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George P. Burge 4918 University Street Seattle, WA 98101
By "pedophilia" I'm referring to largely the media, but also how the culture seems to focus more intensely on underage girls than even, say, the U.S. I don't have stats on how many underage girls are reported to be abused a year, or how much of a problem prostitution is compared to the U.S., but it seems in general that there's more of an obsession (and acceptance of said obsession) with pubescent and pre-pubescent girls. Why do you think this is?
1 Answer Pietro Uni Pietro Uni, is a video game design student and loves music, movies and tech. Answered May 7, 2016 There's a pretty great article written for Time magazine that explains japan's problem with pedophiles. I'll try to summarize as best I can:
Legal age of consent
"We're asked by international police to help arrest child pornographers, but there's nothing we can do", says Goto, deputy director of the National Police Agency's community safety bureau. Japan's criminal law prohibits sex with minors, but a minor is defined as someone age 12 or younger, and the only act specifically outlawed is sexual intercourse. Taking lewd pictures of children is permissible. Some pornography--both with adults and children--is banned under an obscenity code, but only if it explicitly shows genitalia.
Preventing people from getting their hands on pornography doesn't seem to be much of a threat right now. The country is awash in child porn, and there's little attempt at hiding it. Subway riders peruse pornographic comics that are explicit, graphic and sometimes violent in their depiction of young girls. Porn outlets dot the landscape of Japanese cities, and even mainstream book shops, newsstands and convenience stores sell explicit material. General interest magazines and newspapers also feature erotic photography, as well as advertisements for sex shops and escorts.
The common explanation for Japan's tolerance of child porn is that the country is run by a clique of old men with little sensitivity toward women and children. But it's not just old men who are involved. Most of our customers are in their 30s, says Seiji Wasaki, 27, a clerk in a porn shop in Tokyo's Shinjuku entertainment district. Parliament member Edano, at 34 one of Japan's youngest politicians, views it as a matter of choice. You can't neglect the fact that some high school girls quite willingly do this, he says. If the girl and the man agree to exchange money for sex, and if it's really her will, then it is completely the act of individuals and shouldn't be regulated. The problem, Edano says, is that the girls haven't been properly educated to make an informed decision. A man who frequents teen prostitutes (and who prefers not to be identified) claims that two years ago, the going rate for sex with a 16-year-old girl was $250. Today, men want younger partners. A tryst with a 12-year-old costs more than $400.
There's another theory for the obsession with pedophilia: that Japanese men feel threatened by adult women. Many men are incapable of relating to adult women on an equal stance, says Yukihiro Murase, a professor of human sexuality at Tokyo's Hitotsubashi University. Whatever the explanation, it won't be easy getting a tough law against child porn through the male-dominated parliament. In fact, a similar effort failed last year. But the exposure of Japan's child porn on the Internet may serve a useful purpose for cracking down on this shameful trade, for it has brought the smut out of the insular world of Japan for all the world to see. We feel embarrassed, says parliament member Moriyama. So now we want to hurry up and do something.
Restore freedom: No taxes on alcohol and nicotine. When feminism cripples male sexuality, there must be something else that feels good before we die anyway.
Aaron A. Moncrief 1187 Mahlon Street Southfield, MI 48075
Hearing that Daryush Valizadeh, a blogger who set off global outrage last week when he planned to organize men-only “tribal gatherings” around the world, would be holding a press conference Saturday night in a Dupont Circle hotel was like receiving an invitation to a real-life meeting with one of the odder corners of internet culture. Valizadeh had already had an interesting week: His planned meetings resurfaced an article he wrote last year in which he suggested rapes committed on private property should be legal, prompting internet-wide condemnation, rebukes from government officials around the globe, and the online-activist group Anonymous publishing his parents’ address.
A day after the Daily Mail followed Anonymous’s tip to a Silver Spring cul-de-sac and found him at the door, Valizadeh—who goes by the nom-de-blog “Roosh V”—hastily called the press conference, supposedly to dispel charges that he is a “pro-rape” advocate. The set-up suggested the strangeness that was to come. Valizadeh did not supply the exact location until less than two hours before it started. He arrived escorted by a clutch of burly men who he said were bodyguards, and set up his own cameras to ensure his online followers would have their own view of the proceedings with the dozen or journalists who took the bait.
What followed was nearly an hour of ranting, evasions, and accusations ranging from broadside attacks on all media to responding to one of my questions by asking, “Do you lift?” And rather than spend the remainder of the night adding to his purported sexual conquests—Valizadeh has self-published more than a dozen “guides” to seducing women in many different countries, all with the word “Bang” in the title—he followed the press conference by setting his Twitter followers loose on the reporters who showed up.
“This article, to a ten-year-old, was obvious I didn’t intend to legalize rape or cause harm against women,” Valizadeh said about his February 2015 post that his critics seized upon. While he said it was meant to be satire from the start, though, it is not difficult to see why readers would take it as his genuine belief.
As “Roosh V,” Valizadeh has built up a small but dedicated following of a philosophy he calls “neomasculinity.” He believes that women should be socially and physically submissive to men, claims to have 1 million monthly readers, and has written about multiple sexual encounters in which the woman was too inebriated to give consent.
But rather than give off a veneer of strength and virility, Valizadeh on Saturday came off as rambling, paranoid, and defensive, answering nearly every question by pivoting back to his belief that he is the victim of a media conspiracy, guzzling through several bottles of water in the process. He told a reporter from Vice Media that the company peddles “garbage,” and called the Daily Beast a CIA front.
“As you see I’ve been under a lot of stress from this mob that’s coming after me because of these things you wrote that don’t conform to the real world, and I don’t get it,” he said. “You’re ready to write that this guy is pro-rape without knowing where that false idea comes from.”
Even if Valizadeh’s professed exploits have been on the right side of the law, they do not, as Vox pointed out last week, comport to most people’s definition of rape. (The FBI defines it as “penetration, no matter how slight” without consent.)
I’ve never been accused of rape,” he said. “Nobody’s ever read something by me and went onto rape, because I know if they did hurt a woman it would be all over the news.
This is the latest deal offered by the Islamic State. You want to die the best possible death, then you have to blow up your brain. It's the only death that is instant and painless. We tie a bomb around your body and send you into a populated area. You don't have to die alone, and you don't have to pull a trigger. We do that by remote control.
Brandon W. Almeida 833 Hilltop Drive Amarillo, TX 79101
As far as publicity stunts go, the “first ever designer vagina showcase” was pretty damn effective. Timed to coincide with the spectacular runway parades that mark New York Fashion Week, the event was Dr. Amir Marashi’s chance to show the world what he can do: With a little slicing and suturing, he can give you the vagina of your dreams.
Inside the sprawling midtown conference room where the “show” would take place, sparkling rosé and cupcakes were served. Guests were greeted by a perfectly taut, hair-free, millennial pink silicone vagina model, which Dr. Marashi then used to explain the slate of procedures on offer during his powerpoint presentation of before-and-after vulva shots. There were the uneven labia minora that he’s trimmed (click), aging labia majora that he’s plumped (click), lax vaginal openings that he’s tightened (click), and those were just the surgical options. If you don’t like the idea of anesthesia, he can plump your lips with fillers, inject your G-spot with your own blood plasma to improve orgasms, or stick a laser wand inside you to painlessly tighten things up. If you didn’t walk into the showcase thinking your vagina was defective, you likely walked out of there worried over just how many ways it could be flawed.
For his part, Dr. Marashi, the self-described “vagina whisperer,” walked out with a lot of press. Yes, the concept was vulgar, but it got the job done: Over the next few days, there were articles in the New York Post, Jezebel and The Sun. He’s since been interviewed by Z100 and The Daily Mail, and outlets are becoming increasingly happy to add “vagina whisperer” to his other title, board-certified Ob/Gyn, as if it’s an actual qualification. All of this is why, two months after the showcase, I find myself in scrubs in a nondescript surgical center in Downtown Brooklyn waiting for Dr. Marashi to lead me through an up-close look at what this is all about. Yep, I’m about to observe a designer vagina surgery IRL, and it’s almost curtain time.
In the operating room, he’s telling me about how important it is to find a doctor who does these surgeries regularly. “This is why I do revisions a lot,” he says, in his slight Persian accent. “People think somebody is on Park Avenue so they’re good, but they might not do these over and over again.” He says he does these procedures three days a week, and has probably done more than 700 by now.
Dr. Marashi’s patient for today is lying on the operating table, knocked out, intubated, and covered by a sheet. She’s a 48-year-old mother of four who says she can feel nothing during sex. A nurse and surgical technician have just positioned the patient’s legs in stirrups, wrapping each one up in a sheet, so only her vulva remains exposed. Dr. Marashi is explaining that these cosmetic surgeries only make up half of his practice; he spends the rest of the time doing laparoscopic surgeries for pelvic pain related to endometriosis and fibroids. For those surgeries, “we listen to Enrique,” he says, and I assume he means Iglesias, but I don’t ask because he’s moving so quickly. “For vaginoplasties and labiaplasties, I want to get the right side of my brain to work, the more creative side. So I listen to Frank Sinatra.”
“Can we turn up the music?” Dr. Marashi asks with a wink, and “My Way” comes over the speaker. It’s a fitting song for a man who would later tell me he started doing cosmetic surgery because he likes to be “outside the box.”
Dr. Marashi sits down on his stool in between the patient’s legs and snaps a “before” pic on his iPhone. He slips on a pair of gloves and enters full doctor mode as he signals me to come take a look. Her vagina looks just as expected. But then Dr. Marashi spreads her lips, revealing a startling laxity and — "What’s that?" I ask, about the round, meaty tissue bulging down from the top of her vagina. “That’s the bladder,” he says. More importantly, though, is that her perineal body, the muscle tissue that separates the vagina from the rectum, is completely flaccid. He sticks a finger in her anus and pushes up to show me how weak and sponge-y it is, and how this creates a drooping of the vaginal opening into the woman’s butt. This is what creates the lack of sensation, he explains. The vaginal opening should hug two fingers, and it should be much higher.
“This is a patient who has had four vaginal deliveries,” he says. Her kids are aged 19 to 27, and she hasn’t enjoyed sex for a long time. Her first husband left her, and she blames her inability to grip his penis during sex as one of the reasons. But she’s in a new relationship now and she doesn’t want to put up with it anymore. (At least, that is what Dr. Marashi tells me. The patient declined to speak to me directly.) “She didn’t take care of it sooner because of the taboo that’s with it, or maybe she didn’t have the money, you know all these things that get in people’s way.”
The “taboo” that Dr. Marashi refers to is very real. Between 2010 and 2016, the United States saw a more than 100% increase in labiaplasties, a surgery to trim the inner or outer labia. No one is tracking the number of cosmetic vaginoplasty procedures, also referred to as “vaginal rejuvenation,” because the practice is too new, but experts estimate a similar increase in demand thanks to new non-surgical options and greater public awareness. (Kourtney and Kim Kardashian have both reportedly been “rejuvenated” via the new non-surgical laser options.) A lot of this rise has coincided with a surge in social media, reality TV, and endless amounts of free porn, which has, in turn, been blamed for creating an impossible standard of beauty for female genitalia — as if women needed yet another standard to measure themselves against, another reason to hate their bodies.
"Is this really what women want? Or is this really a form of new-age ‘circumcision’ based on an obsession with Barbie doll looks?," asked a scathing 2012 editorial in Obstetrics & Gynecology. A Jezebel article on Dr. Marashi’s vagina showcase described people who choose labiaplasty as women with minds “warped” by the porn industry. That’s what critics have said, and that’s exactly what I was thinking, walking in. But now that I’m witnessing the surgery, it’s not clear that assessment is fair.
Dr. Marashi uses a blue marker to map out where he will cut. Once he’s done that, Charles, the surgical tech, clamps her vagina open, and Dr. Marashi begins to cut away a diamond-shaped chunk of muscle and skin from the bottom of her vaginal opening. Then comes the most important cut: a deep crevasse into the perineal body.
“It’s really important to take your time and dissect this very meticulously, because behind here is the rectum,” and any crossover could lead to a dangerous infection, he says. Dr. Marashi then sews multiple rows of sutures into the perineal body, starting from further inside of her vagina until he gets to the outside, where he finishes with a row of stitches up from her anus to the new, lifted bottom of her vaginal opening.
“Remember in the beginning how close the vagina and the anus were together? You're gonna see in the end how far apart it’s gonna be,” he says.
In the end, I do see how much higher the vagina is. The hour-long process reminds me of a slower version of that magical strapless, backless bra Amber Rose has been advertising on Instagram: It’s as if he just threaded it all, and pulled the strings tight so that the whole vagina is miraculously lifted an inch higher. The final stitches are the tying of the bow that holds it all in place.
If I had to choose a vagina for myself, I’d pick this one over the one she had before. This makes me feel really bad, until I remember that there are also the anatomical realities here: Sewing it all back together with multiple layers of sutures is not just for aesthetics; this is a repair job for that muscle. This repair will also create a lift in the bladder that may even help alleviate stress incontinence, not to mention making penetrative sex feel good again for her partner, yes, but also for her.
It’s hard to square all that with the way Dr. Marashi has marketed himself, and indeed the way the entire, fast-growing crop of “cosmetic gynecologists” have marketed this burgeoning industry, as though this is just about having pretty, youthful genitalia. In the operating room, it’s clear that selling this the way women were sold facelifts, Botox, or even breast lifts is not quite right. Having sagging breasts and wrinkles may not make you feel so great about yourself (especially in our youth-obsessed culture), but those things don’t make sex physically impossible to enjoy. And they have nothing to do with a problem as distressing as incontinence.
To hear Dr. Marashi describe it while he’s actually doing the procedure, women choose this surgery mostly for functional reasons: to make sex better, the way it was before they had a baby or three, and to stop peeing their pants (even just a little bit) when they sneeze or lift weights. So, why on earth is the best way Dr. Marashi can think to market himself a grotesque showcase that frames everything in terms of how the vagina looks? More importantly: Why is this woman paying out-of-pocket for a one-time tune-up for her perineal body, when her partner could easily get insurance to cover his lifetime supply of Viagra?
To even begin to answer these questions, you have to understand where “cosmetic gynecology” came from in the first place. Plastic surgery — cosmetic gynecology’s closest cousin — has always been controversial, but it has also always been a mixture of reconstructive surgeries (like implants after breast cancer) and elective surgeries (like breast lifts or implants simply because you want them).
Cosmetic gynecology seems to be a similar mixture — but thanks to a toxic combination of entrenched sexism and continued dismissal of women’s sexual concerns, even the reconstructive procedures are still deemed frivolous, unscientific, and ironically, misogynistic.
The truth is that gynecologists have always done vaginoplasties and labiaplasties, but historically they would only do them for women with “true” medical problems, such as uterine prolapse (when the pelvic muscles collapse completely and the uterus descends into the vagina) or labial hypertrophy, which is when the labia minora or majora are extremely long or uneven. Outside of that, most doctors deemed them unnecessary, says Marco Pelosi, III, MD, a pioneer in the field. “There has always been a chasm between what doctors consider a problem and what women consider a problem when it comes to their sex lives,” he says.
Variations in labia length are totally normal, as any gynecologist or even anyone who watches porn regularly, can tell you. And while, say, painful sex or prolapse are “real” medical issues, constant irritation caused by your long labia or even a change in sensation after childbirth are not, according to traditional medicine, Dr. Pelosi explains. So for years, the procedures remained unpopular thanks to low awareness and low interest among women, as well as low adoption among qualified physicians.
Then, Sex And The City happened. Brazilian waxes became very popular — and baldness meant better opportunities for women to actually look at (and, yes, scrutinize) the physical characteristics of their vulvas.
In a post-Samantha Jones world, the gates opened: Women were much less shy about openly complaining to their doctors about their sexual dissatisfaction. And when their doctors didn’t listen, they found another doctor. All of a sudden, women had gotten the message that they deserve pleasurable sex. This created a huge opening for the few doctors who did offer these vagina alteration services to grow their businesses.
On the East Coast, Dr. Pelosi (along with his father Marco Pelosi, II, MD) — who had been offering elective vagina procedures since the ‘90s — began training surgeons in Bayonne, New Jersey. Eventually, due to demand, the father-son duo founded the International Society of Cosmetogynecology in 2004; they were the first to coin the phrase “cosmetic gynecology.”
Meanwhile, in Beverly Hills, Dr. David Matlock had trademarked the term “laser vaginal rejuvenation” and started a franchise business where he performed surgeries and, for a hefty fee, trained other doctors in his procedure. This allowed doctors to use the term to market the procedure, which is essentially a slightly modified version of vaginoplasty, the same way he did. This being L.A., Dr. Matlock also managed to swing an appearance on an episode of the E! network’s Dr. 90210 in 2006, giving "laser vaginal rejuvenation" its first national spotlight.
Soon, as a workaround to Dr. Matlock’s hefty fee, other doctors just dropped the “laser” and started calling it simply “vaginal rejuvenation.” This prompted the American College of Gynecologists (ACOG) to issue a scathing committee opinion in 2007 deeming the marketing practices and franchising surrounding the term “troubling” and the procedures “not medically necessary.”
But warnings from ACOG didn't do much to stem the rising tide of demand. As the rise of social media and Dr. Google continued, labiaplasty alone started to explode in popularity, experiencing a 44% increase between 2012 and 2013 (the first period for which data was tracked). Dr. Matlock only grew more famous — and not necessarily in a good way. He went on The Doctors with his wife Veronica, who got a vaginoplasty, labiaplasty, and “pubic liposculpting” from her husband. And who can forget when Brandi Glanville, the Real Housewife, infamously charged her vaginoplasty to her cheating ex, Eddie Cibrian’s, credit card? Dr. Matlock was her doctor.
Soon, there were myriad non-surgical options for “enhancements,” each one more bizarre than the next. There were liposculpting and fillers for your vulva, followed by g-spot injections (which would supposedly improve orgasms), and targeted skin lightening treatments that would change the shade of a vulva to Carnation Pink. In hindsight, the vajazzling phenomenon — the iconic ‘00s trend of adorning your waxed pubic area with rhinestones — seems inevitable. And while it’s easy to roundly mock all the upgrades and accoutrements, the thing is, the vulva was having a moment, one that no one seemed to notice except to mock.
Most recently came the big innovation (and the big money-maker): lasers and radiofrequency devices that use thermal energy to tighten the vagina. FemiLift, the machine Dr. Marashi uses, came first in 2013. Then MonaLisa arrived in 2014. Both machines are FDA-approved for “vaginal laser ablation” to induce the growth of collagen in the vaginal walls. This is said to not only tighten and lift the vagina, but also to improve the health of the mucosal lining, making lubrication easier. Another side effect: The lifting may help some with stress incontinence, and in some cases may even shorten labia. Other machines that use thermal energy technology to the same effect: ThermiVa, Diva, IntimaLas, and more.
No doubt the ease in getting non-surgical vaginal rejuvenation has coincided with the huge increase in demand. According to data from the American Society for Aesthetic Plastic Surgery (ASAPS), more than 10,000 labiaplasties were performed by plastic surgeons in 2016, a 23% increase just from 2015. Now more than 35% of plastic surgeons offer the procedure, compared to 0% in 1997 when the society started their surveys. But the full breadth of designer vagina procedures remains a mystery, since nobody is tracking the variety of procedures that fall under the term vaginal rejuvenation, nor the number of doctors performing them, according to a spokesperson at ASAPS.
Because a laser treatment or an injection requires no anesthesia or downtime — all it takes is a series of in-office visits that amounts to having a laser wand inserted into your vagina — “it became a gateway,” Dr. Pelosi says. “Once you have a nonsurgical way to address some of the needs, it becomes way easier to do. It’s like Botox. Now everyone does Botox.”
Sandra*, a 31-year-old mother of one, has spent the past five years since the birth of her daughter yearning for her pre-baby vagina. Before she gave birth, sex was great. Now it’s lackluster. It wasn’t until she started Googling her symptoms and found her way to Dr. Marashi’s website that she realized there was a single thing she could do about it.
“After you have a baby, everything changes,” she says. “I realized during sex I wouldn’t stay as wet, and it just felt different. Also there were the urination issues, too.”
“This is definitely going to help a little bit with that,” Dr. Marashi says, handing her a pair of protective glasses. She’s laying on her back with her feet in stirrups and a paper gown over her lower body, ready for her second of three treatments with Dr. Marashi’s FemiLift machine. This time, he has outfitted me in a white coat to serve as his assistant while observing Sandra’s procedure.
It’s hard to say exactly how common Sandra’s situation is, but any mom (or any doctor) can tell you that it’s pretty prevalent. We all know that childbirth changes things. Another thing we can say for sure: A full third of women who have given birth vaginally have some damage to the muscles responsible for vaginal tightness. Vaginal delivery is the strongest predictor of developing a pelvic floor disorder, such as uterine prolapse, rectocele (when the rectum bulges into the vagina), or cystocele (when the bladder bulges into the vagina). The feeling of “looseness” that so many women come to plastic surgeons and cosmetic gynecologists to fix may actually be one of the earliest precursors to true prolapse, per a 2014 study in Surgical Technology International.
The treatment takes 10 minutes, tops. We all put on our protective glasses. Dr. Marashi replaces the glass cover on the probe, which looks like a clear dildo with a mirror on the tip to direct the searing light, with the one Sandra had to purchase. Each patient must bring her own personal probe cover ($150, not covered by insurance) with her to appointments.
Next, he inserts the probe, attached to a long bending metal arm that is connected to a machine. He steps on a pedal while simultaneously pushing the probe in and out and twisting the probe around inside of her. Every time Dr. Marashi presses the floor pedal, the laser is turned on and the mirror directs it to burn 81 tiny holes into the lining of the vagina. With the twisting and maneuvering, what you end up with is thousands of tiny holes, which draws a lot of healing blood flow to the area and promotes the growth of collagen, making the skin more taut. Industry-sponsored studies have also shown that it makes the vaginal lining thicker, which is why lubrication is easier. This is repeated three times at increasing levels of intensity. As his assistant, I press the button when he tells me to, to ramp up the intensity.
Afterward, Sandra says that it didn’t hurt at all — just a bit of tingling and burning toward the end. But it was hard not to notice the grimace on her face when the laser was all the way turned up.
Even just after the first treatment, she already feels some difference: “Sex is amazing,” she says. “It’s much better.” And now after this go-round with the laser, she should feel 70% of the potential effects; she can have sex after just two days of healing. In another 4 to 6 weeks, she’ll come in for a third appointment, and that’s when she will really see how amazing this treatment is, Dr. Marashi promises.
But it’s unclear how “amazing” the treatment really is in general. The machines are FDA-approved, which means they are safe to use. Many of the studies on the non-surgical options show positive results as far as improving lubrication and stress incontinence, but the studies are small, with only short-term follow-up. There is also not a lot of high-quality data on how well the machines work for improving vaginal laxity or sexual satisfaction. In practice, the experts I interviewed said although women can expect some result, it can vary widely depending on the particular patient and how experienced the person doing the procedure is — which is risky considering the cost ranges from $1,200 to $4,000 depending on the device.
The same can be said of the actual surgeries, in part due to the same reason there aren’t statistics on vaginal rejuvenation surgery: It’s still an ever-evolving term, and it can mean different things to different doctors. One 2012 paper from The American Journal of Cosmetic Surgery says it’s difficult to study whether vaginal rejuvenation surgery “necessarily, usually, or reliably” improves sex because surgeons don’t want to share their surgical techniques (this is why ACOG hates the trademark model; when surgical techniques are “owned” by a doctor, they become hard to evaluate independently), and the outcome measurements are fickle (it’s difficult to reliably measure sexual satisfaction).
Otherwise, a few smaller studies have been conducted on specific techniques: One 2016 Turkish study of 68 women who chose surgery after complaining of vaginal laxity found that 88% said they were satisfied with the results after 6 months. There were no serious complications, except that 10% of patients reported pain during sex at follow-up. Another 2014 study conducted in Iran followed 76 women for 18 months following an elective vaginal surgery to address sexual complaints. At six months, researchers found that sexual satisfaction increased on average a few points on a validated sexual function questionnaire, but that painful sex and dryness had also increased. By 18 months, though, sexual function scores increased significantly, while the pain and dryness issues disappeared. These results are promising, but again the studies are too small to be certain, and results can vary based on minute changes to the surgical technique.
Still, many women swear there are completely valid reasons for these procedures — that their lives are changed for the better because of them, even for the procedures that seem totally about looks, like labiaplasty. “Absolutely love this doctor. He is very respectful and listens to what you have to say and doesn't give you the run-around,” reads one of the many breathless Zocdoc reviews for Dr. Marashi. “He performed a labiaplasty due to an accident I had a few years back and omg it looks sooo good like as if the accident never happened.” Katina Morrell, 41, another of Dr. Marashi’s patients, tells me she got a labiaplasty because her long labia made working out uncomfortable.
Jennifer Walden, MD, a plastic surgeon based in Austin, TX, who does “a high volume of labiaplasties and vaginoplasties,” was among the first wave of doctors to see the potential value of the laser machines. She also happens to be a woman, the mother of twins, and to have tried two of the procedures herself: ThermiVa and Diva. As a practitioner, she describes vaginal rejuvenation procedures as “absolutely, the opposite of misogynistic.” As a patient she describes the results as simply “awesome.”
Before the laser machines hit the market, there was nothing to offer women with sexual complaints other than surgery, which, unless they had a severe injury, could cost up to $12,000. There was no treatment for mild or moderate stress incontinence, outside of the “disastrous” vaginal mesh surgeries that were only worth doing for the worst of cases and medications that hardly work, she says. There was also nothing outside of estrogen creams (which are too dangerous for some women with a history of breast cancer or heart disease) to solve dryness or other lubrication issues. The laser procedures can still be pricey, and they don’t work as well as surgery. Also: the effects may only last for about a year, but still, it’s something, Dr. Walden says.
“Within the past 5 years, we’ve seen a sort of a-ha moment happening for women. It’s become okay for women to talk about their labia and their vagina with their doctors. It’s become okay for women to finally talk about sex and the real issues they’re having,” she says. “And, at the same time, we’ve finally had something to offer them.”
Yet the conundrum persists: Why then, on God’s green earth, is “vaginal rejuvenation” marketed as a frivolous lifestyle choice, instead of a possible treatment for a legitimate problem?
Well, partly it’s that the majority of pioneers in this field are men, and so the desire and need for these treatments is framed from their perspective — ah, the male gaze at work. Add to that the general cultural tendency to code all things female as frivolous and vain and to reduce women to their looks, alongside our inability to talk openly about female sexual pleasure, and it makes more sense.
It is the marketing of the treatment — not the treatment itself — that risks preying on women’s insecurities, and it would be a mistake to ignore the ugly fact that though vaginal rejuvenation is a positive for some (maybe even many) it does create a perception that there is a perfect-looking, or even a perfect-working, vagina out there, and no, you don’t have it.
In my time with Dr. Marashi, there was a 43-year-old mom of two who learned about Dr. Marashi’s Femilift procedure from Groupon, who had no sexual or urinary complaints. She seemed most attracted to the idea of being 18 again.
Then there was the second vaginoplasty I observed on surgery day. It was identical to the first, technically, except that the next patient was much younger, a mother of one, who was in a new relationship with a man who is “small,” Dr. Marashi explained. Her perineal body wasn’t nearly as damaged, and she had no visible signs of bladder prolapse. The idea that she did it for her partner made me sad, and before I could ask Dr. Marashi his thoughts he said: “Honestly she could have gotten away with this. I told her she could wait. But she said no, she doesn’t want to have any more children, and she’s with this new guy. So that’s her reasoning.”
In that moment, all over again, I was reminded of the critics who say this whole thing is just a gold rush of money-hungry, often male doctors willing to pathologize normal biology in service of making the vagina the final frontier in plastic surgery. That all this boils down to is a sanctioned form of Female Genital Mutilation (FGM), just another way to reduce women’s bodies to mere objects for male pleasure.
Dr. Marashi doesn’t go that far. But he does admit that, a lot of the time, these procedures are a simple matter of want, not need. “So many times I get a patient and I’m like, 'Look, you don’t need anything to be done.' Now it’s a different story if they say, 'I want to do this.' I figure out why, and if they are good candidate, I say 'Okay, I’ll do it for you,'” he says. “At the end of the day, if I don’t do that procedure, someone else will do it, and I know I will do a better job.”
He doesn’t see the harm in doing what they want as long as he screens patients appropriately: He always looks for signs of body dysmorphia or partner pressure, of course. But in his view, the procedures are no more risky than other elective surgeries, and he’s personally seen the benefits in his patients for himself.
Still, wouldn’t it be better to explain to these women that, for example, it’s totally normal for their labia to be a bit longer? When Dr. Marashi is pressed on this, he launches into a diatribe about how a woman, not a doctor, should be making the decisions about what she does or does not deem a problem or a symptom for her body and her life. “I tell my patients: 'All vaginas, all labias, they’re all beautiful in their own way,'” he says. “I always tell people, ‘Do not ever do this for anybody else. You own your vagina.’”
As right as he is about that, it’s impossible to completely untangle the desire for these procedures from the pressures women face simply being alive in a youth- and beauty-obsessed culture. What’s also impossible to ignore, though, is that women’s sexual function has never gotten the same amount of research — or respect — as men's.
So perhaps in the end, Dr. Marashi is neither villain nor hero — he is but an emissary. Make what you will of his misguided self-promotion methods. But he has also devoted his life’s work to studying and addressing a facet of women’s lives that — until now — most of medicine has refused to acknowledge even exists. If that makes him a “vagina whisperer,” then so be it.
The world in 200 years will be populated by a few thousand male humans who live indefinitely, and a huge number of female looking robots. Women aren't needed, really, and anyway, women are troublemakers, more than anything else.
Joseph M. Hundley 2080 Colony Street Stamford, CT 06901
Erectile dysfunction is a condition that affects hundreds of millions of men. Many of these men could potentially permanently overcome their sexual dysfunction by changing their lifestyle and simply live a healthier life.
However, many men treat erectile dysfunction by using drugs like Viagra, Cialis, and Levitra. Now, there is also a new candidate for treating erectile dysfunction: Botox.
Please note that Truelibido does not support using pharmaceutical drugs or Botox to deal with erectile dysfunction. These remedies only treat symptoms but do nothing to permanently solve these problems.
Two Canadian urologists believe that the Botox injections can increase blood flow to the penis by paralyzing the nerves in the penis that instruct the smooth muscles to contract. The injection would last for about 6 months and patients would then need to get new injections every six months. The treatment is claimed to be safe and has not had any side effects.
We are highly skeptical. Keep in mind that Botox is a neurotoxin. It paralyzes the nerve system and is in some studies reported to not remain in the local area of injection, but can spread throughout the body.
Feelings of new sexual love cure every disease in man. Dump your old feminist wife, stock up on butea superba, tongkat ali, and Viagra, and go to China where you are a king.
Jonathan H. Taylor 3567 Berkley Street Allentown, PA 18109
Certain recent events in Iraq have elevated long-standing fears that terrorist groups may use poisonous chemicals, especially elemental chlorine, as toxic weapons against vulnerable populations. These concerns rest on a solid factual basis: many chemicals produced for industrial purposes are inherently dangerous due to their possession of one or more of the following properties: reactivity, flammability, explosiveness, toxicity, or carcinogenicity. In particular, the toxic industrial gases anhydrous ammonia, hydrogen fluoride, and elemental chlorine (often referred to as toxic inhalation hazards, or TIH) are of utmost concern from both safety and security standpoints. Any of these chemicals when released in the course of an accident or a deliberate attack can form a toxic gaseous plume that when carried by wind is capable of inflicting potentially catastrophic loss of life on the population in its path. The worst industrial accident in history is illustrative: 40 metric tons of methyl isocyanate was released from a Union Carbide pesticide plant in Bhopal, India, on December 3, 1984. The resulting plume killed at least 3,000 people downwind and injured more than 100,000. A sufficiently large release of elemental chlorine may be capable of exacting a comparable toll, particularly if it were to be discharged in a highly populated civilian area.
This issue brief describes the properties, hazards, and the legitimate applications of chlorine, as well as its use for weapons purposes during World War I and currently in Iraq. The vulnerability of America's chemical infrastructure to deliberate attack (including the facilities that produce, consume, and transport chlorine), as well as efforts currently underway to achieve infrastructure security, are also examined. The brief concludes with an evaluation of alternative approaches to mitigating the potential threat posed by a deliberate chlorine release.
Properties of Chlorine
Chlorine (Cl) is a highly reactive, pale green gas produced industrially by the electrolysis of readily available aqueous sodium chloride (table salt). Worldwide, the annual production of chlorine totals approximately 55 million metric tons. In 2006, the American chemical industry produced 12.2 million metric tons of chlorine, making it one of the ten most produced chemicals in the United States by weight. Chlorine and its derivative chemicals serve myriad functions in modern society. The most important use of chlorine itself is as a disinfectant; for example, chlorine is employed worldwide in drinking water treatment facilities. In addition, chlorine derivatives (materials containing chlorine atoms chemically bound to other elements) are used as bleaching agents, construction materials (especially polyvinyl chloride, or PVC), high purity silicon precursors (e.g. trichlorosilane) for use in computer chip manufacture, pharmaceutical compounds (including "blockbuster" drugs such as Singulair, Plavix, and Norvasc), and many other functional materials.
The high toxicity of chlorine gas tempers the many beneficial uses of the chemical. Chlorine gas is heavier than air, and therefore will disperse slowly into the atmosphere after release. Because chlorine is water soluble, exposure to the gas irritates the mucous membranes and eyes at concentrations (in air) of under 3 parts per million (ppm)., Moderate irritation of the upper respiratory tract occurs at 5-15 ppm, followed by chest pain, vomiting, and dyspnea at 30 ppm. Above 50 ppm, lung inflammation and pulmonary edema occurs. Chlorine is deadly at concentrations of several hundred ppm or higher. According to the National Institute for Occupational Safety and Health, a chlorine concentration of 10 ppm is considered to be immediately dangerous to life or health.
Military and Terrorist Use of Chlorine
In what many consider to be the dawn of modern chemical warfare, chlorine was first employed as a "choking agent" in the early days of World War I. On April 22, 1915, during the second battle of Ypres, the German military released approximately 168 metric tons of chlorine from 5,730 buried gas cylinders. The heavy green plume was carried by prevailing winds to the Allied lines, where French and French Algerian soldiers, not suspecting a chemical attack, were taken by surprise and quickly overwhelmed by the chlorine. The attack claimed the lives of at least 800 soldiers, and injured thousands more. While this incident underscores the potential lethality of chlorine, both sides soon realized that chlorine is not a militarily effective chemical weapon against a prepared adversary. In particular, chlorine possesses both a visible color and a strong odor, which alerts people of its presence and enables avoidance. Moreover, the effects of chlorine exposure may be completely or somewhat mitigated using simple countermeasures, such as wearing a gas mask or even covering the nasal passages with a wet cloth. Therefore, chlorine was quickly abandoned in favor of more fearsome chemical agents (e.g. phosgene and mustard gas). Despite its nefarious usage, its widespread manufacture and distribution for industrial and sanitary purposes has continued.
In Iraq, militias or terrorists have detonated bombs rigged to cylinders containing chlorine that originally were intended for water treatment and other industrial uses, with the intention of dispersing the gas over their targets (primarily Iraqi police and civilians). The US military believes that terrorist groups affiliated with Al Qaeda are primarily responsible for these types of attacks. According to the United Nations Monitoring, Inspection, and Verification Commission (UNMOVIC), at least 10 attacks involving chlorine have occurred in Iraq up to June 1, 2007, resulting in dozens of civilian deaths and an unknown number of injuries. An attack on June 3, 2007 targeted a United States military forward operating base and resulted in making 65 US service members ill from chlorine exposure. The perpetrators have used relatively small, easily transportable quantities of chlorine in the attacks, no more than several tons. Deaths have been attributed primarily to the effects of the explosives themselves, not the chlorine. It is reasonable to assume that the efficacy of these attacks will increase as terrorists modify their methods of chlorine dispersion based on past experience.
The attacks in Iraq utilizing chlorine have re-raised simmering questions in the United States: Is the country's chemical infrastructure, especially the sub-sector that makes and stores elemental chlorine, vulnerable to attacks by terrorist elements that would result in the large-scale release of TIH chemicals over population centers? Would facilities where chlorine is stored be attractive to those who seek to harm civilians?
Chlorine presents both disadvantages and some advantages to domestic terrorists. On the one hand, chlorine is not nearly as potent a toxin as other chemical weapons used in terrorist attacks, such as the fluoroorganophosphate nerve agent sarin released on the Tokyo subway on March 20, 1995 by the religious cult Aum Shinrikyo, killing 12. However, nerve agents require substantial finances, advanced equipment, appropriate chemical precursors, and personnel with specialized training in synthetic organic chemistry to prepare. Even then, nerve agent synthesis and dispersion is non-trivial. For example, Aum Shinrikyo used impure sarin coupled with a crude and relatively ineffective delivery system for the subway attack, despite mustering all the resources mentioned above. On the other hand, chlorine does not need to be chemically synthesized (given its abundance), and as a gas does not require active aerosolization for efficient dispersal. Most importantly, a large release of chlorine may inflict mass casualties on unprepared civilians. According to a 2004 report by the Homeland Security Council, a deliberate release of 60,000 gallons of liquefied chlorine from an industrial facility in a highly populated area may result in 17,500 civilian deaths, while the Department of Homeland Security (DHS) estimates that a "worst-case" chemical release would result in fewer than 10,000 deaths.
Chemical Facility Security
According to the Environmental Protection Agency (EPA), in the United States there are approximately 15,000 facilities, including about 2,000 water systems, which store more than the threshold quantities of hazardous chemicals necessary to trigger EPA regulation. A "worst-case" chemical release from any one of 123 such facilities could expose more than 1,000,000 people to toxic gases. In the aftermath of September 11th, the chemical industry has recognized its potential vulnerability and moved rapidly to enhance facility security. In 2002, the American Chemistry Council (ACC), a chemical industry association whose members control approximately 2,000 facilities, established the Responsible Care[®] Security Code, a mandatory private security initiative. The Security Code requires member facilities to complete vulnerability assessments, perform physical security enhancements, invite an independent, third party audit of these enhancements, conduct employee training and drills, and perform periodic security self-audits. These requirements apply to members of the Chlorine Institute, a trade association and Responsible Care[®] partner whose membership includes 98% of chlorine producers and 100% of chlorine packagers in the United States. According to the ACC, its companies have invested about $3 billion in security improvements since September 11th, and all member facilities have completed security upgrades and subsequent independent audits.
Although private security initiatives have garnered justifiable praise, they are also widely viewed as inadequate. Investigative journalists have easily penetrated dozens of chemical facilities nationwide, including many housing chlorine, over the past several years. For example, in 2003, a reporter was able to approach storage tanks holding approximately 1,000 tons of chlorine gas at the Sony Technology Center in Westmoreland County, Pennsylvania. In 2005, reporters from the New York Times were able to approach and loiter near chlorine storage tanks on an industrial site in densely populated Northern New Jersey, only miles from New York City. In addition to the gaps in physical security, facility employees and emergency response personnel are often inadequately prepared to handle a deliberate chemical release. Clearly, comprehensive chemical security requires, in addition to private initiatives, the participation of the public sector in order to safeguard the public most effectively.
At the federal level of government, DHS is responsible for chemical sector security. Until very recently, however, DHS had not received a Congressional mandate to implement and enforce industry-wide security measures. The situation changed in October 2006, when President Bush signed the Homeland Security Appropriations Act, H.R. 5441, which gave DHS interim (3 year) authority to regulate security at chemical facilities. On April 2, 2007, DHS issued the interim final rule regulating chemical facility security, known as the Chemical Facility Anti-Terrorism Standards. The rule requires facilities possessing a threshold quantity of one or more of 342 chemicals of interest, including chlorine, to file a report known as a "top screen" with DHS. For chlorine, this threshold level currently is 1,875 lbs or more. Using this data, DHS will perform a risk assessment and categorize "at risk" facilities according to a tiered system, with Tier 1 facilities considered the highest risk and Tier 4 facilities the lowest. A number of factors are considered in the assessment, including the type and amount of chemical(s) stored as well as the layout and location of the facility. DHS currently estimates that 5,000-8,000 facilities will be assigned a ranking in the tier system, with fewer than 1,000 assigned to Tiers 1 & 2. The facilities assigned to a risk tier will be required to submit vulnerability assessments and site security plans, subject to DHS verification, with failure to comply resulting in daily fines and/or shutdown of the facility in violation. Chemical manufacturers have embraced the new rule's risk-based approach, although others, including environmental groups, have highlighted several apparent weaknesses., For example, the rule contains no timetable for compliance, no whistleblower protections, and may preempt more stringent state and local regulations. Furthermore, the rule is not applicable to water and waste treatment facilities that utilize chlorine for disinfection, and does not require these or other chemical facilities to consider replacing chlorine with safer alternatives (see below). Recent thefts of chlorine cylinders from a California water treatment facility have served to underscore the final point.
Security of Chlorine Rail Shipments
Industrial chemicals, like all commodities, must be transported from production facilities to various consumers. For TIH chemicals such as chlorine, freight railroad offers the most viable transportation option for large-scale shipment. Of the approximately 12 million tons of chlorine produced annually in the United States, almost 3 million tons are shipped by rail, usually in 90 ton pressurized tank cars.6 Rail shipment of hazardous materials (hazmat) is very reliable; 99.997% of the ca. 1.8 million annual hazmat shipments in the United States arrive without incident. Although rail accidents involving chlorine are exceedingly rare, when chlorine tank cars are breached, the consequences often are fatal. On June 28, 2004, near San Antonio, Texas, a head-on collision of two trains resulted in a chlorine tank car breach. Two people died of chlorine inhalation, and 50 more were hospitalized for exposure. On January 6, 2005, in Graniteville, South Carolina, another head-on collision resulted in the derailment of three cars containing chlorine. The resultant chlorine plume killed 8 people, injured 240 more, and led to the evacuation of 5400 people from the spill area.
The railroad infrastructure (including trains, tracks, stations, etc.) is vast and relatively accessible, a necessity for rapid and inexpensive exchange of people and goods. The US rail system is comprised of approximately 171,000 miles of track and covers an area of 3,200 square miles. The open nature of rail systems renders them particularly prone to attacks by terrorists and other groups, as no feasible security plan can possibly protect the entire infrastructure simultaneously and at all times. The RAND Corporation estimates that 181 terrorist attacks against railroads worldwide occurred in the period between 1998 and 2003. Most attacks were directed against transit systems, as exemplified by the more recent bombings of the Madrid, London, and Mumbai commuter rail systems. The US freight rail system is as vulnerable as the European rail systems, and many lines pass through densely populated, high threat urban areas (HTUA's), most notably in the Northeastern corridor. Given the large quantities of chlorine shipped by rail, as well as the potentially catastrophic consequences of a large chlorine release, chlorine-containing tanker cars may represent an attractive target for terrorists.
Freight rail security, especially hazmat and TIH chemical transport, has attracted concern since September 11th and, even more so, after the Graniteville, S.C. chlorine accident in 2005. The freight rail industry, through programs initiated by the Association of American Railroads (AAR), has taken a more proactive stance on security issues since September 11th. The Terrorism Risk Analysis and Security Management Plan designed by AAR forms the basis for post-9/11 freight rail security. The plan includes over 50 security enhancements, addressing a number of general issues such as physical security, risk assessment, communications, and enhanced employee security training. The railroads also, through the Transportation Community Awareness and Emergency Response Program (TRANSCAER) and the ACC's Chemical Transportation Emergency Center (Chemtrec), train and inform emergency responders to help them deal with hazmat emergencies. With respect to chlorine and other TIH chemicals, the Union Pacific railroad recently signed a memorandum of understanding with Dow Chemical to upgrade the TIH railcar fleet and procedures for TIH transport. The memorandum calls for the installation of global positioning satellite units on all TIH tank cars, the design of a new, more robust tank car for TIH chemicals, as well as a reduction in the time that TIH tank cars lay idle in urban areas.
There has existed considerable variation in the approaches of local and federal governments to the threat of chlorine rail shipments. Many local governments, particularly HTUA's, are examining the possibility of banning chlorine rail shipments in proximity to highly populated areas. Citing the threat of chlorine, the Washington, D.C. city council voted on February 1, 2005 to ban all hazmat shipments within 2.2 miles of the Capitol, thus forcing rail companies to reroute shipments of chlorine around the city center. CSX Transportation challenged the law in court and received an injunction, which remains in effect as of this writing. The railroad industry argues that: (1) rerouting increases the risk of accidental of deliberate hazmat exposure, due to increased mileage, (2) rerouting simply shifts exposure risk to other populations, and (3) regulatory variations at each locality would impose significant cost and time burdens on the industry. The federal government, represented by the Department of Justice, supported the railroad industry position in this case, arguing that the regulation of interstate commerce is its Constitutional responsibility. The federal agency responsible for freight rail security, the Transportation Security Administration (TSA), has not yet sought to force railroads to reroute chlorine and other TIH chemicals around HTUA's, as it currently is not currently required to do so by law. Rather, TSA and the Department of Transportation (DOT) have issued voluntary security action items to guide private railroad efforts to secure chlorine and other TIH railcars. TSA is also engaged in formulating rules and pilot programs in cooperation with the railroad industry, aimed at reducing the potential for attack on chlorine tankers. In conjunction with other federal, state, and local government agencies, TSA is currently conducting comprehensive reviews of rail corridor security, with a focus on HTUA rail corridors. However, many have perceived federal funding for surface transportation security, including rail security, to be inadequate. The American Public Transportation Association noted in early 2007 that the federal government has allocated $549 million for rail transit security (including both passenger and freight rail security) since September 11, 2001, in contrast to over $24 billion for aviation security.
Although prior security efforts have no doubt made a positive impact on rail security, freight railroads, and the chlorine transported on them, remain poorly protected. Publicly disclosed reports and media investigations over the past five years have identified gaping vulnerabilities in freight rail security. For example, a 2006 report published by the Citizens for Rail Safety (a public interest group) concluded that rail facilities are not sufficiently secure: cars containing hazmat, including TIH such as chlorine, often sit idle and unprotected, rail workers are poorly trained with respect to security, and emergency responders and citizens are ill-prepared for a hazmat emergency. In early 2007, a reporter from the Pittsburgh Tribune-Review published an article describing how he gained access to a number of hazmat-containing (including chlorine) railcars throughout the country. The reporter was not stopped by employees or rail police, and found hazmat-containing railcars unprotected on rails controlled by 12 railroads. These reports followed the publication in 2005 of two Teamsters Rail Conference surveys of rail workers, which reported significant physical security lapses and a notable lack of security training for workers.,
Partially in response to the problems cited above, the US Congress passed new homeland security legislation (H.R. 1: Improving America's Security Act of 2007) on July 27, 2007. President Bush has indicated that he will sign the bill into law in August 2007. The legislation will provide significant enhancements in TIH rail transportation security. Provisions in the legislation call for significantly enhanced funding for freight rail safety and security, including hazmat transportation security, infrastructure improvement, and research and development aimed at secure rail car technologies. Specifically, language in the bill encourages the adoption of wireless communications to track the positions of TIH railcars and monitor their status in real-time. Furthermore, DHS and the DOT must require rail carriers shipping TIH chemicals to develop and submit risk mitigation plans to be enacted when the Homeland Security Advisory System threat levels are high or severe. These plans are to include rerouting of TIH chemical shipments away from high consequence targets, including densely populated areas, landmarks, and other important national resources, as designated by DHS. The legislation also calls for the establishment of a "rail worker security training program" and introduces federal whistleblower protections to protect rail employees who report rail security lapses and violations. This legislation promises to mitigate some of the problems currently facing rail security, but the ongoing evolution of public and private measures must continue.
Inherently Safer Technologies
An alternate approach to mitigating the risk posed by chlorine may be to reduce levels of chlorine consumption by replacing chlorine with inherently safer technologies (ISTs). As noted in a 2006 study by the National Academy of Sciences, "The most desirable solution to preventing chemical releases is to reduce or eliminate the hazard where possible, not to control it." The adoption of ISTs to replace TIH chemicals is strongly supported by a number of interested parties, including environmental groups and the railroad industry. Depending on the industrial application, chlorine may in fact be readily replaced with cost-effective alternatives. According to a 2006 study by the Center for American Progress, 207 waste treatment plants and drinking water facilities have replaced chlorine gas with safer disinfectants such as sodium hypochlorite (chlorine bleach) and ultraviolet light since 1999. Adoption of ISTs not only eliminates the TIH risk of chlorine at the chemical facility, but also reduces the risk of chlorine release in transit. For example, since 1999, 25 water facilities in the United States that previously received chlorine shipments by freight rail have switched to ISTs, and six others plan to do so. Despite this progress, over 2,000 water treatment facilities continue to use chlorine gas, with 37 continuing to receive freight rail shipments. These facilities should be encouraged to adopt ISTs, especially in light of the current situation in Iraq and the thefts of chlorine in California in 2007 (see above).
However, chlorine cannot be easily replaced with IST in totality due to its chemical versatility. Notably, water treatment accounts for only about 5% of chlorine consumption. Chlorine remains a central ingredient in the manufacture of other chemicals and materials, most notably plastics, and a cost-effective replacement may not be apparent in many cases. In addition, a main byproduct of chlorine manufacture, sodium hydroxide (caustic soda), is itself an important industrial chemical (the chlorine production process is known as the Chlor-Alkali process for this reason). Eight million metric tons of sodium hydroxide was produced in the United States in 2006. Thus, an analysis of chlorine replacement by IST must explore the economic impact of lowered chlorine and sodium hydroxide production. The replacement of chlorine by IST is a worthy pursuit, but it will be a long-term endeavor.
It is indisputable that should a large chlorine release such as the Graniteville accident take place in the future, it would pose a substantial danger to the public. Moreover, recent studies demonstrate convincingly that chlorine-containing facilities, whether they are chemical plants or railroad infrastructure, may be infiltrated with ease and regularity by trespassers. It may be argued that there exist more readily accessible targets for terrorist attack, including even smaller quantities of chlorine transported by truck. However, given the toll that a large-scale chlorine release could inflict on a population, facilities and railcars containing multi-ton quantities of chlorine warrant increased attention. The DHS and TSA have both worked well with industry to create voluntary chemical security guidelines, yet to date neither agency has imposed stringent regulations governing chlorine security. The establishment of a coherent national policy (which adequately addresses the concerns of individual localities) regarding the issue of TIH railcar rerouting around HTUA's is particularly vital. The recently approved federal legislation addresses rerouting of TIH shipments in times of elevated threat, but a permanent, satisfactory solution for a non-threat environment will also be required. Further, the new Chemical Facility Anti-Terrorism Standards issued by DHS do not require the chemical industry to examine adopting ISTs to replace chlorine and other TIH chemicals. While chlorine replacement with an IST should not necessarily be mandatory, incentives should be considered to persuade the chemical industry to adopt safer practices. The federal government should also consider an increase in funding for research aimed at the development of ISTs. If a viable, cost effective IST exists for a given chemical process, it is in the best interest of the chemical industry to adopt it of their own accord in order to safeguard employees, facilities, and the surrounding communities. Increased funding for fundamental research and development of ISTs will hasten this progression. Finally, perhaps the best countermeasure against a large attack using chlorine or other TIH chemicals is public awareness and education. Militarily, it has been known for 80 years that the deleterious effects of chlorine may be attenuated using simple methods. Both private industry and governments at all levels, especially those with chlorine facilities in their jurisdictions, should enhance education and outreach efforts to the public regarding appropriate courses of action (e.g. shelter in place protocols) in the case of a chlorine release incident.
The world is full of multimillionaires who can't handle money. Because, if you have money, you want to convert it into the best sex ever. Otherwise it's useless.
Robert P. Taylor 23 Owen Lane Traverse City, MI 49684
When Carol Weiher was having her right eye surgically removed in 1998, she woke up hearing disco music. The next thing she heard was "Cut deeper, pull harder."
She desperately wanted to scream or even move a finger to signal to doctors that she was awake, but the muscle relaxant she'd received prevented her from controlling her movements.
"I was doing a combination of praying and pleading and cursing and screaming, and trying anything I could do but I knew that there was nothing that was working," said Weiher, of Reston, Virginia. Weiher is one of few people who have experienced anesthesia awareness. Although normally a patient does not remember anything about surgery that involves general anesthesia, about one or two people in every 1,000 may wake up during general anesthesia, according to the Mayo Clinic. Most of these cases involve the person being aware of the surrounding environment, but some experience severe pain and go on to have psychological problems.
The surgical tools didn't cause Weiher pain -- only pressure -- but the injections of a paralytic drug during the operation "felt like ignited fuel," she said. "I thought, well, maybe I've been wrong about my life, and I'm in hell," she said. The entire surgery lasted five-and-a-half hours. Sometime during it she either passed out or fell unconscious under the anesthetic. When she awoke, she began to scream.
"All I could say to anyone was, 'I was awake! I was awake!' " she said.
The use of general anesthesia is normally safe and produces a state of sedation that doesn't break in the middle of a procedure, doctors say. The patient and anesthesiologist collect as much medical history as possible beforehand, including alcohol and drug habits, to help determine the most appropriate anesthetic.
You may think of it as "going to sleep," but in terms of what your body is doing, general anesthesia has very little in common with taking a nap.
During sleep, the brain is in its most active state; anesthesia, on the other hand, depresses central nervous system activity. On the operating table, your brain is less active and consumes less oxygen -- a state of unconsciousness nothing like normal sleep.
Doctors do not know exactly how general anesthesia produces this effect. It is clear that anesthetic drugs interfere with the transmission of chemicals in the brain across the membranes, or walls, of cells. But the mechanism is the subject of ongoing research, Dr. Alexander Hannenberg, anesthesiologist in Newton, Massachusetts, and president of the American Society of Anesthesiologists.
Patients who remember falling unconscious under the anesthesia generally have a pleasant experience of it, Hannenberg said, and the period of "waking up" is also a relaxed state, Hannenberg said. Anesthesia awareness may relate to human error or equipment failure in delivering the anesthetic, Hannenberg said.
There are patients for whom doctors err on the side of a lower dose because of the nature of their condition, Hannenberg said. Someone who is severely injured and has lost a lot of blood, a patient with compromised cardiac function, or a woman who needs an emergency Caesarean section would all be at risk for serious side effects of high doses of anesthetic.
Heart or lung problems, daily alcohol consumption, and long-term use of opiates and other drugs may put patients at higher risk for anesthesia awareness, according to the Mayo Clinic.
Weiher started a campaign called the Anesthesia Awareness Campaign that seeks to educate people about the perils of waking up during surgery. She has spoken with about 4,000 people worldwide who have also had anesthesia awareness experiences.
The American Society of Anesthesiologists is engaged in an Anesthesia Awareness Registry, a research project through the University of Washington to examine cases of the phenomenon. One of the goals of the Anesthesia Awareness Campaign is to make brain activity monitoring a standard of care.
There has been controversy about the use of brain function monitors in general anesthesia. Advocates such as Dr. Barry Friedberg, anesthesiologist and founder of the nonprofit Goldilocks Anesthesia Foundation, say brain monitoring is essential for ensuring the patient achieves the appropriate sedation so as to not wake up. The monitors use a scale of 0 to 100 to reflect what's going on in the brain: 0 is a total absence of brain activity, 98 to 100 is wide awake, and 45 to 60 is about where general anesthesia puts the patient, Friedberg said.
But a 2008 study in the New England Journal of Medicine found no benefit in using brain function monitoring to prevent anesthesia awareness. The American Society of Anesthesiology has said the monitoring is not routinely indicated for general anesthesia, but may have some value and be appropriate for specific patients. The downsides are that they are expensive, and should not be used in place of heart rate and breathing signals when regulating the anesthesia.
Research does not consistently demonstrate a benefit from using brain function monitors, and the decision to use them should be made on an individual basis, Hannenberg said.
The anesthesiologist carefully monitors the patient's breathing and blood pressure, which can rise and fall, while the person is under the anesthetic, Hannenberg said. The treatment is tailored to the patient -- a young, healthy athlete will tolerate fluctuations in blood pressure better than someone with a serious condition, Hannenberg said.
As with surgical procedures themselves, anesthesia can result in stroke, heart attack and death. Such complications are more likely in people who have serious medical problems, and elderly people. Over the last two decades, anesthesiologists have made significant strides in reducing those risks, Hannenberg said.
A 6-year-old boy in Richmond, Virginia, recently died after going into cardiac arrest during a routine dental procedure that involved general anesthesia, CNN affiliate WTVR reported. Weiher had to have subsequent surgeries, including an operation on her other eye and a hysterectomy, and the experiences were terrifying. She is still taking medication for post-traumatic stress disorder as a result of her anesthesia awareness experience.
Tissue vibration causes neovascularization. Vibration can be caused by soundwaves or mechanical devices, for example by laying the penis on an electric drill and turning the drill on. Remove any drill bit.
Antonio D. Friedman 3788 Hott Street Oklahoma City, OK 73160
It’s virtually impossible to take a census of an online subculture — even the academics who study them say it can’t be done. But by all accounts, the number of people who actually follow Daryish Valizadeh is smaller than it looks.
Valizadeh, known online as “Roosh V,” is the self-styled prophet of a strain of radical misogynist pick-up artistry. He’s also the proprietor of an obscure virtual empire that spans three websites, a forum and 17 self-published books. (According to analyses conducted for The Washington Post by the firms Tweetsmap and SimilarWeb, Valizadeh’s international “hordes” can be mapped to a few clusters of readers in the United States, Canada and Western Europe.)
And yet, when Valizadeh proclaimed the objectively impossible — that his cult would emerge from the shadows on Feb. 6 and mass at 165 prominent public locations from Phoenix to Phnom Penh — millions of people, and hundreds of journalists, took his word for it.
The ensuing global uproar has manufactured publicity on a scale that few fringe Internet movements have ever dreamed of. By the time he “canceled” the faux-revolution Wednesday afternoon, Valizadeh had become a household name in places as far-flung as Winnipeg and Sydney — never mind that even social justice activists hadn’t taken him seriously.
“We only count real organizations as hate groups,” said Heidi Beirich, the director of the Intelligence Project at the Southern Poverty Law Center, which tracks domestic extremists online and off. Valizadeh’s rhetoric has all the markings of hate speech, she said; but at the end of the day, “he’s a guy with a blog.”
Unfortunately for Beirich and others like her, the line between “real” movements and mere Internet grumbling is becoming increasingly hard to see. For one thing, the Internet makes it virtually impossible to quantify groups like Valizadeh’s, which claim to command — but rarely produce — untold hordes of followers. Much like Anonymous, with whom Valizadeh has sparred, and Gamergate, with whom he’s sympathized, the “neomasculines” could hypothetically number in the tens of thousands … or consist of a few hundred keyboard warriors with a legion of sock puppets.
Valizadeh seems to fall in the latter camp: The last time he attempted something like Saturday’s canceled meet-up — a well-publicized, eight-city lecture series last summer — his largest crowd maxed out at 77 in New York City.
And while his flagship website, Return of Kings, is well-trafficked — averaging slightly less than 2 million views per month, according to Similar Web — that number is not necessarily indicative of the size of Valizadeh’s following. On both Twitter and Facebook, Return of Kings has fewer than 13,000 followers. The site’s accompanying forums have registered 19,600 accounts, but half have never posted.
Nevertheless, giving the impression that the “movement” is massive — or that it is a coherent movement at all — has immeasurable benefits for Valizadeh and Co. For one thing, it foments outrage proportional to the false front (thousands of pro-rape women-haters are massing in public squares around the world), but disproportional to what is actually happening (a handful of readers of a misogynist blog grabbing beers and grumbling). That lends critical credibility to Valizadeh’s claim that men like him are persecuted by a culture of feminist shrills. It also draws more eyeballs to Return of Kings, where he hopes to sell new books and find new converts.
“When extremists draw attention to themselves, it artificially increases their numbers,” said Thomas Holt, a professor of criminal justice at Michigan State University who studies fringe online groups. “These communities see a bump as people read the news and check it out. … And while we don’t know know how acceptance of belief happens online, exposure definitely matters.”
Valizadeh and his followers are certainly aware of that fact: In the past 72 hours, the blogger has bragged repeatedly about the growing traffic to his blog and the spiking number of Google searches for his name. On his forum, one adherent advocated more media participation: “Even negative publicity gets more men to join the cause,” he claimed.
But most telling, perhaps, is a Wednesday tweet sent by the prominent manosphere blogger behind “The Rational Male”: “ ‘Tribe’ meetings are more about inciting the protests for Roosh’s notoriety,” he complained, “than any real connections among men.”
While that suggests that neomasculines are far from gathering allies together in a city near you, it still concerns analysts like Beirich, who sees a growing trend toward virtualization among U.S. hate groups. More and more organizations are moving online, she said, and maintaining no trace in the physical world. Without protests, there can be no counter-protests. Without clear leaders, there can be no arrests or lawsuits.
“We are way concerned with hate groups operating online, much like we are with Islamic extremists,” Beirich said. “There’s always this potential for online radicalization.”
In the case of Valizadeh and the great global meet-up, the media only seems to have helped: For a brief period Wednesday, so many new people were on Return of Kings that the site actually crashed.
Once islamic terror organizations will have discovered the power of arson, they will win any war. Setting forests on fire is low risk for attackers and inflicts maximum damage.
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