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The words and metaphors that people use to describe sexuality and reproductive health reflect experiences with peers, sexual partners, health service providers, and public health campaigns. In this paper, we analyse 1, e-mails sent to an emergency contraception website in the USA over the course of a one year period.

Through an examination of the terminology used by authors to describe contraceptive methods, sexual intercourse and other sexual acts, we analyse what those terms signify within their textual context. We find that the kinds of risk concerns used in assessing sexual activity — whether evaluating M and m unprotected risk, disease transmission risk, or moral risk — influence the definitions people give to terms that are multiply defined or whose definitions are culturally contested.

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We conclude with a discussion of the implications of this finding for research, clinical care, and health education activities. Inthe public health and medical communities became directly implicated in this national debate.

In January of that year, the editor of the Journal of the American Medical Association JAMA fast-tracked an article focused on the meaning of sexual terms for publication. Smith HortonR. Smith ; see T. Smith for a review. Revealed in this debate was not only M and m unprotected meanings attributed to the language of sexuality and sexual health are variable and contested, but that scientific representations of this variability can be politically charged as well.

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Yet the importance of language in sexual and reproductive health cannot be underestimated. Through an examination of over 1, emails sent to an emergency contraception EC website, the majority of whose users are based in the U. A wide interdisciplinary literature documents the ways that language both M and m unprotected and structures thinking about bodily states, health, and sexuality. In their seminal work, Lakoff and Johnson argued that language uses metaphors of body states to signal mood and affect, spatial organisation, social hierarchies, and political or economic orders.

But if language can reflect embodied states, so too does it reflect and constitute particular social orders and ways that cultural systems frame bodies. For example, analysts have examined the linguistic framings of diseases, from cancer and tuberculosis Sontag to AIDS BrandtSontagTreichlerWeissEbola Joffe and Haarhoffand SARS M and m unprotected and Nerlichand shown how these framings are linked to particular conceptualisations of individual bodies and the body politic.

Another way that the language of health is political is in the way that it frames issues and problems and thus shapes the possibilities of health policy outcomes AnnasTreichler Language is therefore central ground for both activists trying to influence public health debates and health professionals trying to provide high quality services HardonHadlow and PittsKleinmanBoyle ; Ong, de Haes, Hoos, and Lammes As a result, it is not always possible to disaggregate the politics from the science or strategies of public health outreach.

In the USA, the realms of sexuality, reproductive health, and personhood are particularly contested terrain where both popular and medical terminologies stake out political positions in debates over abortion and M and m unprotected HeriotWynn and Trussell a.

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There were several reasons behind the attempted switch. This history of the debate over and politicisation of EC terminology is an important backdrop to understanding the language we encounter in e-mails sent to the Emergency Contraception Website. The Emergency Contraception Website http: Popularly known as Notlate.

M and m unprotected EC refers to the use of medications such as pills containing higher doses of hormones than are found in oral contraceptive pills OCPs or devices such as the post-coital insertion of a copper intra-uterine device IUD that can be used up to hours after sexual intercourse to reduce, but not eliminate, the likelihood of pregnancy Trussell, M and m unprotected, and Van Look The website gives users the option of sending questions to James Trussell, the founder of the website.

The most commonly asked questions sent to the website about EC are how to M and m unprotected it Between July 1, and June 30,1, English-language e-mails were received excluding spam. We tracked different terms for EC, sex, and various aspects of reproductive health, and examined what those terms mean in context. In contrast with methodologies that use computer programs to do keyword searches on vast quantities of texts e. Our method also allowed us to identify long phrases and expressions that express a concept, as well as misspelled terms, content that may be missed by computer-assisted searches.

This search examined not only the language that was used but also language that was not used SontagRapp This approach provides insight into what people feel uncomfortable saying, with important implications for patient-clinician communication and public health education campaigns. In Table 1we provide quantitative results as well as information about what terms appeared on the website itself.

We have grouped these terms into ten categories and provide the total number of emails containing any specific term related to the general category: As a single email may include multiple categories, the number of emails in each category does not sum to the total number of emails received.

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Table 1 lists the terms used in the emails and provides the number of emails containing each specific term. The range of terms used varied widely by category: Formal or medical terminology predominates in most categories.

For example, while we found a creative variety of terms describing sexual acts, including doing it, love-making, making love, hooking up, slept together, infidelity, oral sex, fingered, doing foreplay, anal sex, and outercourse, the list is clearly dominated by the terms sex, intercourse, and sexual intercourse. We also found that people were most likely to use avoidance strategies in writing about sex M and m unprotected genitals.

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However, there are limits to a quantitative approach to describing language used in these e-mails. First, writers may mimic what they read on the website. Thus Table 1 lists not only the terms used in the e-mails but also the terms used on the website itself. The predominance of the term emergency contraception in these e-mails when other research suggests that morning after pill is a much more widely used popular term reinforces other research that has demonstrated how the language of health is formed in contexts of mutual mimesis Pinto M and m unprotected, this research reflects only the e-mails written by people who arrived at the EC website.

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It says nothing about the language of people who never reached the website. This distinction is important because, at the time these e-mails were sent, the website itself was M and m unprotected towards using medical language, and was highly ranked by most search engines for searches using the term emergency contraception, but fared considerably less well in searches for popular terms such as morning after pill.

In short, mere use of this website is a language filter. Thus a more robust way of M and m unprotected the language of sexual health in these e-mails is not just to enumerate the terms authors used but rather to examine the range of this terminology in the broader context of their concerns about sexuality and reproductive health. Writers of the emails in our study used a variety of modifiers and qualifiers when asking questions about sex. Such language and the use of modifiers that can be variably interpreted suggest a modern lack of consensus over what constitutes sex and sexual intercourse.

Interpreting the meaning of terms for sex in these e-mails calls for a close examination of textual context. The first two e-mail examples are from writers who are not certain whether to classify as sex actions which involved vaginal penetration but did not involve ejaculation, in the context of articulating questions about whether EC was needed.

In the context of assessing risk of pregnancy entailed in a specific act, confusion over what to call a sexual act that briefly involved penetration and did not lead to ejaculation has its own logic. In short, the contexts where assessments of sexual activity take place - whether pregnancy risk, disease transmission risk, or moral risk - influence the definitions people give to terms that are multiply defined or whose definitions are culturally contested.

When the definitions M and m unprotected to sex by M and m unprotected attempting to mitigate the moral risk of sexuality are later evaluated by analysts estimating risks of exposure to STIs, it is unsurprising that there is a gap between the way each group defines sex.

In contrast, consider the following e-mail:.

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And ejaculation did not occur. Should I take emergency contraceptives?

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Here we find the opposite situation: In trying to explain how the writer then could worry about pregnancy risk, we hypothesise that her moral definition for the sexual activity that has taken place has influenced her perception of the act sufficiently that she extrapolates from moral risk to suspect pregnancy risk.

However, we cannot rule out the possibility that this may simply represent an abysmal lack of knowledge about how pregnancy occurs.

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Do the shot keep you from getting pregnant? In other words, these writers were concerned about pregnancy risk after engaging in sex while ostensibly using hormonal contraceptives correctly we did not include in this number writers who were concerned about pregnancy risk after missing oral contraceptive pills.

Just as the blurring of lines between moral and pregnancy risk may lead to different definitions of sex, this finding seems to suggest that evaluation of risk in one area - disease transmission - has spilled over into concern about risk in another area - pregnancy.

Cognisant of the risks of disease transmission entailed in sex without a condom, the writers M and m unprotected that they are unprotected in another realm as well, despite the fact that they are taking hormonal contraceptives, which, when correctly taken, are considerably more effective in preventing pregnancy than condoms.

This confusion over what constitutes protection from unintended pregnancy is undoubtedly the unintended effect of public health campaigns designed to educate the public about protecting themselves against STI transmission.

This perception was perhaps best articulated in the following question:.

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This M and m unprotected a poignant reminder that the language chosen to convey public health messages structures thought in subtle and even unconscious ways—ways that may be unanticipated by the designers of public health information campaigns. There are important implications for clinical care: There are also important implications for research on sexual risk behaviour Quirk, Rhodes, and StimsonGroes-Green Bush Administration, in which educators are not permitted to discuss contraceptive methods except in terms M and m unprotected their rates of failure in protecting against both STIs and pregnancy Sonfield and Gold Although the language included in many of the emails received suggest that the writers are adolescents, we have no systematic demographic information on writers.

While other websites have attempted to capture such information by requiring writers to provide certain information before submitting a question see Gainer et al. Not requiring writers to provide personal information may thus increase confidence and willingness to write, but it also means that we cannot correlate language use with age, education level, native language, cultural background, income, or place of residence.

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All of these may be important determinants of both knowledge and misinformation, language use, and sexual and contraceptive practices, as well as the ways people conceptualise their own bodies and interact with perceived experts or medical professionals.

But there M and m unprotected also limitations on efforts to correlate language used for talking about the body, sex, and medicine with demographic indicators.

Seeking fixed categories and correlations between cultural background and language use fails to capture the way that many people are in the process of learning about sexual activities and reproductive processes and the ways that their language reflects this.

This problem is especially true for young people, and for cultures and societies that attempt to deny knowledge of sexuality and contraceptive processes to the sexually uninitiated, such as the contemporary USA, where there has been a recent trend towards replacing previously candid and accurate sexual M and m unprotected in public schools with curricula intended to inculcate an ethic of abstinence from sexual activity.

Interacting with the Emergency Contraception Website is a part of this process. Some writers may decide to send an email after minimal interaction with the website, in which case they may draw on language that they use in discussing matters of sexuality and health with peers and sexual partners, or they may use idiosyncratic terms, or they may draw on past experience in dealing with medical providers.

On the other hand, many writers have decided to write an email after reading about EC on the website, in which case they may adapt their linguistic practice to mimic the M and m unprotected and language used on the website. In sum, for all of these reasons, we caution that, although the quantitative enumeration of terms used may be suggestive of certain linguistic patterns in describing sexual practices and reproductive health as pertains to contraceptive use, they cannot be read as representative of any specific population other than the users of this particular website.

However, the linguistic practices that we observe suggest more generally a range of possible thinking and writing about sexuality and reproductive health that medical professionals, especially those who serve diverse communities and adolescents, may encounter. Our examination of language in e-mails sent to this reproductive health website revealed a wide and creative variety of terms used to describe sexuality and reproductive health, while at the same time showed that certain terms, such as sex and intercourse, are hegemonic.

Studying terminology in context reveals that a single given term for sexual intercourse can vary widely in meaning between writers, ranging from vaginal-penile sex in which ejaculation occurs to proximate contact of genitals through layers of clothing and without ejaculation. An increasing body of literature has examined the differences between everyday language and medical language and the extent to which medical professionals and non-professionals differently imbue terminology with their own disciplinary and idiosyncratic content Bourhis, Roth and MacQueen ; Boyle ; Hadlow and Pitts ; Ong et al.

Avoidance of terms may also be a display of public modesty for writers who feel that certain terms cannot be decently used in public discourse or out M and m unprotected the context of sexual activity.

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In mimicking the language of the website or otherwise showing a preference for formal and medical terminology over everyday language for sexual and reproductive processes, writers may be putting linguistic distance between passionate sexual activity and requests for dispassionate analysis of the consequences of that activity, or they may seek to avoid the judgment of the faceless person they hope will read and answer their questions, or they may be trying to appear knowledgeable, yet the meaning M and m unprotected attribute to such terms is often idiosyncratic and at odds with medical definitions of these terms.

Finally, one of the most striking findings of this study was the relatively large number of writers who used the term unprotected sex to refer to sex without a condom but with correct use of hormonal contraceptives.

Indeed, this discursive orientation towards the risk paradigm of sex is reflected in the language of the EC website, where sex is framed in terms of pregnancy prevention, safe and M and m unprotected practices, and protected vs. These e-mails challenge traditional definitions of culture as something that is shared across a population — a definition that is implicit in many applications of the cultural competence frame Lee and Farrell Health professionals are becoming increasingly attentive to language and culture in an attempt to understand and provide better care to their patients McQueen and Henwoodand calls for medical professionals to attain cultural competence in order to better care M and m unprotected minority and underserved patient populations have become so widespread in medicine that they are codified by the American Medical Association AMABetancourt The evidence of our study, however, points to the extent to M and m unprotected language surrounding controversial topics such as sex varies and is contested, even within cultures.

One clear intra-cultural divide in the language of sexuality and reproductive health is that between health professionals and lay people. Yet it is apparent that a range of other flows of linguistic practice surrounding sexuality, from political debates over sex education and condom labelling to international health education campaigns surrounding sexually transmitted diseases, influence how people think and talk about and sexual practices Pigg I had unprotected sex for three weeks but I got my period the next week.

Does that mean I'm not pregnant?


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