoy their husband’s masculinity, may be less willing to have an extramarital romance.

The final surprise of the study was finding that financially dependent men are still more likely to cheat than their bread-winning counterparts.

TIME Sex/Relationships

Will the New ‘Women’s Viagra’ Finally Get FDA Approval?

The drug could be a first for women's sexual desire, or it could join other failed attempts

On Thursday, a drug for female sex drive called flibanserin will once again be considered by the FDA for approval. It’s already been rejected twice by the agency, which has cited a lack of proof for its effectiveness as well as side effects like sleepiness and nausea. This time around it could get the stamp of approval, or it could fall in with several other failed attempts at a drug for women’s sexual desire.

Sprout Pharmaceuticals, which owns flibanserin, is not the first to put time and resources into a drug to enhance women’s desire for sex. Pfizer, for instance, had been trying to invent a successful Viagra for women more than 15 years ago, and in 2004, they gave up, saying sexual desire for men and women are very different, and that for women, arousal and desire are not necessarily always related. That same year, the FDA rejected a testosterone patch for women citing concern over its long-term safety. In the intervening decade, many other attempts have been made to develop a little pill as effective—and popular—with women as Viagra is with men.

Why some women have low sexual desire is still the subject of some debate. A lack of desire can, some experts say, signal non-biological issues like stress or trouble in the relationship. But many experts believe that’s not the full picture and there’s a biological basis for libido.

“I think it would be nice if a drug like this could work, having better sex is important to my patients,” says Dr. Mary Jane Minkin, a clinical professor of obstetrics, gynecology and reproductive services at Yale School of Medicine. “The earlier results showed it definitely increased desire, but the benefit was not overwhelming enough.”

MORE: ‘Women’s Viagra’ to Seek FDA Approval, Again

Sprout’s flibanserin is intended to treat pre-menopausal women with Hypoactive Sexual Desire Disorder (HSDD) and works by targeting neurotransmitters in the brain involved with sexual arousal and desire. The drug is thought to temporarily lower levels of serotonin and increase levels of dopamine and norepinephrine in the brain. The company says its clinical trials have shown that when placebo is accounted for, women experience a 37% increase in sexual desire.

Those who don’t support the drug’s approval say it doesn’t have enough evidence to back it up. The drug is intended to be used daily, which some in the medical community say raises concerns over its long-term safety. And some experts argue that flibanserin may not be the blockbuster drug it’s being made out to be. “This one is not a fabulous drug, but it would be nice to have it. It’s for someone else to decide if nausea is worth more libido,” says Minkin.

Whether the tide changes for flibanserin this week is yet to be seen, but it underlines the ongoing debate over just how complicated sexuality can be.

TIME society

14 Pieces of Practical Dating Advice From My 85-Year-Old Grandmother

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xoJane.com is where women go to be their unabashed selves, and where their unabashed selves are applauded

"Even though I married at 21, I think it’s alright to wait, especially in today’s dating world"

xojane

Dating these days can be frustrating and confusing. With all of the technology, dating apps and hook-up culture, things can get complicated.

My friends and I usually try to help each other out when it comes to crushes, but at 22-23 years old, we are all relatively new to the dating world. We all have different opinions on how to approach it. That’s why I decided to take a step back and talk to someone with a little more wisdom: my 85-year-old grandmother.

I am extremely fortunate to have two healthy and loving grandmothers that are still alive today. Sometimes I get so caught up in my own life that I forget to call, or more importantly, forget to listen to the people who always have time to call and listen to me.

I’ve come to realize by talking with my grandmothers that older people are often more than willing to give great advice if we are willing to listen.

While visiting home recently, I had the time to sit down with my grandmother, Kitty, and hear her stories about dating and seek her advice. She was in Pi Phi at the University of Ohio and has tons of interesting stories. She said that because of the time period, there were tons of young men coming home from World War II and she had four or five dates a week.

Eventually, Kitty met my grandfather at a sorority mixer, and after he spent a year trying to get her to accept a date with him, she said yes. They were married for 59 years until my grandfather passed away. I can only hope to find a love like theirs. Maybe with her advice, we all can.

1. “Look for someone who is compassionate.”

The first things people seem to look for in a date (whether they know it or not) is how good-looking they are or what kind of job they have. While you can’t completely ignore these factors, it is also important to look for qualities such as whether or not they are polite to the waiter at a restaurant. Look for little signs that show they are a compassionate person.

2. “If you get involved in something you like, then you might meet someone who likes the same things as you.”

It’s hard to meet people. My grandmother met her husband when she was in college at Ohio State during a sorority and fraternity mixer. When I asked her about how to meet someone, she said to worry about yourself first. Don’t go looking for someone, but rather join clubs or groups that you are interested in and make connections through that.

She does not recommend trying to meet people at bars.“I think it’s sort of crazy you think you have to go to a bar to meet somebody. Sometimes you meet the wrong people there anyway.”

3. “Usually the boy should initiate the first date, but I think sometimes the girl can subtly initiate it by flirting.”

Well, there you have it boys, don’t be nervous — just ask her. And girls, help a guy out by dropping a couple of hints; you don’t just have to sit back and wait for him, but let him know you are interested.

My grandmother said she used to ‘flirt’ or ‘drop hints’ by making sure she was where he was and had the opportunity to talk to him. She also said to smile a lot.

4. “I think being ‘official’ or not, and labels and all that crap are too much of a worry. It should be just sort of something that happens between you and the guy or girl you like.”

Communication is key, and figuring out where you stand with the person you are dating is important. Talking about whether or not you can call someone your boyfriend or girlfriend shouldn’t be a point of stress.

Grandma says, “It just happens. You know you don’t want to go out with someone else—you are happy with the person you are with. But you don’t have to figure it out right away.”

5. “I remember a fun date I went on when we just went to dinner and then we played ‘Fox and Geese’ in the snow (Google it), and decided to come back to the house and put music on and we were trying different dances. And acting just silly. It was spontaneous.”

A first date doesn’t have to be at a fancy restaurant or expensive place, it just has to be fun. Maybe try and find out what the person you are taking out is interested in and do something along those lines.

Do they like music? Find a bar that has a live band to grab a drink. Google has plenty of date ideas. Just remember, too, that not everything has to be planned out but some of the best dates are spontaneous.

8. “If a guy asked me on a date over text, I would text back, ‘Let’s meet for a coke or something and we’ll talk about it.'”

I laughed out loud when my grandmother said this because I can totally see her doing it, but her words have some truth in them. She told me she would meet that person for a coke and then make them ask her on a date in person.

While maybe this isn’t always realistic in lives that are dominated by technology, we need to remember how much better it is to speak face to face than over text message. Grandma says, “Technology has changed things because you don’t hear someone’s voice anymore. Hearing someone’s voice and the feeling or tone of it on the phone is better than a text because then you can kind of feel what’s going on.”

9. “Why can’t your friends introduce you personally?”

When I asked her about dating apps, she just didn’t understand why people have to meet virtually instead of introducing one another. It’s okay to play matchmaker if you’ve got a bunch of single friends.

She says, “I know dating apps happen and they work. I just don’t like that stuff. But if you are sitting around and you haven’t met anybody and that might be something you could do.”

10. “Even though I married at 21, I think it’s alright to wait, especially in today’s dating world. You don’t get together half the time to date so no wonder it takes a while.”

Marriage is huge, so there is no need to rush into it until you’ve found the right one. When you do find the right one, don’t lose them!

11. “I think that you don’t have to see someone and say ‘Oh gosh, he or she is not very good looking, I don’t think I’m going to have fun with that person.’ Don’t rule people out so soon.”

With Facebook, dating apps and so much information readily available before you even go on a first date or meet the person, it is easy to rule people out.

Don’t be judgmental and be open to different people. You’ll never know what a person is really like until you give them a chance.

12. “Relationships are compromise and that’s kind of tough sometimes. Especially for me because I’m bossy.”

Perfection doesn’t exist. I hate to be a pessimist, but everyone you date will have something that eventually will bother you. They say you don’t know if you have a good relationship or not until you survive your first fight.

You just have to learn to work together to build a relationship; the long lasting ones don’t just build themselves.

13. “If you are in love with someone I think you just know that is the person you want to be with, you want to share things with and you know you are happy with them.”

I asked my grandmother, “What does love feel like?” and thought I would get a romantic answer of something along the lines of “flying” or “Your heart beats a million miles per hour.” But according to my grandma, the real kind of love is simple.

You know in your heart that you want to be with that person. It just feels right. Love makes you happy. She says, “There are different kinds of love—when you first get married there is a big romantic passionate kind of love, and then there’s a different kind of love, almost a deeper love. Love is something you have to work on.”

14. “Do what you feel in their heart is right and keep their head on straight. Be true to yourself, and don’t try and be someone else or fit the mold of who you think that person might like.”

Sometimes we are so desperate to find someone that we try and change who we are. This never works.

Besides, you don’t want someone to date you or fall in love with you who doesn’t know the real you.

And keep your head on straight; I guess that means don’t go out of your mind searching for love, it will find a way.

Charlee Dyroff wrote this article for xoJane.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Sex/Relationships

The Science of How Women Can Have Twins With 2 Different Fathers

It's rare, but not impossible

Paternity tests usually give a straightforward answer—a man either is or isn’t the father. But, for a woman in New Jersey suing for child support, things are a little more complicated. It turns out the man she thought was the father of her twins was only the father of one of the pair.

That result is rare—so rare that the condition has the improbable name “superfecundation.” But it turns out a lot of things can happen when it comes to birthing multiple children at the same time. Here are the different types of multiple births:

Superfecundation twins: When a woman has intercourse with two different men in a short period of time while ovulating, it’s possible for both men to impregnate her separately. In this case, two different sperm impregnate two different eggs. This is what happened to the woman in New Jersey. One child was the product of her relationship with the man she brought to court, and the other child was conceived during a separate encounter with another man. While this phenomenon is rare, research suggests it does happen from time to time. A 1992 study found that superfecundation twins were at the root of more than 2% of paternity suits in the United States involving twins.

Fraternal twins (50% shared genetics): Fraternal twins result when two separate sperm fertilize two separate eggs. Both babies are a mix of the mother and father, but they don’t share the exact same genetics.

Polar body twins (75% shared genetics): You might think of polar body twins as half-identical twins. They occur when an egg divides in two during ovulation, creating a primary body and a polar body, both of which have the same genetics. In most cases, the polar body, which has less cytoplasm, will die off, but in some cases both the primary body and the polar body will be fertilized by separate sperm creating twins with identical genetics from the mother and different genetics from the father. While the theory of polar twinning makes sense from a scientific perspective, there’s some disagreement among scientists about whether polar twinning actually occurs in the real world.

Identical twins (100% shared genetics): Identical twins result when a single sperm fertilizes a single egg and the resulting cell then divides in two. The two bodies, soon to be babies, share the same genetics and look the same.

Things can get complicated when you start dealing with triplets, quintuplets, and even bigger single-pregnancy broods. For instance, a mother having triplets could have identical twins from the same egg and a third child from an entirely different egg and sperm. Once you start to mix and match like that, the possible combinations—to say nothing of the dynamics of the playroom—can get very complex.

TIME Sex/Relationships

Why Menopause Isn’t the Sex Killer You Thought It Was

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A woman's sex drive isn’t as affected by menopause as we once thought

Hormones are generally at the center of any discussion about sex. At puberty, the surge in estrogen and testosterone is responsible for the emergence of a sex drive, launching the most fertile period in our lives, while at the other end, a decline in hormones means a waning libido.

But we shouldn’t be so quick to blame that change in hormones, at least in women, say researchers led by Dr. Tim Spector, professor of genetic epidemiology at King’s College, London.

In a report published in the Journal of Sexual Medicine, Spector and his colleagues studied four years’ worth of answers that women provided about their sexual health both before and after menopause. It’s the first study to analyze how various domains in sexuality, including desire, arousal, orgasm, satisfaction and pain, interact with each other and change over time.

They expected that sexual drive and problems with sexual function would increase with time and be higher among women after menopause. But the rate of sexual dysfunction over the four-year study period was about the same—22% to 23%—for both pre- and post-menopausal women. That suggests that menopause, which marks the end of a woman’s reproductive years and is biologically triggered by a decline in estrogen levels, isn’t as important a contributor to sexual issues as once thought.

“We were surprised by the results a little bit,” says Spector. “They suggest that menopause has been exaggerated as an excuse for everything.”

What’s more, the proportion of women reporting improvements in sexual function during the study also remained about the same in pre- and post-menopausal women, hinting that declines in things like desire or arousal can be reversed to a certain extent. “Women do see improvements in sexual functioning after menopause,” Spector says. “What that says is that you are not necessarily stuck” if you experience sexual dysfunction.

The best predictor of how your sex life will change, in fact, is where you start. Women reporting issues with desire, arousal or orgasm at the start of the study, for instance, were more likely to continue to have those issues at the end of the study. But, as the results show, where you start doesn’t have to dictate where you end up when it comes to sexual function. “By modifying your life and attitudes about sexual desire,” Spector says, “you can change things sometimes surprisingly for the better, although you are getting older.”

TIME Heart Disease

What Divorce Does to Women’s Heart Health

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When it comes to the fallout from a divorce, one spouse is harmed more by it’s biological and psychological effects on the heart

Dissolving a marriage is hard on everyone, but researchers say the psychological stress of a divorce can have serious physical effects on the heart, especially for women.

Women who divorced at least once were 24% more likely to experience a heart attack compared to women who remained married, and those divorcing two or more times saw their risk jump to 77%. In the study published in the journal Circulation: Cardiovascular Quality and Outcomes, Matthew Dupre of Duke University and his colleagues found that men weren’t at similar risk. Men only saw their heart attack chances go up if they divorced two or more times compared to men who didn’t split with their spouses. If men remarried, their heart risk did not go up, while for women who remarried, their chances of having a heart attack remained slightly higher, at 35%, than that of divorced women.

MORE: Divorce More Likely When Wife Falls Ill

These findings remained strong even after Dupre’s team adjusted for other potential contributors to heart attack, including age, social factors such as changes in occupation and job status and health insurance coverage, and physiological factors including body mass index, hypertension and diabetes. Previous studies have found links between divorce or widowhood and heart disease that were explained, at least in part, by changes in people’s access to health care and their ability to keep up healthy eating and exercise habits.

But these are the first results from tracking people over a longer period of time—18 years—to capture the cumulative effects of changes in marital status, says Dupre. “We looked at lifetime exposure to not only current marital status, but how many times someone has been divorced in the past. What we found was that repeated exposure to divorce put men and women, but particularly women, at higher risk of having a heart attack compared to those who were married.”

MORE: Study: Marriage is Good For The Heart

And it wasn’t simply changes in health insurance coverage or financial status resulting from the divorce that explained the higher heart risk. Even after Dupre’s group accounted for these, the relationship held. While he admits that the trial did not investigate exactly how divorce is seeding more heart attacks, other studies hint at a possible explanation. Dramatic life changes such as divorce, which signal an end to not only a significant relationship but potentially to stable financial and social circumstances as well, can lead to spikes in the stress hormone cortisol, which in turn can push blood pressure, cholesterol and blood sugar to unhealthy heights.

The long term scope of the study revealed the impact that social and life events can have on the physical functioning of the body. “The health consequences of social stresses are real,” says Dupre. For women, the 77% higher risk of heart attack connected to multiple divorces was on par with well-established factors such as hypertension (which boosts risk by 73%) and diabetes (which elevates heart problems by 81%).

MORE: Do Married People Really Live Longer?

That’s doesn’t mean, of course, that women should avoid getting divorced to save their hearts. “Another way to put it is to say that women who are stably married are at an increased advantage of preventing heart attacks than women who may have had to go through transitions where they weren’t,” says Dupre.

It also makes a good case for doctors including discussion about potential stressors, including lifestyle and social circumstances, in their health assessment of patients. Recognizing that divorce may be a life event that can contribute to higher heart attack risk, for example, they can monitor patients experiencing divorce more carefully, and be alert to the first signs of potential problems with cholesterol, blood pressure or blood sugar. “Understanding all of the factors that lead to a physiological response are equally important,” says Dupre. And potentially life saving.

TIME Sex/Relationships

Teens Aren’t Using the Most Effective Birth Control

IUD birthcontrol
Photo Illustration by Mia Tramz for TIME; Corbis

A new CDC report reveals few teens use IUDs and implants

American teenagers are getting better at practicing safe sex, but a new federal report reveals very few teens are using the most effective forms of birth control.

In the new report, the Centers for Disease Control and Prevention (CDC) looked at 2005–2013 data from the Title X National Family Planning Program on teen contraceptive use and found that teen use of long-acting reversible contraception (LARC)—such as the intrauterine device (IUD) and the implant—are up but still very low. The numbers show that U.S. teen LARC use increased from under 1% in 2005 to 7% in 2013. Implants were used more than IUDs by women of all ages. The state with the highest use of LARC among its teens in 2013 was Colorado at 26%. All other states ranged from use of less than 1% to 20%.

Currently, teens are opting for methods like condoms and birth control pills, which while still good options, are less effective and more prone to incorrect or inconsistent use.

MORE: Why The Most Effective Form of Birth Control is the One No One Uses

The benefit of contraceptives like the IUD and implant are that they are low maintenance and highly effective. For example, the typical use failure rate of the IUD is 0.2% and for the implant it’s 0.05%. By comparison, the birth control pill and vaginal ring have a failure rate of 9% and condoms have a fail rate of 18%.

In 2012, the American Congress of Obstetricians and Gynecologists (ACOG), considered an authority on reproductive health, concluded that IUDs and implants are safe and appropriate for adolescents and teens. In 2014, the American Academy of Pediatrics (AAP) agreed and said it recommends LARC for adolescents.

“Long-acting reversible contraception is safe for teens, easy to use, and very effective,” said CDC principal deputy director Ileana Arias in a statement. “We need to remove barriers and increase awareness, access, and availability of long-acting reversible contraception such as IUDs and implants.”

CDC

According to the new CDC report, there are a variety of reasons why a young person may not opt for the IUD or implant. Many teens don’t know very much about them and they often think they are too young to use them. As TIME reported in June, some physicians may remember the IUDs of past, which caused severe problems for women and were discontinued. Modern-day IUDs are safe and appropriate but there are still misperceptions about the device that persist within the medical community. Many providers are also not properly trained on insertion or removal of the IUD and implant. However, a recent report showed that among female health care providers 42% use LARC, which is much higher than both the general population of teens and adult women.

Overall, the CDC report shows that American teens are waiting to have sex, and when they are sexually active, nearly 90% report using birth control. The teen pregnancy rate in the United States appears to be steadily dropping, though in 2013 over 273,000 babies were born to girls between ages 15 and 19. The CDC says encouraging young women to consider LARC is an important strategy for further reducing teen pregnancy.

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