Senator Bernie Sanders of Vermont has called on a government watchdog to investigate. Here’s what you need to know.Last week, Senator Bernie Sanders of Vermont, chair of the Senate health committee, called on a government watchdog to investigate why insurance companies are still charging women for birth control — a move that thrust access to contraceptives back into the spotlight.In a letter to the Government Accountability Office, the senator noted that insurance companies were charging Americans for contraceptives that, under federal law, should be free — and that they were also denying appeals from consumers who were seeking to have their contraceptives covered. Some experts estimate that those practices could affect access to birth control for millions of women.Since 2012, the Affordable Care Act has mandated that private insurance plans cover the “full range” of contraceptives for women approved by the Food and Drug Administration, including female sterilizations, emergency contraceptives and any new products cleared by the F.D.A. The mandate also covers services associated with contraceptives, like counseling, insertions or removals and follow-up care.That means that consumers shouldn’t have any associated co-payments with in-network providers, even if they haven’t met their deductibles. Some plans might cover only generic versions of certain contraceptives, but patients are still entitled to coverage of a specific product that their providers deem medically necessary. Medicaid plans have a similar provision; the only exception to the mandate are plans sponsored by employers or colleges that have religious or moral objections.Yet many insurers are still charging for contraceptives — some in the form of co-payments, others by denying coverage altogether.A Quarter of Women Are Paying Unnecessarily for Contraceptives In his letter, Senator Sanders cited a recent survey by KFF, a nonprofit health policy research organization, that found that roughly 25 percent of women with private insurance plans said they had paid at least some part of the cost of their birth control; 16 percent reported that their insurance plans had offered partial coverage, and 6 percent noted that their plans did not cover contraceptives at all. Additionally, a 2022 congressional investigation, which analyzed 68 health plans, found that the process to apply for exceptions and have contraceptives covered was “burdensome” for consumers and that insurance companies denied, on average, at least 40 percent of exception requests.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Changes to the vagina can mess with your sex life. But there are solutions that work.In a 2022 study that asked a few dozen postmenopausal women who experienced pain during penetrative sex to describe their experiences of intercourse, the most common response was “burning.” Other terms were “raw,” “dry,” “sharp,” “ripping,” “sandpaper” and “knives.”What they were describing is known as dyspareunia, which is one of the more overlooked and under-treated symptoms of menopause, said Dr. Martha Goetsch, an emeritus assistant professor in the obstetrics and gynecology department at Oregon Health & Science University and a co-author of the paper.Dyspareunia can occur at any life stage but it spikes after the menopausal transition, though signs can emerge during perimenopause too, said Dr. Lauren Streicher, clinical professor of obstetrics and gynecology at Northwestern University and author of “Slip Sliding Away: Turning Back the Clock On Your Vagina.” Estimates about the prevalence of dyspareunia range between 13 and 84 percent of postmenopausal women — a highly inexact figure in large part because many women and doctors don’t broach the subject.As a result, women often don’t receive the care they need for dyspareunia despite the fact that it is easily treatable, Dr. Streicher said. If left untreated, the condition can worsen to a point that it leads to a loss of self-esteem, reduced quality of life, depression and a significant shift in the relationship dynamic with a partner.“They just think ‘OK, well, I guess my sex life is over,’” Dr. Streicher said.Why does sex become painful in menopause?The drastic drop in estrogen during and after menopause is the main reason sex can become a painful affair. Among its many functions, estrogen is responsible for keeping the vaginal walls elastic and lubricated, Dr. Streicher said. The accordionlike folds in the vaginal wall that enable them to stretch, called rugae, are plumped up by estrogen.Without it, the vaginal walls thin out, the rugae all but disappear and lubrication becomes “history,” Dr. Streicher said. “When we look inside the vagina with the speculum, we can see it — we can see that these little folds in the skin are no longer there” and the lining is dry.The loss of estrogen also alters the vestibule — the small, highly sensitive entryway to the vagina that is packed with nerve endings or, as Dr. Goetsch described it, “the two square inches that could wreck your life.” In fact, in her research and among her patients, she has found that a majority of women who complained about painful sex suffered from pain in the vestibule rather than inside the vagina. After menopause, those two square inches can become extremely tender. In her research, Dr. Goetsch has found that it might be because the drop in estrogen may stimulate a proliferation of new nerve endings in the area, which can signal pain.“Quite a few animal studies show that when estrogen levels go low, the various nerves sprout new nerve endings,” she said, “and then when the estrogen levels go back up, those extra nerve endings are pruned back.”Not all postmenopausal women will experience severe changes associated with the drop in estrogen, but even mild shifts in the vagina can make pain-free, pleasurable sex elusive, leading to irritation and possibly even cuts and tears of the brittle vaginal tissues, Dr. Goetsch said.There are several other factors that can also contribute to dyspareunia among menopausal women. The hormonal changes alter acidity levels of the vagina, Dr. Streicher said, which can lead to recurrent urinary tract infections among menopausal women, creating discomfort in the area whether or not they are having sex. And some common health conditions among older people, like diabetes or cardiovascular disease, can also dry out the vagina, she added.So what is the solution?It all depends on the degree of changes to the vaginal area, Dr. Streicher said, and the safest way to determine what treatment you need is by seeking out an expert who will do a thorough exam. “There’s a big difference between ‘Oh, you know, I’m not as wet as I usually am’ versus it is so dry, so tight and so thin that the tissue literally splits.”Here are a few of the treatment options:Lubricants: This is a quick and easy solution for women who suffer only from dryness. Dr. Streicher recommends warming the lubricant because “cold is a vasoconstrictor, which will make you have even less natural lubrication, whereas heat is a vasodilator and will help the muscles relax,” she said. One option is placing a bottle of lubricant in a bowl of hot water for a few minutes before use.Vaginal moisturizers: These creams and gels can be found over the counter. “What they actually do is increase water content in vaginal mucosal cells — the ones that are lining the wall,” Dr. Streicher said, helping restore their elasticity and lubrication, though they can also be helpful for those who have pain in the vestibule. Some moisturizers can also help lower vaginal pH levels, she said. Beware that many lubricants market themselves as moisturizers; the difference is that a moisturizer will have instructions to apply it inside the vagina, Dr. Streicher said, whereas a lubricant should only be used on the outside.Estrogen creams: Studies have repeatedly found that this prescription option is highly effective at reducing pain, including in the vestibule area. They are generally low-dose, localized and come in different formulations that your doctor can help you choose among.Lidocaine: This is an unconventional prescription option that Dr. Goetsch has recommended for many of her patients, particularly those who can’t use hormones, like breast cancer survivors. Liquid lidocaine is an anesthetic that numbs the nerve endings of the vestibule. In a small randomized trial in women with dyspareunia, lidocaine reduced pain substantially during intimacy for most participants, Dr. Goetsch said, and women who had sex while using lidocaine rarely reported residual pain after the anesthetic wore off. And, Dr. Goetsch added, application of liquid lidocaine didn’t numb the partner.

The things Nataliya Pleshkova misses most about her childhood home in central Ukraine are the smells.In 2011, Ms. Pleshkova, 42, moved to Estes Park, Colo., with her daughter, seeking better work opportunities, and, in September of this year, her mother followed, fleeing their war-torn homeland.“Mama packed some of the clothes I had left in Ukraine, and the first thing I did was bury my head and nose into the pile because it smelled like home,” she said. “Memories of my childhood rushed through my head. I remembered playing hide and seek in the wardrobe where these clothes hung.”For her mother, Tamara Plieshkova, it is her husband’s grave in the cemetery back home that she knows she’ll miss, and her pets — a dog and a cat — that she had to leave with a neighbor.“She said she feels like she’s an old, mature tree being replanted into new soil,” Ms. Pleshkova said, translating for her 69-year-old mother who does not speak English, and was fresh off a 96-hour journey from Ukraine to the United States, via Poland and France.Feeling uprooted is something many immigrants are familiar with, split between the here and the back there, between the push to assimilate and the pull to preserve parts of themselves and their culture. And it is often the intangibles from home — the smells and sounds, the metaphors and jokes in a native tongue that can’t be translated, and cherished rituals — that they long for.When Nataliya Pleshkova, pictured left, moved to Estes Park, Colo., she packed a black and white framed photograph of her grandmother, taken in 1937, that reminds her of home. This September, her mother, pictured top right, fled their war-torn country, leaving behind a community of friends and her beloved pets, pictured middle right.Top left and bottom: Theo Stroomer for The New York Times; Top right and middle right: via Nataliya PleshkovaThough it is not well-known, that feeling has a name: cultural bereavement. Coined in 1991 by Dr. Maurice Eisenbruch, a psychiatrist and professor at Monash University in Melbourne, Australia, while interviewing Cambodian refugees, it is more complex than culture shock. Dr. Eisenbruch felt as though he needed more precise vocabulary to capture the refugees’ emotions and mental health; their experiences did not fit neatly under anxiety or depression or post-traumatic stress disorder, he explained in a paper at the time. Research from 2005 expanded the concept beyond refugees to all migrants and also children of migrants.Coping With Grief and LossLiving through the loss of a loved one is a universal experience. But the ways in which we experience and deal with the pain can largely differ.What Experts Say: Psychotherapists say that grief is not a problem to be solved, but a process to be lived through, in whatever form it may take.How to Help: Experiencing a sudden loss can be particularly traumatic. Here are some ways to offer your support to someone grieving.A New Diagnosis: Prolonged grief disorder, a new entry in the American Psychiatric Association’s diagnostic manual, applies to those who continue to struggle long after a loss.The Biology of Grief: Grief isn’t only a psychological experience. It can affect the body too, but much about the effects remains a mystery.“The tragedy for migrants is that their identity as a migrant quite often trumps everything else,” said Dinesh Bhugra, a professor of mental health and cultural diversity at King’s College London and the lead author of the 2005 study. “You are not a doctor who just happens to be a migrant; you’re suddenly a migrant doctor.” That “reorganization of the self” can lead to “multiple layers of stress,” he added, and depression or high levels of anxiety.Now, the term is slowly gaining recognition. Researchers around the world are starting to explore the phenomenon further, applying Dr. Eisenbruch’s original framework to other groups of refugees and migrants. One small study of Ethiopian refugees in South Korea, published in January, confirmed that cultural bereavement is characterized by complex mental distress. Nonprofit organizations that regularly work with refugees and new migrants are beginning to open up conversations about the phenomenon.But it is still rarely taught in the Western-trained mental health sphere or understood among clinicians and therapists. “While I was in grad school, I was taking a grief-counseling class, there wasn’t anything that covered cultural bereavement in what I was learning,” said Sahaj Kaur Kohli, who received a master’s degree in clinical mental health counseling and created Brown Girl Therapy, a social media account that discusses the specific mental health struggles that people of color experience.This summer she shared on social media that she was navigating cultural bereavement, and said in an interview that it quickly became one of her higher-performing posts, with dozens of people commiserating in the comments.“I just assumed that there was always going to be a part of me that felt alone and isolated. I would feel ashamed because I should know more about my family or my history,” Ms. Kohli said. “But when I talked about it openly on Brown Girl Therapy, I realized, oh my gosh, we’re all kind of navigating this in some capacity.”Why Cultural Bereavement Gets OverlookedWhat complicates matters is that cultural bereavement often manifests as amorphous depression or anxiety without an obvious cause, experts said. And the more an immigrant assimilates, the more intensely they might feel the grief of “losing familiar social structures, cultural values and self-identity,” as Dr. Eisenbruch described it.“When refugees or immigrants come to America, we know we’ve lost our country, food, language, all those clear objects, but we quickly jump into assimilation,” said Shinhee Han, a psychotherapist at the counseling center of the New School in New York City and co-author of the book “Racial Melancholia, Racial Dissociation.” “We think ‘I must lose the accent’ or ‘I must not smell like my food,’ without stopping to think about the consequences of shedding those parts of an identity.”The pandemic, which hindered family reunions, might have also intensified those feelings. “The losses that have been incurred over time or intergenerationally exploded during the pandemic because, all of a sudden, we couldn’t go see our families. I have patients who still have not been able to go to Hong Kong or other parts of the world to see their family members,” Dr. Han said. “So there is this kind of melancholia — an undercurrent of mourning.”The author Min Jin Lee, seated at her home in New York, saw signs of cultural bereavement in the experiences of her parents after they moved from Seoul, South Korea. Her father, pictured middle left during a work trip to Tokyo in the 1960s, was a marketing executive back home. But when Ms. Lee’s family, pictured middle right at the airport in Seoul, moved in 1976, he bought and ran a newsstand in what is now Koreatown, where he received little respect from customers. “That humiliation or loss of status would have been felt very keenly,” Ms. Lee said. Framed pictures of her family and childhood back in Seoul help Ms. Lee feel connected to her roots.Top and Bottom: Christopher Lee for The New York Times, Middle left and middle right: via Min Jin LeeDr. Eisenbruch noted in his 1991 research paper that a big part of the sadness associated with cultural bereavement comes from the inability to complete significant rites and rituals, like birth ceremonies or burials, in culturally specific ways.Paurvi Bhatt, 56, a health care executive in Minneapolis, Minn., said one of the hardest parts of losing her parents — who migrated from India in the 1960s — was recreating funerals for them the way that her family might have done at home. “We have to scatter the cremated ashes into the water,” she said. “That is very difficult to do here” because individuals have to get permits to dispose of anything into the water, hindering her ability to carry out that Hindu tradition.The author Min Jin Lee, 53, who often touches on the feelings of loss and grief associated with migration in her work, including in her novel “Pachinko,” witnessed degrees of cultural bereavement in her own parents after they moved to New York from Seoul, South Korea, in 1976. Her father was a marketing executive back home. After moving, he bought a newsstand in what is now the Koreatown neighborhood of the city.“I remember, as a little girl, watching people throw a dime at him or 15 cents to purchase the daily paper,” she said. “In Korea, when you hand an object to another person, you use both hands. That’s a sign of respect and he faced so many of these kinds of indignities.”Ms. Lee found others expressing that same sentiment when she conducted interviews for her books. “It’s not a nation or a place and it’s not just that they miss the taste of food — it’s that all those things are essentially associated with a loss of an identity.”To reconnect with her ancestors, Sahaj Kaur Kohli, a mental health professional, wears a bangle and ring that belonged to her grandmother. She has picked up a passion for collecting East Asian ceramics, pictured middle left, from her mother, shown middle right in India with Ms. Kohli’s father, who grew up in Japan.Top, middle left, and right: Gabriela Bhaskar for The New York Times; Middle right: via Sahaj Kaur KohliThough Ms. Pleshkova moved to the U.S. for better professional opportunities, she could only find work as a camp counselor and a day care worker, despite her experience as an English literature professor in Ukraine. “I was upset when I found out that the payment is not adequate,” she said. “And I did feel like I could do better. I’m suddenly at the bottom of the food chain.”She eventually decided to put aside her passion for teaching and now works in event planning for a steakhouse in her town. ‘My Feet are Hurting’The fact that people from different cultures tend to express sadness in different ways can further complicate how those individuals seek help, said Ms. Kohli. Oftentimes, given cultural stigmas around mental health, many people might not feel comfortable asking at all.“When my dad is stressed out, he’ll never say he’s stressed; he’ll say, ‘My feet are hurting.’ Or my mom will say, ‘I have a headache.’ She won’t say ‘I’m overwhelmed,’” Ms. Kohli said. “And that will show up in the room with a clinician as well, and there’s no rule book for a Western-trained practitioner that says, ‘Here’s the criteria for this type of grief, here’s how to medicate it, treat it and so on.’”Ms. Kohli suggests seeking out therapists who may have a deeper understanding of different cultural expressions of grief or anxiety and depression. During the pandemic, more and more of her Brown Girl Therapy followers were reaching out to Ms. Kohli asking for references to therapists who would understand their cultural background, so she made a spreadsheet of names that she linked to from her Instagram page.Even using and understanding the term cultural bereavement can be “powerful,” she said.“Naming it makes the grief more manageable. If you were to go to a clinician and say, ‘I think I’m struggling with cultural bereavement,’ I would hope a good clinician will do their research and will want to explore that with you to understand how it’s impacting you,” she said.There are also ways to cope beyond therapy. While it can look different for everyone, dealing with cultural bereavement often involves variations of two things. The first is rediscovering or relearning one’s history, culture and self, said Dr. Han, and the second is finding and building your community.She often recommends that her Asian American patients, for example, read books by Asian American authors or watch movies that represent their different cultures so that they can see their own experiences reflected back and feel less alone in their grief. It also helps resurrect the things — the food, the language, the smells — that were perhaps pushed to the side in an attempt to assimilate.After Ms. Kohli’s last grandparent died in 2019, she realized that she had lost all physical connection to her ancestry. So she started relearning her mother tongue, Punjabi, and is hoping to learn some family recipes from her mother.Seeking out community, Dr. Han said, can reduce feelings of isolation and help people recreate the kind of social network they might have had at home. This can involve befriending people at work or in your neighborhood who might have similar cultural backgrounds, and participating in or even organizing culturally specific annual celebrations, like the Lunar New Year.When Dr. Bhugra moved from Punjab to Cork, Ireland, in the 1980s, no one spoke his language. One day, “somebody told me about a guy in Dublin who spoke Punjabi,” Dr. Bhugra said. He looked up this stranger’s phone number and “rang him, just to speak Punjabi. I know it sounds rather silly but you miss those things; you miss language, you miss art and so on.”Ms. Bhatt said her parents were very deliberate in building community around them. “My mom and I would have a Diwali open house,” she said, referring to the annual Hindu new year festival of lights. “We’d open our doors, our neighbors were invited, anyone and everyone could come. That became a way for us all to feel a bit closer.”

What Men Who Have Experiences With Abortion Want People to Know

Ro, the parent company of Roman, the brand that is best known for delivering erectile dysfunction and hair loss medication to consumers, announced on Wednesday that it would acquire Modern Fertility, a start-up that offers at-home fertility tests for women.The deal is priced at more than $225 million, according to people with knowledge of the acquisition who spoke on condition of anonymity because the information was not public. It is one of the largest investments in the women’s health care technology space, known as femtech, which attracted $592 million in venture capital in 2019, according to an analysis by PitchBook.Modern Fertility was founded in 2017 with its flagship product: a $159 finger prick test that can estimate how many eggs a woman may have left, which can help determine which fertility method might be best.“We essentially took the same laboratory tests that women would take in an infertility clinic and made them available to women at a fraction of the cost,” said Afton Vechery, a founder and chief executive of Modern Fertility, noting that her own test at a clinic set her back $1,500.The company now also sells an at-home test, available at Walmart, to help track ovulation, as well as standard pregnancy tests and prenatal vitamins.Ro, which was founded in 2017 with a focus on men’s health and was valued in March at about $5 billion, has in recent years expanded into telehealth, including delivering generic drugs by mail. In December, Ro acquired Workpath, which connects patients with in-home care providers, like nurses.The global digital health market, which includes telemedicine, online pharmacies and wearable devices, could reach $600 billion by 2024, according to the consulting firm McKinsey & Company. And yet, by one estimate, only 1.4 percent of the money that flows into health care goes to the femtech industry, mirroring a pattern in the medical industry, which has historically overlooked women’s health research.“Gender bias in health care research methods and funding has really contributed to sexism in medicine and health care,” said Sonya Borrero, director of the Center for Women’s Health Research and Innovation at the University of Pittsburgh. “I think we’re seeing again — gender bias in the venture capital sector is going to exactly shape what gets developed.”That underinvestment was part of the reasoning behind the acquisition, said Zachariah Reitano, Ro’s chief executive. The company developed a female-focused online service in 2019 called Rory.“We’re going to continue to invest hundreds of millions of dollars over the next five years into women’s health,” Mr. Reitano said, “because ultimately I think women’s health has the potential to be much larger than men’s health.”