6
Contraception and STIs
Avoiding pregnancy and the lumps, bumps, and things that itch in the night
Sex can give us the most pleasurable moments of our life—and the most painful. Getting pregnant by the waiter in Greece who did more than lay your table or discovering a T-shirt wasn’t the only thing your ex left behind are both very real consequences of not treating sex with the respect it demands. Don’t kid yourself: having sex can be dangerous. Terminating an unwanted pregnancy is not fun. Getting very, very sick from a sexually transmitted infection (STI) is not fun. Dying from AIDS isn’t ever on the top of our “Things I want to do this year” list. And if you’re not careful, all can happen to you, no matter how “nice” you are.
Have I put you off sex for life? If you’re not prepared to take the associated risks seriously, I truly hope I have. But the fact is, most of the “nasties” of sex can be avoided. With all the contraceptive choices available today, you’d have to be a complete dud not to find a method that suits both you and your partner. That removes the pregnancy risk immediately. Condoms (used properly and every single time) significantly reduce the risk of sexually transmitted infection. Add a good dollop of common sense and sex education and your chances of catching one drop to almost zero. At the risk of sounding like your mother, reading this chapter will not only save you heartache, it could save your life.
HOW NOT TO GET PREGNANT
The ideal contraceptive is 100 percent effective, easy to use, and economical—with no known side effects. Unfortunately it hasn’t been invented yet. But here’s the good news: not only are traditional methods of contraception being constantly improved, there’s some new kids on the contraceptive block that you may never have heard of. So while there’s no such thing as a perfect contraceptive, for most women there’s one that comes pretty damn close! This is a list of the latest and greatest contraception around, to help you find a hassle-free method for your personality, lifestyle, and relationship. Since most women take responsibility for contraception, I’ve devoted this section to them. I’ve listed the prices for contraception as a comparative guide only. They were correct at the time of publication but may increase over time.
The symptothermal method
It sounds complicated, and it is, but if you’re the “herbal” type—drink green tea, own CDs of whales singing, and recycle everything (including what the cat threw up on the carpet)—this could be the method for you. It’s totally natural and completely cost-free but, alas, only for the truly dedicated: “fussy,” “messy,” and “time-consuming” are adjectives that immediately spring to mind.
How it works
The symptothermal technique aims to pinpoint ovulation (the most likely time to get pregnant) by reading the body’s signals. You use a combination of the calendar, mucus, and temperature methods to work out what days to avoid intercourse. By combining the three natural methods, you up the effectiveness rate considerably.
The calendar method: Ovulatory cycles are usually around twenty-eight days. It is assumed that ovulation takes place mid-cycle, that the released egg will die after twenty-four hours, and that sperm live for no longer than three to five days. Note I said assumed. One of the problems with this method is that everyone’s body behaves differently. To be totally accurate, you should write down when you start and finish your periods for at least six months (eight to twelve if possible) to work out your own personal menstrual cycle. It’s then a matter of counting up the number of days between each period and doing some rather complicated math. If you’re truly devoted, invest in a book detailing the Billings method (the name of the people who formulated it). It’s far too complex to summarize here—and not terribly reliable even if you do master it.
The temperature method: There’s a minute increase in our body temperature following ovulation (in the range of 0.36 to 1.08 degrees Fahrenheit). The theory is that by taking your temperature daily with a thermometer (either in your mouth or vagina), you’ll know when ovulation has occurred and shouldn’t have sex for three days after your temperature has risen.
The mucus method: Around ovulation time, vaginal mucus (the clear or whitish discharge that comes out between periods) is clearer and thinner; after ovulation has occurred it becomes sticky and tacky and stretches like chewing gum. Recording changes in your mucus, again over a period of months, helps pinpoint when in your cycle you tend to ovulate. Some months, the mucus may change from clear to tacky on day 14 (day 1 is the first day of your period), others on day 18. If a pattern forms, you can get a rough idea of when ovulation usually occurs (and avoid sex around those days in the future). It’s best to test mucus at night, just before you go to bed.
What’s good about it
By combining three natural methods, you up the effectiveness rate considerably. It’s natural and involves no chemicals or equipment.
The bad news
It requires a lot of effort and it’s horrifyingly easy to miscalculate. The method relies rather optimistically on ovaries and sperm behaving in a predictable manner; infections, viruses, and other health problems can cause false readings for both temperature and mucus.
Best suited to
Long-term couples trying to space a family.
Protection against HIV and STIs
None.
The theoretical failure rate is 2 to 5 percent but the actual failure rate is more like 15 to 20 percent.
Do I need to see a doctor?
No, but you might like to buy a few books on the subject so you know exactly what you’re doing.
How easy is it to use?
It’s complicated.
Is it expensive?
The price of a thermometer.
How enthusiastic will he be about it?
If you’re long-term and it doesn’t matter if you have “an accident,” very. Sex is totally natural, and he doesn’t have to do a thing.
The withdrawal method
How it works
You probably used this method when you were a teenager. He removes his penis from your vagina before ejaculation (coming), so there’s no sperm inside you and little chance of you getting pregnant. Preejaculatory fluid (the stuff that comes out before he orgasms) does contain some sperm, but it’s unlikely to cause pregnancy. This method requires strong self-control on his part and many couples find it emotionally and physically unsatisfying, for obvious reasons.
What’s good about it
If he’s experienced, it can be quite a successful method of contraception. It’s natural, has no side effects, and costs nothing.
The bad news
You need to trust your partner implicitly to withdraw at the right time.
Best suited to
Couples in long-term relationships who could cope with an unexpected pregnancy.
Protection against HIV and STIs
None.
The failure rate
It depends on whether he withdraws every single time. Family planners put the failure figure at once every four years with experienced couples.
Do I need to see a doctor?
No.
How easy is it to use?
There’s no effort required on your part.
Is it expensive?
It’s free.
How enthusiastic will he be?
He may feel “robbed” of the grand finale of orgasming inside you. Good self-discipline on his part is a must.
The condom
Condoms, as well as diaphragms and cervical caps, prevent pregnancy by providing a physical barrier between the sperm and egg. Each is an ideal alternative if you don’t want to, or can’t, take the Pill and are prepared to do a little preplanning.
Number of condoms sold by a popular bicoastal condom shop per month: upwards of 30,000. Number of different varieties stocked: 300.1
For maximum effectiveness when using a condom, use a spermicide as well—possibly one containing the purported AIDS-fighter, Nonoxynol-9. (In the laboratory, Nonoxynol-9 had some effect against the HIV virus but no one knows if it’s equally effective in the human body.2 Still, there’s no harm in hedging your bets!) You can buy spermicides from any pharmacy.
How it works
How it works
The condom was virtually ignored when the Pill appeared on the scene; now it’s back in vogue because of AIDS. A very thin but strong latex (rubber) sheath, it’s designed to fit over his erect penis and catch the sperm in a pocket at the tip. The main complaint? Intercourse doesn’t feel as pleasurable. For this reason, scientists are currently researching a plastic condom that conducts heat more efficiently and feels much more like the “real thing.” A condom with a looser end (which apparently feels better for him) is also in the trial stages.
What’s good about it
It’s a great germ stopper. Not only does it stop sperm, it helps prevent you catching viruses like HIV (which can lead to AIDS) as well as blocking bacteria that carry other nasties like gonorrhea.
The bad news
Condoms only protect you against pregnancy and diseases if they’re used properly, each and every time you have sex, and if they don’t break. Breakages and tears are usually your fault not “the bloody manufacturer.” If you haven’t put the condom on properly and squeezed the air out of the end tip, an air pocket can form that heats up (as you two do) and expands during intercourse, causing the condom to burst. Use plenty of water-based lubricants like K-Y to prevent splitting but avoid oil-based lubricants like baby oil and Vaseline, which can weaken the latex.
Best suited to
Couples prepared to wear a condom every single time they have intercourse and put up with a decrease of sensation; anyone who’s single and planning on having more than one sexual partner.
“It was the first guy I’d ever slept with purely for sex. We used a condom but he obviously didn’t put it on properly because it kept sliding off. We put on a new one but when he withdrew, found it had a huge tear in it. I was scared stupid. It wouldn’t have been so bad with a boyfriend but a guy I didn’t know and sure as hell didn’t want a baby with? I got the Morning After Pill and a checkup for STIs that week, then waited three months for an AIDS test. Now I provide the condom, I put it on and make sure we use lubricant.”
Jenny, 26, secretary
Protection against HIV and STIs
Condoms will protect you against HIV if you use them each and every time you have sex and they don’t break.’ As HIV can be present in preejaculatory fluid, you must put the condom on before any kind of penetration and before it even touches your genitals.
“Condoms. I hate them. I can’t stand them. I use them for safety but can’t wait to get to the point where we’re serious, can get tested and dispense with the damn things.”
Phillip, 27, promotions manager
The failure rate
Somewhere between 1 percent and 60 percent because it all depends on how often they’re used and how; 30 percent is probably a realistic figure.
Do I need to see a doctor?
No.
How easy is it to use?
Some couples complain that condoms interrupt the “flow” because they have to stop sex to put them on. But it can become part of foreplay if you put it on for him (go on, at least try to do it with your mouth); besides, a seasoned condom user needs only a few seconds to prepare.
Is it expensive?
Around $5 to $10 for a pack of twelve, one-use only, depending on the brand and whether it’s prelubricated or has spermicide. A tube of spermicide costs between $8 and $17.
How enthusiastic will he be?
Probably not very. You’ve heard the jokes (it feels like having sex with a raincoat on).
HOW TO USE A CONDOM
Be careful when you’re unwrapping it. Don’t rip the packet open with abandon (and don’t even think about doing it with your teeth). Rings and fingernails can snag and while condoms are tough, they’re not that tough.
Wait until he’s erect. Put the condom on before the penis touches the vagina but only when he’s hard.
Leave the condom unrolled and squeeze the tip to get rid of any air. Hold it against the tip of the penis, then …
Gently unroll the condom, all the way down to the base of the penis. Smooth out any air bubbles once it’s on. Apply some extra water-based lubricant on the outside of the condom even if it’s been prelubricated.
Have fun—guilt-free!
Withdraw the penis immediately after ejaculation while it’s still erect. One of you should hold the condom firm at the base of the penis while he withdraws, to stop it slipping off or any sperm leaking out.
Point the penis downward and slip the condom off carefully.
Remember you can only use a condom once, if you want to have sex again, get him to wash his penis and use a new one.
Tie a knot in the used condom, wrap it in paper, and put it in the trash. Don’t flush it down the toilet—it’s not biodegradable. Do you enjoy catching your toes on used condoms while walking on your local beach?
Score full marks for putting it on with your mouth. If you can cope with the taste, unwrap it and place it (unrolled) on the top of your tongue, the open end facing upward. The first time, cheat and use your fingers to position it over the penis head, then use your tongue and mouth to unroll it.
The female condom (femcondom)
How it works
It appeared amidst a fanfare of publicity but there is currently only one brand on the market. A soft, loose-fitting plastic pouch with a soft ring at each end, the ring at the closed end is inserted into the vagina, holding the condom in place. The other ring is external and partly covers the labia. Like the male condom, it works by acting as a physical barrier, stopping sperm entering the vagina.
What’s good about it
It does have advantages. Because the condom covers the labia as well as the vagina, it helps protect against herpes and other STIs, reputedly including HIV. It’s readily available in drugstores and supermarkets.
The bad news
The general consensus of women who’ve tried it? Distinctly negative (“It feels like having sex in a plastic bag”). It can also be noisy, may irritate the vagina or penis, and can be difficult to insert. The outer ring may slip inside the vagina during intercourse.
Best suited to
Women who are allergic to latex or spermicide and want protection against STIs.
Effect on future fertility
None.
Protection against HIV and STIs
Because it covers the labia, it does offer some protection against STIs and reputedly HIV.
The failure rate
The typical failure rate during the first year of use is 25 percent.
Do I need to see a doctor?
No.
How easy is it to use?
If you’ve got short fingers or are squeamish about touching your genitals, it’s not for you (unless you let him insert it for you).
Is it expensive?
Around $2.50 per condom.
How enthusiastic will he be?
Not very. He may even prefer pulling on his own protection.
The diaphragm
How it works
The diaphragm is a shallow dome of thin rubber with a firm, flexible rim. It looks like a tiny alien spaceship and can seem just as mysterious, according to frustrated users. You put it inside your vagina so it covers the cervix and tucks in behind the pelvic bone, held in position by the pelvic muscles. There are three types available in America: flat-spring, coil-spring, and arcing-spring, with fit and ease of insertion the main differences. The diaphragm isn’t a popular method of contraception—in our “instant” era, no one wants to prepare for sex. You need to be fitted for one by a nurse practitioner, your doctor or gynecologist and change sizes after a baby, pelvic surgery, or significant weight loss (10 pounds or more). You’ll be shown how to insert it then left for a little while to “practice”—and practice you will, because for some women insertion is difficult. Lots feel squeamish, others can’t quite get the hang of it. But once you do, it’s a ten-second job. It’s a good idea to buy two diaphragms and leave one in continuously so you’re always prepared. (The best place to carry a diaphragm is in your vagina, not your handbag!) Swap over every day or, if you only have one, take it out (but not before six hours after intercourse!) and wash and dry it before reinsertion. If it starts to smell, wash in one part vinegar, four parts water.
How it works
The diaphragm needs to be left in for six hours after intercourse to ensure all the sperm are dead. Up until a few years ago, most women were advised to apply spermicide around the rim of the diaphragm to kill any renegade sperm but all that did was cause it to slide around. If you still feel safer using spermicide, avoid the rim. There’s no need to reapply it each time you have sex, just when you first insert it.
An Australian survey found that 66 percent of women let trust interfere with their decision on whether to use a condom. In other words, factors like “But I love him” and “He’s a nice guy” stopped them from using protection. Romantic but hideously dangerous.3
What’s good about it
The diaphragm is fairly free of side effects, it’s cheap, and relatively reliable in capable hands. When fitted properly and inserted correctly it usually can’t be felt by either partner—and if you leave it in permanently, there’s no preplanning required.
“My girlfriend had a diaphragm fitted and we had no end of problems. I could feel it inside and while it didn’t hurt, it was irritating. She got constant urinary infections and used to disappear for ages inserting it. It was a major disaster.”
David, 25, psychologist
The bad news
Lots of women find insertion difficult; others find the whole thing messy. Some women with persistent urinary tract infections claim it makes them worse; others believe diaphragms are plain uncomfortable, though this is usually the result of being fitted with the wrong size or inserting it incorrectly. A very small amount of women are allergic to latex and/or the spermicide.
Best suited to
Women with strong pelvic floor muscles to hold the diaphragm in place and who are comfortable with their bodies.
Protection against HIV and STIs
No protection against HIV but it does help protect you against chlamydia and gonorrhea.
The failure rate
Theoretically, the failure rate is 4 percent but in practice it’s much higher because, like the condom, people don’t use it properly every single time they have sex.
Oral contraceptives have been around for 2000 years. The ancient Romans used the sap of now extinct plants to “not only prevent conception but destroy an existing one.”4
First, rescue it from him—he’ll think it’s a scream and whiz it around the room like a Frisbee. You’ll be less enthusiastic when it twangs out of your hands while you’re struggling to insert it and it flies across the bathroom (again). But persevere you must. Master the insertion part and the rest is simple.
Stand with one foot on a chair, sit on the toilet, squat, or lie down with your knees bent for insertion. Experiment with each position until you find the one easiest for you.
Feel with your fingers where the diaphragm is to sit—locate your cervix and pubic bone, as shown by the doctor who fitted you.
Squeeze the edges of the diaphragm into a long, narrow shape between your thumb and first finger.
Hold the vaginal lips apart with one hand and use the other to insert the diaphragm into the vagina. Press down along the back wall of the vagina (the side nearest your rear end) until the far rim passes the cervix. Then, tuck the front rim up behind the pubic bone.
Check it’s in place properly by feeling your cervix through the latex. It should be completely covered.
Do I need to see a doctor?
Yes. You need to be professionally “sized” initially.
How easy is it to use?
It’s complicated at first, but once you’re in a routine, changing diaphragms becomes part of your daily toiletry routine.
is it expensive?
They range from around $13 to $25. Diaphragms usually last about two years unless you’re wearing the same one continuously, which will cause it to deteriorate more quickly.
How enthusiastic will he be?
Some men claim they can feel the diaphragm with the head of their penis; most don’t notice.
The cervical cap
How it works
The cap works like a diaphragm but it’s smaller. A firm, cup-shaped or dome-shaped device, it sits snugly over the cervix and is held in place by suction. Some women find it more difficult to insert than the diaphragm—you need to have a reasonably long cervix and to be able to reach it easily. Caps are generally only available through family planning clinics and selected doctors.
What’s good about it
Because it’s smaller than a diaphragm, some women find it more comfortable.
The bad news
It’s design is also a disadvantage because it can be knocked off during intercourse. The cap isn’t advised for women plagued with urinary tract infections.
Best suited to
Women with weak pelvic floor muscles who can’t, but would like to, use the diaphragm.
Protection against HIV and STIs
Same as the diaphragm—no protection against HIV but it protects you against chlamydia and gonorrhea.
The failure rate
One study put the figure at around 18 percent.5
Do I need to see a doctor?
Yes, for the initial fitting.
How easy is it to use?
Some women find it harder to insert and remove than the diaphragm.
Is it expensive?
Around $25.
How enthusiastic will he be?
Very. He’s unlikely to feel it.
The intrauterine device (IUD)
How it works
The IUD has suffered some pretty bad press over the years—mainly due to a faulty IUD, the Dalkon Shield, which raised questions about the safety of all IUDs. The Dalkon Shield is no longer available and the World Health Organization, the American Medical Association, and the American College or Obstetricians and, Gynecologists stand by their claim that all the other IUDs remain one of the safest, most effective reversible methods of birth control for women around. It’s a fantastic method for the right person because once it’s in, you can leave it there for up to ten years. Immediately errective on insertion, remove the IUD and its contraceptive effect is also immediately reversed.
“The pill made me sick and ill-tempered. Theand ill-tempered. The cytitis. Condoms made me sore I'd heared horror story about the IUD but when doctor suggested I try it I did it's brilliant I have had no problem with contracaption since.
Sally, 36, health worker
Two types of IUDs are available in the States. The ParaGard Copper T 380A can stay in place for up to ten years. Progestasert works by continuously releasing a small amount of progestin, so must be replaced annually.
Scientists aren’t entirely sure why the IUD prevents fertilization of the egg. It may be that it prompts the egg to move through the fallopian tube too quickly to be fertilized and/or that the copper (in ParaGard) changes the environment in the uterus by affecting the behavior of enzymes in the lining. Experts suspect the progestin in Progestasert thickens cervical mucus, providing a barrier that prevents sperm from entering the uterus. Whatever it is, it’s incredibly effective. The IUD’s protection against pregnancy is beaten only by Norplant and Depo-Provera.
Most trained clinicians will insert an IUD in their consulting rooms. First, they’ll explore your medical history and then do a pelvic and bimanual exam (inserting one or two fingers inside) to ensure your vagina and cervix are normal and the size, shape, and position of your uterus and ovaries is suitable for this method.
IUDs can be inserted at any time but it’s usually more comfortable during a menstrual period, when the cervix is softest. You might be asked to take an over-the-counter painkiller before insertion and could be given antibiotics to protect against infection afterward. Most women find insertion a little uncomfortable but certainly not painful. (If you have a sensitive cervix, you can request an injection of local anesthetic.)
You’ll need to schedule a checkup following the first period after insertion to check the IUD is still in place but can check yourself between annual checkups by feeling for the plastic strings that are left on the device for this purpose. (The string can’t be seen outside the vagina but is long enough to be felt by a finger pushed inside.) Once it’s inside, neither you nor your partner is aware of the IUD.
What’s good about it
It’s cheap, long-term, maintenance-free once inserted, and highly effective because you don’t need to remember to do or take anything before having intercourse.
The bad news
If you’ve had previous pelvic infections, abnormal Pap smear results, or a heart condition, you’ll be advised against this method (your clinician will discuss these, and other conditions, with you during your medical history check).
After insertion, many women adjust to their IUDs pretty quickly. Others aren’t so lucky, experiencing heavy bleeding and cramps in the first few months. There may also be some spotting between periods and quite a few women find their periods are permanently heavier and longer than usual. If you change partners frequently and (very stupidly) plan to ditch condoms once fitted with an IUD, forget it. It offers no protection against STIs.
Serious infection from an IUD is rare but you’re more likely to develop a pelvic infection during the first four months. In one to three out of 1000 insertions, the uterus is accidentally punctured, though it’s usually discovered and corrected immediately. Sometimes IUDs come out, usually with the first few periods, so it’s imperative to check the strings each month after your period. During the first few months after insertion, check every few days.
Women who haven’t had pelvic inflammatory disease, gonorrhea, or chlamydia within the last year, who aren’t at risk of contracting an STI, and aren’t breast-feeding. It’s a great alternative if the Pill doesn’t suit you or you have other medical conditions that prevent your taking it.
Effect on future fertility
Because untreated infections associated with IUDs may make it impossible or difficult for you to get pregnant, they’re not usually recommended to women who’ve never had children, want more, or have had trouble conceiving in the past.
Most pregnancies happen when the IUD falls out without your realizing. If you become pregnant with the IUD still inserted, there’s a 50 percent greater risk of miscarriage. Get it taken out as soon as possible and the risk drops to 25 percent.
Protection against HIV and STIs
None.
The failure rate
Only Norplant and Depo-Provera are more effective. Eight out of 1000 women using copper IUDs will become pregnant during the first year of use. Less than 3 in 100 will get pregnant using an IUD with progestin.6
Do I need to see a doctor?
Yes. To find out if it’s suitable for you, for insertion, and subsequent checkups.
How easy is it to use?
After insertion, you simply need to check it’s in place by feeling the strings. IUDs are available from Planned Parenthood centers, your HMO, or doctor.
Is it expensive?
The cost of the exam, insertion, and follow-up visits ranges from $250 to $450 (though some centers price according to income and are covered by Medicaid). Pretty cheap when you consider the one-time insertion cost of $400 (for a copper IUD) lasts ten years!
The IUD is inserted deep inside so he won’t feel a thing.
The combined oral contraceptive (the Pill)
How it works
The Pill has been around for more than twenty years and is the contraception chosen by most young women. The Pill gives a daily dose of synthetic hormones, estrogen and progestin, which act like the natural hormones in the body. When there’s a certain level of these hormones acting on the brain, the ovary does not get stimulated to produce an egg—and if there’s no egg, there’s no pregnancy. There are lots of different Pills on the market, each containing various combinations of progestin and estrogen. They come in twenty-one-day or twenty-eight-day packs; the latter includes sugar pills, which you take during your period so you don’t get out of the habit of taking a pill every day. Usually you’ll be started on a low-dose Pill or a triphasic Pill (one that varies the amount of hormone taken throughout the month) but if breakthrough bleeding occurs and doesn’t settle down within three months, a higher dose is prescribed. It’s quite normal to try a few different Pill brands before settling on one that suits you.
The Pill is almost 100 percent effective if you take it at around the same time every day and don’t have any health problems that may affect its absorption. If you miss a pill or are late by more than twelve hours, take it as soon as you remember; take the next pill at the usual time and you’ll still be protected. If you miss more than one dose, use other contraception for seven days while continuing to take the Pill. Because it’s designed to be swallowed and absorbed at a certain rate, vomiting and diarrhea, some medication (including some antibiotics), and extraordinarily high doses of Vitamin C can interfere with its effectiveness.
What’s good about it
It’s easy to use and highly effective, and there’s another great spin-off for women who hate having their periods—there’s really no need to have one. Manufacturers believed women wanted periods (and some do like the reassurance that they’re not pregnant) so they included the sugar pills to allow a break from the hormones, which brings on a period. But lots take the pill continuously (just skip the sugar ones and continue to the next packet), or break for a period every three to six months or so. If you do choose to still have periods, chances are they’ll be lighter, less painful, and nearly always on time. The Pill may also help cure acne and reduce PMS—and there’s scientific evidence that it may have other benefits: there’s less chance of getting serious pelvic infection, cancer of the ovary, cancer of the endometrium (the lining of the womb), anemia, noncancerous breast lumps, and cysts on the ovary.
The bad news
Some women shouldn’t even consider taking the Pill. If you’re over thirty-five and smoke, steer clear—the Pill makes smoking even more dangerous. The hormones in the Pill slightly increase the blood’s natural tendency to form clots; combine this with an unhealthy diet, excessive drinking, and smoking and you’re asking for trouble. Before it’s prescribed, your doctor will go through a long list of health problems and your family health history to check if you’re a suitable candidate. Women who have had liver problems or breast cancer, for instance, will probably be advised to use another method. Minor side effects may include chloasma (a slight pigmentation of the skin which makes it look brown and blotchy) and some minor fluid retention (though it’s a fallacy that the Pill makes you fat). Some women complain of mood changes and depression but changing to a lower dose or a different brand often solves the problem. Years ago, women were advised to take breaks from the Pill because they were high-dose formulas; today’s newer, low-dose Pills are fine to take continuously.
Best suited to
Women who don’t smoke and have no serious health problems or a family history of health problems.
Effect on future fertility
Contrary to common perceptions, the Pill doesn’t “build up” in your body and there’s no need to wait a few cycles to get it out of your system before trying to get pregnant. Usually, you’ll revert to a normal cycle within a month or two, with most women getting pregnant within six months after they’ve stopped taking it—about the same fertility rate as women who’ve never taken the Pill.
Protection against HIV and STIs
None.
The failure rate
When used properly the Pill has a tiny failure rate—only 5 pregnancies per 1000 women per year. Forgetting to take it every day is the most common cause of failure.
Do I need to see a doctor?
Yes, for the initial prescription and for subsequent health checks when you renew it.
How easy is it to use?
Simply swallow a tablet daily. If you’re the forgetful type, work it into a routine (maybe keep the packet on your bedside table so it’s the first thing you see when you open your eyes in the morning).
Is it expensive?
The cost varies depending on which Pill you’re on, but most work out to be between $15 and $25 per cycle (per month), often less at family planning clinics.
How enthusiastic will he be?
Over the moon. There’s practically no chance of pregnancy if you take it every day.
The progestin only pill (the Mini Pill)
How it works
The Mini Pill contains about one-third to one-fifth of the dose of progestin that’s in the combined oral contraceptive and it doesn’t contain any estrogen. It’s slightly less reliable than the regular Pill but useful if you can’t take estrogen because it makes you feel sick. The Pill works by delivering a daily dose of synthetic hormones that act on the brain and stop the ovary from being stimulated to produce an egg. The Mini Pill works differently: its dosage of progestin increases the mucus plug at the cervix, making it thick, tacky, and difficult for sperm to penetrate. It also changes the lining of the uterus (the endometrium), making it less “friendly” to fertilization, and it can have an effect on ovulation. It’s taken every day without a break so it always comes in a twenty-eight-day pack and it’s essential that it’s taken at around the same time every day. Its contraceptive effect is greatest three to twenty-one hours after each tablet is taken, so if you have sex at night and/or in the early morning, take your tablet between midday and the early evening.
Feeling sexy? It could be your Pill, not him! Women who take triphasic Pills, with varying levels of hormones, appear to be more interested in and enjoy sex more than women on fixed-dose Pills.7
What’s good about it
Unlike the combined Pill, the Mini Pill can be taken by women who have a history of blood clotting, stroke, heart attack, or who smoke heavily.
The bad news
It’s imperative that you take it at the same time every day and do not miss any pills. As with the combined Pill, if you’re vomiting, have diarrhea, or are on any other medication, take extra precautions. Unfortunately, the Mini Pill doesn’t have the advantage of cycle control, so you can’t skip periods or manipulate your cycle to have a period at a certain time. You may experience spotting (bleeding in between periods) or mood changes like PMS and depression.
Best suited to
Organized women who can’t take the combined oral contraceptive Pill, who are breast-feeding, or who can’t take estrogen.
Protection against HIV and STIs
None.
The failure rate
The failure rate is around 2 to 3 percent.
Do I need to see a doctor?
Yes, for the same reasons as the Pill.
How easy is it to use?
You take one tablet daily, but it must be at the same time.
Is it expensive?
Around $15 to $25 per month.
How enthusiastic will he be?
Extremely, if you’re sensible and can be relied upon to remember to take it—nervous if you’re not.
Depo-Provera, injectable hormonal contraceptive
How it works
The newest, widely available contraceptive, Depo-Provera works just like the Pill by stopping the release of an egg from your ovaries. The difference is that it’s injected once every twelve weeks rather than being taken orally every day—which means a much lower failure rate because you can’t forget to take it! The first injection of a progestin preparation is given into the muscle of your upper arm, rear end, or upper thigh during the first seven days of your period. You need a booster once every twelve weeks. Despite its obvious benefits, Depo-Provera isn’t a common method of contraception, probably because it can wreak havoc with your periods and can delay fertility for between seven to eighteen months.
What’s good about it
It’s effective immediately and has an extremely low failure rate. You can forget about contraception for three months at a time. Depo-Provera is also used to treat endometrial cancers.
The bad news
You can’t predict the effect it has on a period. Most women after two or three injections have no period at all, but you could experience erratic, unpredictable bleeding. You might get no period for two months, then bleed for eight to ten days. Depo-Provera has also been associated with weight gain, headaches, and depression.
Best suited to
Like the Pill, there are women who shouldn’t use Depo-Provera—those with a history of depression and breast cancer, for instance—but your doctor will discuss this with you. Otherwise, if you’re constantly forgetting to take the Pill, this is a great alternative.
Effect on future fertility
This isn’t the method to choose if you’re planning on getting pregnant sometime soon. Depo-Provera takes a long time to wear off; most women will take seven to eighteen months from the last injection to ovulate and become fertile, with the average time being about ten months.
Protection against HIV and STIs
None.
The failure rate
Theoretically, it’s the same as the combined oral contraceptive Pill; in practice it’s more effective, because you can’t forget to take it.
Do I need to see a doctor?
Yes. You’ll need to visit your doctor or a family planning clinic once every three months.
How easy is it to use?
It’s just a case of writing your appointments in your diary and sticking to them.
Is it expensive?
Around $30 to $75 per three months, plus the cost of the visit to the doctor’s office.
How enthusiastic will he be?
Highly.
Norplant
How it works
Effective within twenty-four hours of insertion, Norplant offers protection against pregnancy for five years. Not surprisingly, it’s becoming an increasingly popular contraceptive. This method involves inserting six thin, flexible plastic implants (around the size of matchsticks) under the skin of the upper arm. Each implant releases levonorgestrel, a hormone similar to progesterone, which stops the ovaries from releasing eggs and thickens cervical mucus, which prevents sperm joining with the egg.
The implants are inserted through one small cut (don’t panic, your skin is numbed with a painkiller first). The whole process takes about ten minutes, but you need to avoid heavy lifting and wear a bandage for a few days afterward. Some women find that the implants feel a little uncomfortable for the first few days. A follow-up visit is recommended three months later and annually after that. The implants are removed (and replaced, if you want) after five years or whenever you want to get pregnant.
Not everyone can use Norplant, so you’ll be thoroughly checked by your clinician. He or she will discuss your medical history and do blood pressure checks, a breast and pelvic exam, and Pap smear.
What’s good about it
It works within one day, is virtually painless, maintenance-free, and the contraceptive effect disappears mere hours after the implants are removed. You don’t have to even think about contraception for five years.
The bad news
In return for all the benefits, you might have to put up with some irregular spotting and bleeding between periods. Some women may also experience headaches, nausea, depression, nervousness, dizziness, and weight gain or loss. If you’re prone to scarring, there might be a scar or discoloration of the skin where it’s inserted.
Best suited to
As always, certain conditions (in this case including diabetes, high cholesterol, and heart disease) prevent you from using the method. If you’ve ever had high blood pressure, unexplained vaginal bleeding, breast cancer, or other specific conditions (which will be explained to you during your exam), you’ll probably be advised against it.
Effect on future fertility
A few hours after the implants are removed, you’re capable of getting pregnant again.
Protection against HIV and STIs
None.
The failure rate
Fewer than 4 in every 100 women who use Norplant for five years will become pregnant (less than one a year). It’s slightly less effective than sterilization—but not permanent.
Do I need to see a doctor?
Yes. To check for suitability, for insertion, and checkups.
How easy is it to use?
After insertion, the odd checkup hardly qualifies as difficult.
Is it expensive?
You’ll pay between $500 and $600 for the medical exam, the implants, and insertion. That’s around $100 per year over a five-year period. If you’re on a low income, several programs may subsidize the cost (see your doctor or family planning clinician for details).
How enthusiastic will he be?
Couldn’t be happier.
Emergency Hormonal Contraception, or the Morning After Pill
How it works
Despite its name, you can take the Morning After Pill (MAP) up to seventy-two hours after unprotected sex. Most regular users, according to a family planning study of 400 women, are in their twenties and used condoms that broke or a rather ineffective withdrawal method (that is, their boyfriends forgot to). This method of contraception involves taking two doses of high-dose combined estrogen and progestin twelve hours apart. It prevents pregnancy in one of two ways: if the pills are taken before you ovulate they can delay ovulation (which means you need to be particularly careful for the rest of the month because you may ovulate later than usual). If they’re taken after you’ve ovulated and an egg has been fertilized, the MAP prevents the fertilized egg from implanting in the womb.
What’s good about it
While it shouldn’t be relied upon as permanent contraception, it’s ideal as a backup when condoms break or if you suspect your regular contraception has failed. Some women, who have sex very infrequently, use the MAP instead of using regular contraception.
The bad news
The major side effect isn’t pleasant—about 50 percent of women feel sick and are. For this reason, you’ll often be given antinausea pills to take as well. If you’re sick within two hours of taking a dose, you may not have absorbed the hormones and need to start all over again. You may get other mild symptoms—breast tenderness, headache, or light bleeding—but these usually disappear within forty-eight hours and require no treatment.
Best suited to
Women who need an emergency backup.
Effect on future fertility
If you’re already pregnant (if you conceived in a previous cycle or earlier in your present cycle), the MAP will not stop that pregnancy continuing or harm the fetus.
Protection against HIV and STIs
None.
The failure rate
About 2 to 3 percent.
Number of women who’ve failed to use contraception at least once: 87.1 percent.8
Do I need to see a doctor?
Yes, the pills aren’t available over the counter.
How easy is it to use?
It usually requires a hastily scheduled doctor’s appointment and twenty-four hours time out if you feel ill.
Between $8 and $25.
How enthusiastic will he be?
Relieved that there’s no unwanted pregnancy and hopefully sympathetic if the pills make you sick.
Permanent contraception
Forgive me for stating the obvious, but permanent contraception usually means permanent. Though some operations can be successfully reversed to make you fertile again, don’t count on it. Proceed with caution. Are you absolutely, totally sure you’re that serious?
Tubal ligation (or sterilization)
Commonly known as “getting your tubes tied,” the fallopian tubes are cut, clipped, or tied to stop sperm going up the tubes and eggs going down. The egg is still released but it’s harmlessly absorbed by the body. Usually done under general anesthetic through a laparoscope, it only requires a one-day stay in the hospital, though it will be a week before you’ll feel normal. Permanent is the key word here; reversal is tricky and it’s successful only 30 to 60 percent of the time, depending on the particular case.
Vasectomy
This is a simple twenty-minute operation that stops sperm traveling out of the testes and into the semen; sperm is still produced, but it’s reabsorbed. Done under local or general anesthetic, the surgeon cuts the front of the scrotum, picks up the vas deferens (the tube that carries the sperm) on each side in turn and cuts and seals the ends. Though pretty hazard-free, it’s not effective immediately: it may take as many as sixteen ejaculations to clear sperm that’s still in the tubes. You must continue using contraception until he gets a negative sperm count. Having a vasectomy isn’t a decision that should be made flippantly. Even if the reversal procedure goes smoothly, there’s no guarantee he’ll go on to father a child.
Clever boy! The same guy who discovered the G-spot also came up with the world’s first IUD. Ernst Grafenberg experimented with silkworm gut before designing a ring of coiled silver wire.9
Coming attractions
RU486—Mifepristone
Some say RU486 is a better alternative to existing emergency contraceptive pills because it has fewer side effects, i.e., it doesn’t make you sick. It may also be effective in treating fibroid tumors, endometriosis, and some types of breast cancer. But the struggle between antiabortionists and (among others) the Feminist Majority Foundation continues and RU486 is not yet available to women worldwide as a contraceptive method.
Available in France since October 1988 (the French Minister of Health declared it “the moral property of women”), RU486 has been approved for distribution in the U.S. but the French company that makes the drug has been unable to find a manufacturer and distributor.10
The vaginal ring
Dubbed “the contraception of the future,” vaginal rings are as effective as the combined oral contraceptive Pill without the failure risk. This is what most of us will dump our current method for. A ring, smaller than the average diaphragm, is inserted into the vagina where it releases the same hormones that are in the combined oral contraceptive Pill. Once inserted, the ring stays there for three weeks—you remove it for a week only if you want to have a period or you can leave it in permanently and enjoy a period-free life for up to a year at a time. The obvious benefit? You don’t have to remember to take a pill every day. Family planning clinics in Australia are also doing trials of a gel containing progestin, which is rubbed onto the skin of the abdomen each day, where it’s absorbed like the Mini Pill.
Male contraception
Despite the occasional excited announcement that a male contraceptive pill is in the planning stages, effective male contraception (apart from the condom) is light-years away. It’s not a conspiracy to keep contraception our problem; it’s simply much easier to control our fertility than a man’s—one egg per month as opposed to 50,000 sperm per minute that have taken three months to mature. A method involving a weekly injection of testosterone is in the experimental stages. If successful, it’ll take the form of three-monthly injections or an implant similar to Norplant. Australian researchers are currently experimenting with implants using Depo-Provera. If successful, they may be available within three years. The problem is lots of contraception methods work on the pituitary gland, and if you stop its functioning in men the result is often impotence—effective contraception all right, but not quite what he (or you) had in mind!
SEX ON VACATION
The sun’s shining, the waves are lapping, and the hardest decision you’ve had to make all week is which way to point your beach chair. That wonderfully relaxed mood can make it seem like real life doesn’t exist. Unfortunately, AIDS, STIs, and unwanted pregnancies don’t disappear just because you’re feeling blissfully brain-dead. Vacations are danger time for many people. Make sure you don’t come home with more souvenirs that you’d bargained on.
Pack condoms, lubricant, and enough supplies of your chosen contraceptive to last the trip, plus “spares.” (It’s tough enough asking directions when you can’t speak the language—try explaining what a flat-spring diaphragm is and why you need one now!)
Don’t rely on the calendar, mucus, or withdrawal methods. Symptothermal methods are notoriously unreliable at the best of times, worse on vacations. Time differences and long flights can screw up your menstrual cycle and it’s difficult to keep track of fertile days. Heat, lounging around spas, a yeast infection brought on by pre-vacation panic, all can affect vaginal secretions. Use condoms and lubricant instead; they’ll protect you against pregnancy, HIV, and STIs. Don’t use the withdrawal method with weekend romancers. It’s easy enough for a boyfriend to get carried away—can you trust a stranger to keep his word?
It’s Tuesday there and Thursday at home, so when should you take the Pill? Keep your watch on “home” time during the flight and take a tablet that morning or evening (whichever is usual for you), even if it means taking it early. Then take one tablet per day until the flight back home. Keep your watch on vacation time on the flight back and continue taking the tablets. When you get home, repeat the process: take a tablet that morning or evening, then settle back into your old routine. Remember that the Pill’s effectiveness is hampered by vomiting and diarrhea caused by a bug you picked up on vacation. If you vomit within an hour of taking it, it hasn’t been absorbed. Use condoms or a diaphragm as backup.
If you use a diaphragm, pack two and keep them in separate bags (in case you lose a suitcase). Flying, swimming in salt water, even scuba diving won’t affect your diaphragm. Just remember it must stay in for six hours, so don’t get confused with changing time zones. If you suffer a particularly bad bout of gastric, (or anything else that causes you to drop ten pounds or more), your diaphragm may be the wrong size and ineffective. That new, flat tummy won’t stay flat for long if you’re pregnant!
Practice safe sex in all senses. What might pass as flirting back home may be interpreted as a blatant invitation for sex somewhere else. Quiz your travel agent on the customs and morals of the country you’re visiting. And don’t assume any guy you invite in for coffee will behave like a gentleman—no matter what country you’re in.
THE (DREADED) STIs
It’s no wonder soap opera scriptwriters never write sexually transmitted infections (STIs) into the plot. Since the entire cast of Melrose Place have slept with one another—without so much as a rustle of a condom being unwrapped—“infecting” one character would have the whole cast on antibiotics. Hollywood isn’t too fond of nasty little bugs and viruses, either. We don’t see the Bond girls doubled up in agony, peeing razor blades, two weeks after James has swept suavely through, or Kim Basinger braving a whopping penicillin injection nine and a half weeks after having unprotected sex in sewers and kitchens.
Which leads some people to believe life really is like a glamorous, exciting action film where people dive under the covers looking fabulous, and emerge, makeup intact, wondrously infection-free and ready for the next love scene. If only it were true. In real life, orgasms aren’t the only thing you can get through sex, so arm yourself with the facts as well as with condoms. Read this section now rather than frantically flipping through the pages searching for a symptom you have just discovered.
A sexually transmitted infection (STI) is any infection that can be passed from one person to another through sex. Unfortunately, there are a lot of them. Some are fairly harmless and are cured by a course of antibiotics, others can kill you. They’re usually passed on at the beginning of a new relationship so every time you have unprotected sex (sex without a condom) with a new partner, you should be tested for STIs.
Now here’s some really bad news if you’re feeling smug about the half-empty family-sized pack of condoms in the bedroom drawer. While condoms will protect against STIs spread by the exchange of bodily fluids (like sperm, blood, and mucus), you can still catch herpes and warts because they can be spread simply by touching infected skin. And pubic lice or scabies won’t care if he’s wearing six condoms; they’ll still merrily jump on the nearest strand of hair they can find. In fact, the only guaranteed defense against all STIs is not to have sex at all.
Right, now that you’ve spent a millisecond considering that option, what next? The next best thing is a monogamous relationship with an uninfected person (where neither of you sleeps with anyone else), the third is to only have casual sex in ways that are considered “safe” (like kissing, touching, and mutual masturbation), and the fourth is to sleep with whomever you like but to use condoms (and common sense) every single time.
Like most diseases, STIs aren’t fussy and you can’t pick out the people who have one. Avoid “dirty,” “promiscuous,” or “bad boy” types all you like but if you think you’re safe having sex only with “sweet,” “nice,” “clean,” or “innocent” people, you’re being unbelievably naive. Ditto those who think they’re okay because they have asked their partner if they have any symptoms. Let’s face it, they’re hardly going to look up and say, “Well, now that you mention it, I had these godawful blisters on my penis yesterday and now they’ve turned into pus-infested ulcers.” Besides, they may not have noticed anything unusual because some STIs are alarmingly symptom-free.
If you notice any change in the discharge from your penis or vagina, pain or irritation during intercourse or when you pee, any blisters, ulcers, warts, lumps, or rashes anywhere on or around your genitals or buttocks, or any itching or irritation there, put this book down and go see a doctor or a sexual health clinician NOW. If you find you are infected, it’s not only polite but essential that you pick up the phone and tell anyone else you’ve slept with. No, they’re not going to be thrilled by the news, but they should be grateful. Left unchecked, many STIs can affect our ability to have children later in life. Others, like AIDS, are fatal.
Following, in no particular order, is a rundown of some of the most common STIs. I sincerely hope you never become intimately acquainted with any of them.
AIDS
What is it?
This gets top billing for obvious reasons—it’s lethal. AIDS stands for acquired immune deficiency syndrome and HIV (human immunodeficiency virus) is the virus that causes the disease. It was first noticed in the early 1980s and it predominantly affected homosexual and bisexual men and people who injected drugs. They still make up the two biggest groups affected by AIDS. HIV is spread by sex (oral, anal, and vaginal through semen and vaginal secretions), by needles (sharing a needle that is contaminated), and can be passed on during pregnancy and childbirth. It’s not spread by saliva (except in one or two rare and extraordinary circumstances), touching, kissing, drinking out of the same cup as an HIV-infected person, toilet seats, shaking hands, mosquitoes, sneezing, or swimming pools. HIV attacks the body’s immune system, which is our natural defense against disease. Eventually, it becomes so weak the body can’t fight against any infections or diseases and you can die.
How do I know I’ve got it?
There’s no immediate sign. A few weeks after exposure about half of its victims get a glandular fever-type sickness (fevers, tiredness, swollen glands), which passes. At this stage you’re “healthy” but carrying the virus—a condition known as “HIV-positive.” Months or years later, if you get really sick, you then have AIDS or an AIDS-related illness. Persistently swollen lymph glands is a typical symptom of the later stage and you may experience fevers, night sweats, and a cough, lose weight, have chronic diarrhea, develop skin lesions (sores or raised red marks), and be constantly tired and weak.
What now?
A blood test around three months after the initial infection can identify if you’re carrying the HIV virus. If you tested negative it’s wise to get retested three to six months later. Obviously, count the three months from when you last had sex without a condom or shared needles.
Can it be cured and will it come back?
At the moment, AIDS is incurable. Researchers the world over are working on a cure but, at the time of publication, none had proven to be effective though several are looking promising. Usually, the inevitable bugs and diseases you pick up are treated as they arise, until late in the disease when the body has so few defense cells, it can’t respond to antibiotics.
Have I infected my partner?
Quite possibly. If your result is positive, the news will usually be delivered by a crisis counselor who’ll help you work through the pain, grief, and anger you’ll feel. They’ll also advise you on how to tell your current partner and any past partners you may have infected. It goes without saying that not telling them is paramount to sponsoring your own personal killing spree, especially if the person who infected you doesn’t know he or she is a carrier.
Your best defense against the virus?
Take it seriously, use condoms and lubricant (unless both of you have tested negative and you’re 100 percent certain there’s no chance of unprotected infidelity), and don’t share needles. Oral sex is considered low-risk.
Will it affect my chances of having children?
AIDS can be passed from mother to child, an important factor to consider if you’re planning a pregnancy.
Gonorrhea
What is it?
It sounds dreadful—and it can be. Caused by bacteria passed on by an infected partner, it turns into an infection that sometimes spreads via the bloodstream. Gonorrhea isn’t common, but it’s still out there.
How do I know I’ve got it?
The incubation period (the time it takes to develop symptoms or show signs of exposure) is anywhere from two to ten days and the first symptoms are often so minor, you may not notice. Men may find peeing painful or notice a white or yellow discharge from their penis. Women may also find urination most unpleasant and/or that their vaginal discharge is heavier than usual. You can catch gonorrhea in the anus or throat as well.
What now?
Your doctor will take a swab (a sample) from the pus discharge and test it. Gonorrhea is usually sensitive to penicillin and you may be given a single, high dose by tablet or injection. Sometimes, it’s resistant to penicillin and you’ll need other antibiotics. You’ll probably also be treated for chlamydia, since the two often go (miserably) hand in hand.
Can it be cured and will it come back?
That’s usually the end of it, though repeat tests will be ordered to make sure it’s totally gone.
Have I infected my partner?
Gonorrhea is spread through vaginal, anal, or oral sex. If you’ve done all or any of those and not used a condom, it is possible they’ve got it too (or gave it to you in the first place).
Will it affect my chances of having children?
Not if it’s treated promptly.
Genital herpes
What is it?
Pre-AIDS, it was the most feared of all the STIs. Post-AIDS, coping with a little cold sore suddenly seems bearable. Herpes sounds bad, but it’s not serious and just means you get cold sores on the genitals rather than on the mouth. It’s an infection caused by the herpes simplex virus and it comes in two types, 1 and 2. It’s the same virus that causes cold sores on your lips, so if your partner has one and gives you oral sex, he may leave more than just a nice memory.
How do I know I’ve got it?
Your first warning may be an odd, “tingly” sensation on or around your genitals. Then—what a fabulous surprise!—one or several blisters form on or around the genitals around two to twenty days after exposure, rupturing to form ulcers. It’s pretty hard to miss if you have a severe attack. In women, the sores or “lesions” usually appear on the vulva or the entrance to the vagina, though you may develop some on your cervix. In men, they’ll appear on the penis, sometimes on the testicles. The initial infection is often the worst and can last up to twenty horrible, sickly days. You may feel feverish and achy, your lymph nodes may swell and feel tender. The sores heal in about twelve days but—sorry—haven’t disappeared forever. Further attacks usually occur in the same place but are less severe and heal quicker (around four to five days). You are more prone to attacks when you are run down, tired, stressed, or have been drinking too much. The latest research has shown it’s quite possible to pick up herpes and not get a lesion for several years afterward. Bear this in mind if your partner suddenly shows symptoms but swears he or she has been faithful—it might well have been picked up way before meeting you.
What’s the single most effective cancer screening tool in the history of modern medicine? The Pap smear test.
What now?
Your doctor will take a swab from one of the sores and analyze it. You may be given local anesthetic jelly to apply and aspirin or codeine for the pain. Some experts believe there’s a link between herpes and cervical cancer; more recent research indicates it’s unlikely. Either way, it’s another good reason to have regular Pap smears if you’ve been infected with any STL11
Can it be cured and will it come back?
Herpes is manageable but not curable. The virus remains in the body, lurking in a nerve fiber, ready to come back out and party if you party too hard. Some people find taking relatively new antiviral drugs, which shorten the length and severity of attacks, helpful (your doctor can give you a prescription), others simply treat each outbreak by bathing the area with salty water or antiseptics and taking painkillers. The better your general health is and the less stress you’re under, the less prone you’ll be to an attack.
Have I infected my partner?
Herpes is spread by vaginal, anal, or oral sex or direct skin-to-skin contact with infected areas. As a general rule, you’re unlikely to infect someone if you avoid sex from the moment you’re warned of an attack (by the “tingling” sensation) right through until the blisters have formed, dried up, and the skin has returned to normal. However, some people have “asymptomatic shedding” (the virus is present but there are no symptoms) or sores that are hidden from view and not noticed. It’s rare but you can pass it on unawares during this time. Condoms help to stop transmission and, so long as the part that’s infected is covered, provide 100 percent protection if there’s an active sore. Despite this, it’s not recommended you have sex during an attack, simply because it’s painful.
Will it affect my chances of having children?
If you have an attack at the time of birth, they’ll deliver the baby by caesarian to ensure you don’t pass it on to the child.
Pubic lice (crabs) and scabies
What is it?
Pubic lice are tiny little crablike insects that are spread through any intimate contact (in bedding, towels, etc.), not just intercourse. Scabies are a mite and spread the same way.
How do I know I’ve got it?
If you’ve got crabs, your pubic hair will be itching like crazy. Look closely and you’ll discover it’s not your imagination: there are tiny little insects scurrying around. Scabies cause red, itchy lumps in all the same places.
“I’ve had herpes for years and I tell all my future sex partners. Some of them freak out and assume I’m a male slut. It’s so unfair since I caught it from a much-loved girlfriend, who’d been infected when she was really young.”
Craig, 25, laborer
What now?
Race to the nearest pharmacy, swallow your pride, and ask for a lotion to kill pubic lice and/or scabies. They’re sold over the counter and come with instructions.
Can it be cured and will it come back?
Simply apply a lotion to the affected areas (no, you don’t have to shave your hair off) and that should be it.
Have I infected my partner?
If you’ve had close contact, yes. They should be treated as well.
Will it affect my chances of having children?
Not unless you’re so put off by the experience, you never have sex again.
Syphilis
What is it?
In the old days, anyone who was anyone had syphilis (artists, kings, queens, you name it); today it’s very rare in the heterosexual population unless you’ve been traveling through Southeast Asia (and not used condoms) or your partner has (flashing red light alert if the unprotected sex he had was with a prostitute). Syphilis is spread through intercourse and goes through three stages.
How do I know if I’ve got it?
The first sign may be a painless sore on the penis, vagina, rectum, or throat that sometimes develops during the primary stage, anywhere from three weeks or three months after exposure to the disease. The infection reaches the bloodstream and spreads during the secondary stage, causing a fever, painful ulcers in the mouth or throat, rashes, and sometimes warts on the genitals. Stupidly ignore the symptoms and you may think it was all a bad dream because the body’s defenses now get to work and the symptoms fade away for anywhere from two to fifty years. Unfortunately, it’s hidden, not eradicated. About one-third of sufferers go on to the tertiary I stage, developing large ulcers that can damage the heart, major blood vessels, spinal cord, and/or the brain or prove fatal.
“I went to the bathroom one day and felt this intense stinging sensation. When I took a look, I saw a tiny little blister inside my vagina and knew I had herpes. I just couldn’t figure out how the hell it had happened since I’d been in a monogamous relationship for years. My boyfriend was as horrified as I was. We went to an STI clinic, both eyeing each other very suspiciously, to find out he’d probably transmitted it to my genitals from a tiny cold sore on his mouth.”
Trina, 20, student
What now?
If you’ve experienced any of the symptoms or fear you’ve been exposed, you’ll need a blood test to identify the disease. If it’s positive, you’ll be given a course of high-dose penicillin injections and carefully watched for several years to ensure it hasn’t progressed.
Can it be cured and will it come back?
If it’s treated before the tertiary stage, it’s completely curable.
Have I infected my partner?
Syphilis is spread by vaginal, oral, or anal sex. If you test positive, you must inform as many previous or current sexual partners as you possibly can.
Will it affect my chances of having children?
Not if it’s treated promptly.
Trichomoniasis
What is it?
It’s a common infection, caused by a one-celled organism of the same name, with ghastly symptoms. It incubates for between one and four weeks though some researchers claim women can carry the germ for years before showing symptoms. Trichomoniasis is usually passed on through intercourse.
How do I know if I’ve got it?
You’ll know it if you’re a woman and showing symptoms! A thin, revoltingly smelly, greenish-yellow and sometimes frothy discharge appears from your vagina. Most men have no symptoms, though some notice a slight discharge and need to pee more often.
What now?
A smear (sample of the discharge) will be taken and analyzed. If it’s positive, you’ll be put on a course of antibiotics—either one, strong single dose or a week’s worth.
Can it be cured and will it come back?
Yes it’s curable and, unless you’re reinfected, it won’t come back. A good home remedy to relieve symptoms until you can see your doctor is to soak a tampon in two tablespoons of white vinegar, one drop of baby shampoo, and a pint of warm water. Insert (which is easier said than done—tampons tend to explode to EXTRA-large size after being soaked) and leave in place for up to four hours. Don’t do it immediately before seeing a doctor because it can affect the swab results.
Have I infected my partner?
It’s spread by vaginal sex, so quite possibly. Both of you should be treated simultaneously.
Will it affect my chances of having children?
No.
Human papilloma virus (HPV) or warts
What is it?
In fairytales, the princess kisses the warty frog to turn him into a prince. In real life, having sex with a wart-infected person will simply get you warts. HPV is a virus that causes warts in the genital area.
How do I know if I’ve got it?
It’s common—about 70 percent of women (and most likely a vast majority of the population) carry the virus—but only a small percentage go on to develop warts on their genitals.12 They’re small, painless lumps that look like tiny cauliflowers, and they appear on the vulva, vagina, penis, or anus. They can take weeks or years to develop after exposure and you may not even notice very small lesions which, nonetheless, shed virus particles and make you infectious.
What now?
There are fifty-two different strains of the HPV virus.13 Numbers 6 and 11 cause genital warts; numbers 16 and 18 are the ones most likely to be associated with cervical cancer—but they don’t cause warts. The reason I’m dazzling you with statistics is because lots of people think having genital warts puts them at risk of cervical cancer. It usually doesn’t (though regular Pap smears are still a very good idea). If you have visible warts, a doctor will paint them with an acid solution, which causes them to dry up and fall off after a few treatments. Alternatively, you may need to have them removed in a hospital through diathermy (burning), cryotherapy (freezing), or laser treatment.
“When I was sixteen, I was terrified of catching a disease but when I got to college, everyone’s attitude changed. It was like, ‘I’ve got a dose of the clap, I’ve got to see the doctor.’ You boasted about it. It was a bit of a hero thing; proof you’d been screwing girls.”
Nathan, 21, student
Can it be cured and will it come back?
Recurrence is common, especially if you’re stressed, smoke, or use steroids. As with herpes, the better you look after yourself, the less I likely you’ll be plagued by attacks.
Have I infected my partner?
In adults, HPV is spread by having vaginal or anal intercourse with an infected partner. Condoms help prevent the spread but even they aren’t 100 percent protection against infection. Avoid having sex while one of you is having warts treated.
Will it affect my chances of having children?
No.
Hepatitis A, B, and C
What is it?
Hepatitis is inflammation of the liver caused by a number of things, including alcohol, chemicals, drugs, and infections by viruses. Hep A is usually transmitted by contaminated food or drink and through anal sex; it’s not transmitted through intercourse but may be by oral sex. Hep B is passed on via semen, mucus, or blood through intercourse (vaginal or anal) or needle-sharing. (In fact, you’re more likely to pick up Hep B than you are HIV through heterosexual sex because of the nature of the bug—it can survive for longer in less ideal environments.) Hep C is similar to Hep B but mainly blood-borne and usually transmitted through sharing needles. Whether it’s transmitted sexually or not is unclear at the moment. Both Hep B and C are associated with liver cancer.
How do I know if I’ve got it?
Hep A usually lasts a couple of weeks (causing vomiting and diarrhea) then disappears spontaneously, leaving no lasting effects. The incubation period for Hep B and C is anywhere from six weeks to six months and you may show no symptoms or very serious ones. Yellowing of the skin and eyes (jaundice), unusual tiredness, darker than usual urine, and paler than usual stools are some symptoms.
What now?
If you suspect you’ve been exposed to any of the three types, get a blood test (even if you aren’t showing symptoms). As with AIDS, there’s a window period—which means you should be retested several months later. Unfortunately, there is no effective cure. Because it’s a virus, it doesn’t respond to antibiotics, though some drug treatments have proved helpful.
Can it be cured and will it come back?
Hep B and C sufferers can be lucky—your body fights the bug, it goes away, and you’re no longer infected or infectious. Other times (for reasons unknown), the Hep B or C bug hangs around in the bloodstream and you’re a carrier. Even if it doesn’t make you sick (though it usually does cause problems like liver disease later in life), you can still pass it on to others. Hep B can be prevented with a vaccine that involves a course of three injections. If you inject drugs or have unprotected sex, it’s worth getting vaccinated, (and therapy while you’re at it, to stop you from doing either).
Have I infected my partner?
Quite probably. It’s safest to have all sexual partners tested.
Will it affect my chances of having children?
No.
Chlamydia
What is it?
It’s common—in the U.S. about 4 million women and men become infected each year—but it’s a shy little bug and few sufferers realize they have it.14 Nicknamed the “silent STI” because it causes mild or no symptoms, chlamydia can make a woman infertile very rapidly. It’s picked up through intercourse with a person who’s already infected, and the ramifications are serious.
Chlamydia can cause permanent damage to the tubes vital for reproduction in both sexes, making you infertile. It’s one of the major causes of pelvic inflammatory disease in women and ups the chances of ectopic pregnancy (where the baby grows in the tubes instead of the womb).
How do I know if I’ve got it?
It’s silent, remember, which means it’s often symptom-free. If symptoms do occur in women, they’re likely to be a thick, sometimes bloodstained discharge, pain when you pee (or needing to go more often), or pain during intercourse. Men may also have a discharge, pain on urination, swelling of the testicles, or diarrhea.
“He was the first guy I’d ever slept with, a doctor and twelve years older than me. He gave me hepatitis, and I was sick for months. I learned the hard way why condoms are a must.”
Flavia, 22, waitress
What now?
It’s tested by a swab taken from the cervix or inside the tip of the penis, or (more recently) by a urine test. Luckily, chlamydia is relatively easy to treat through antibiotics: either one high-dose or a ten-day course. You’ll be retested after the course to make sure the disease is cleared.
Can it be cured and will it come back?
If you test negative after treatment, you’re cured.
Have I infected my partner?
It’s spread through intercourse. Condoms help prevent passing it on but both of you should be treated simultaneously if you haven’t used them every time, to avoid passing the disease back and forth. Avoid sex while you’re taking the antibiotics and until you’ve both been given the okay.
Will it affect my chances of having children?
If it leads to pelvic inflammatory disease, yes.
Pelvic inflammatory disease (PID)
What is it?
It’s something women should avoid like the plague if they plan on ever having babies. PID is an infection in the womb and tubes, often caused by bacteria passed on through sexual intercourse. As the name suggests, some or all of the organs and tissues in the pelvis become inflamed and sore. If you suspect you have it, see a doctor NOW. Left untreated, PID can permanently damage the tissue and affect fertility and/or increase your chances of ectopic pregnancy (pregnancy outside the womb). Chlamydia and gonorrhea are common causes. A termination (abortion), childbirth, and some gynecological operations can also trigger PID.
It can cause no symptoms or quite severe ones, including stomach pain, vaginal discharge, pain on sexual intercourse, pain on passing stools or urine, bleeding between periods or heavy, painful periods, vomiting, and fever.
What now?
Your doctor will give you a pelvic examination (feel your abdomen and inside your vagina) and take vaginal swabs (samples of your discharge), particularly for chlamydia, which is a common cause. PID can be “acute” (you’ve noticed symptoms recently) or “chronic” (it’s been there a while but gone unnoticed). Chronic PID can cause symptoms on and off over a period of months or years. Either way, once it’s discovered, you’ll probably be put on antibiotics, perhaps several types over a period of weeks. If it’s a serious attack, you may need intravenous antibiotics in the hospital. It’s important to rest and drink fluids during treatment, and you must avoid having intercourse until two weeks after the treatment has ended. Follow-up examinations and tests will give you a clean bill of health.
Can it be cured and will it come back?
It won’t recur if it’s treated properly, but if you’re severely infected, you might well be in for bouts of chronic pain and general ill health before full recovery.
Have I infected my partner?
Condoms help prevent infection but usually your partner is treated as well, just in case, to stop passing the infection back and forth.
Will it affect my chances of having children?
Sadly, yes. Many women with PID have major difficulties getting pregnant. After one episode of PID, 10 percent of women have damaged tubes. If untreated or reinfected, two episodes leave 25 percent of women infertile, and after three episodes the figure jumps to 50 percent.15
FESSING UP—HOW TO TELL A LOVER YOU HAVE AN STI
Sarah got herpes when she was seventeen. At twenty-seven, she still had mild attacks about once every two years but avoided sex at those times and figured the chances of infecting her fiancé were pretty slim. Five years later, her now-husband found out—as she was about to give birth to their first child. The stress of pregnancy brought on a massive herpes attack and the child was at risk of being infected.
“We have to do a caesarian,” the obstetrician explained to the anxious father, “because Sarah’s infected right now.”
“With what?” he answered. What should have been a gloriously happy event was marred by angry arguments about why he hadn’t been told.
Lots of people don’t tell their partner they’ve got an STI because they’re worried they’ll be branded “cheap,” “slutty,” or “dirty.” And sometimes they’re right—some sexually naive, uneducated, or extremely narrow-minded people will judge you. But the way I figure it, if you explain the facts and your lover still thinks you’re trash, surely it’s better to find out early on that he/she’s a righteous bigot? Anyone who’s sexually active is at risk of getting an STI. If you’ve used condoms with the person you’re about to tell, the most they can justifiably accuse you of is having unprotected sex in the past, though even that isn’t true in some cases.
Here’s some pointers to help guide you through a tricky discussion. (If you’re carrying HIV, see “Should I have an AIDS test”.)
If you’ve just found out you’ve got an STI, had unprotected sex recently, and think you may have infected your partner, there’s nothing to do but tell them immediately. (I’m taking it for granted no one in their right mind would knowingly have sex without a condom if they knew they were infectious.) Say you had no idea you were carrying anything but are worried sick you may have inadvertently passed it on. If they’re angry and accuse you of all sorts of irresponsible behavior, calmly point out that the decision not to use a condom was made by both of you. You both took risks and who knows who gave it to whom, anyway?
If you have herpes or an STI—other than HIV or AIDS—that can’t be cured, you don’t need to tell every person you sleep with. If transmission of the STI is prevented by condoms, you use one, and you aren’t currently having an attack, it’s unnecessary to tell casual lovers. They’re not at risk so it’s none of their business.
Pick the moment carefully to tell long-term partners if you have herpes or an STI that can’t be cured. The time to confess a long-standing STI is when you decide the relationship is serious, or has the potential to be. A good relationship is based on trust and if you leave it too long, your partner will feel understandably “had.” Pick a time and a place where you’re both relaxed and won’t be disturbed but…
Prepare first. If you don’t already have books or leaflets explaining the STI you have, get some (family planning clinics usually have great info you can take with you). Your partner can then read the facts for themselves. Rehearse what you’re going to say so it doesn’t get all mixed up on the way from your brain to your mouth. Imagine how you’d like to be told if the roles were reversed.
Speak calmly. Say you have something to say and would appreciate it if they don’t interrupt until you’re finished. Then simply tell your story—how you got the disease, how upset you were when you found out, how you deal with it now. It’s a very good idea to explain early on that because you’ve been using condoms, there’s no chance you’ve infected them. That way, they’ll listen to what you’re saying rather than sit there thinking, “Oh my God, now I’ve got it too.” Tell them you’re confessing because you trust them not to judge you, can see a future together, and want to be completely honest. Now’s the time to bring out the literature to back up the facts you’re presenting.
Refuse to be judged. Unless you got it from screwing their best friend behind their back, it’s nothing to be ashamed of. Expect a little uncomfortableness (if they like you, they don’t even want to think about your having sex with someone else, let alone what you got from it), but don’t let anyone put you down. Once you’ve told them and worked out any effect the news will have on your sex life, drop the subject.
Ask that they keep it confidential. It should go without saying, but protect yourself anyway. Even if you are healthily undisturbed by others knowing you’ve got an STI, it’s for you to tell people, not them. If they breach the agreement and blab to all and sundry, send him or her back to the nursery and get them out of your life.
If they can’t accept it, reconsider the relationship. If your partner has read all the facts and can’t deal with the news, tell them they’ve got two choices: either talk to a counselor (try an STI clinic) to get over any issues it’s thrown up or leave. Do you want to be with someone who constantly reminds you of how “bad” you are or makes hurtful jokes at your expense?
If someone’s given you an STI, treat them with the respect you’d hope they’d show you. It’s rarely deliberate, so don’t point the finger and blame them; just get the facts and get on with your life—with or without them.
SHOULD I HAVE AN AIDS TEST?
Anyone who’s ever had unprotected sex (in other words, pretty well all of us over the age of twenty-five) has had those terrifying moments when we’re convinced we’ve got AIDS. Even if it was one, stupid encounter, we huddle under the bedcovers, stare into the darkness, and think, “I bet I’ve got it, I know I’ve got it.” Health workers call us “the worried well”—usually infection-free people in a low-risk category who take the test more for peace of mind than anything else. (That’s not to say we haven’t been infected, it’s just pretty unlikely.) Others have been infected or are in a high-risk group. They’ve injected drugs, are homosexual men, have had sex with bisexual men who haven’t used condoms, or they’ve had lots of heterosexual unprotected sex with a number of people. Whichever category you fall into, having an AIDS test is well worth considering. It’s not scary, no one will look at you “funny” or think you’re promiscuous, and they don’t allow Big Brother cameras in clinic waiting rooms, honest.
More than 40 percent of AIDS cases worldwide are among women, with nearly nine million HIV-infected. There are currently 85,500 cases of women with AIDS in the U.S.16
Where do I go?
First, wait three months from the last time you had unprotected sex or shared a needle, then head for a sexual health clinic (most major hospitals have them), family planning clinic, or your doctor. You can then be tested for all STIs many of which have no obvious symptoms. The clinics are legally bound to ensure confidentiality, so they can’t tell your parents, your partner, or your boss (though they may suggest you tell them if you do test positive).
What will happen?
You’ll be counseled first and asked about your sexual history, drug use, and general health. The counselor will ask why you want the test, how much you know about the disease, and how you would react if you tested positive (they need to be satisfied you won’t throw yourself off the nearest cliff immediately). Then, you’ll be taken to an examining room and a doctor will take some blood (and swabs if you’re getting a thorough checkup). The blood test will detect the antibodies produced by your body when it encounters HIV. Few clinics give results over the phone, so you’ll need a second appointment to find out the verdict.
What happens if it’s negative?
Say a “thank you God” prayer. Now’s the time to make a personal pact to practice safer sex always.
What happens if it’s positive?
Some people don’t go further than pretest counseling because they aren’t prepared to deal with a positive result. Others take the punt. Remember that if the news is bad it still doesn’t mean you have AIDS—it could be ten years before you experience symptoms. A counselor will tell you the result and help you decide if or how you’ll tell family, lover(s), friends, and your employer. It’s advisable to get regular counseling for at least a few months after; as you can imagine, being HIV-positive isn’t something that’s easy to deal with. Your reaction to the news will vary over the next few months and years and it helps to know people in the same situation. The clinic will give you phone numbers of the many support groups available as well as explicit instructions on how not to pass it on.
Number of women who say they’ve changed their sexual behavior because of AIDS: 53.6 percent.17
OTHER THINGS THAT CAN HAPPEN “DOWN THERE”
The human body is an amazing thing and awfully efficient when it’s well oiled and whirring along happily. But let’s face it: if we were a car or a CD player, we’d have been recalled by now due to machinery faults. One microscopic, teeny-weeny bacteria or bug and the whole thing can fall apart. Even if you’re one of those sickeningly health-conscious, never-do-a-thing-wrong types, you’ll still get sick occasionally. And while we’ll all happily trot along to the drug store or doctor for help getting over the flu, we’re not so quick to find out what’s causing problems “down there.” Many people, particularly women, get embarrassed—which is a bit silly when you think about it. Your doctor or gynecologist has seen vaginas, penises, and breasts before. Granted, maybe not yours, but they’re all pretty similar, don’t you think? Then you have to admit you have—What? SEX!—to explain your symptoms or worries? I suspect this won’t come as a horrible shock to your doctor either—she might even have it herself every now and again.
In other words, there’s no need to be shy, red-faced, or self-conscious. If you suspect you have any of the following common infections, get professional help. Unless you’re a seasoned sufferer (and your doctor’s given you the go-ahead), don’t attempt to cure yourself. I’ve listed some home remedies to tide you over until you get to see your doctor and things you can do to avoid future attacks, but they’re not substitutes for medical attention.
Cystitis and other urinary tract infections (UTIs)
Inflammation of the bladder can affect men, women, and children. In adults, cystitis is the most common complaint (62 percent of women will get it at some point).18 It’s caused by germs entering the urethra, and—guess what?—one of the most effective ways to get it is to have lots and lots of great sex, hence the nickname “honeymoon disease.” (If you’ve had a big session, pee immediately after intercourse to flush out any germs; using lubricant during sex helps.) Classic symptoms for both sexes include an urgent need to pee (then nothing comes out when you get there), intense pain on urination, or blood in your urine. Given that the symptoms are truly miserable, most people are begging their doctors for the first available appointment, which is just as well because it can lead to more serious things if left to fester. Once you start treatment—usually a course of high-dose antibiotics—it is wonderfully, immediately effective. The problem doesn’t disappear that quickly (you need to take a full course), but the symptoms do.
Do-it-yourself relief until you can see a doctor
Drink a solution of 1/4 teaspoon of baking soda in a cup of water once every eight hours, and a glass of plain water once every two hours. Over-the-counter UTI remedies are also useful for mild attacks. To prevent future infections, drink cranberry juice (it helps stop bacteria from latching on to the bladder walls), shower regularly, use mild soap, dry thoroughly, and wipe front-to-back when you go to the bathroom. Drink lots of water regularly to flush out germs and pee immediately after sex.
Yeast Infection (candida)
This is a relatively harmless fungus infection. Why, then, do some women run screaming from the room at the mere mention of it? Because it can be a living hell if it won’t go away. As persistently annoying and as stubborn as a two-year-old, recurrent yeast is single-handedly capable of ruining sex lives, good moods, and underwear without very much effort at all. In short, it can leave you feeling as hot for sex as a tub of ice cream.
Candida is a yeast that most of us have growing in our vagina all the time. It’s generally kept under control by the natural acidity of the vagina but things like the Pill, antibiotics, heavily perfumed soaps and bubble baths, vaginal deodorants, sex, pregnancy, diabetes, stress, and general ill health can cause an imbalance. It’s not new—candida was found in the tombs of Ancient Egypt—and men get it too, but to a lesser extent (even so, he needs to be treated as well).
Symptoms include itchiness, a white, cheesy-looking discharge, vaginal swelling or redness, and pain during sex or peeing (usually caused by urine or sperm stinging the tiny cuts you’ve made by scratching wildly in your sleep). Your doctor will prescribe antifungal vaginal suppositories (you insert them and they “melt” inside your vagina) or cream (with an applicator to insert inside). There’s also a new, single-dose, oral antifungal tablet. A man can use the cream or the tablet.
Do-it-yourself relief
To prevent further infections, up the “good” bacteria in your body by eating yogurt with live lactobacillus cultures daily or go on a course of acidophilus tablets (available from drug stores and health food shops). Eat less sugar, yeast products, and alcohol. If you’re plagued by it, pick up one of the many books on the subject which list umpteen theories on getting rid of it for good.
Gardnerella vaginalis
More common than candida, it’s something that normally lives in your vagina, keeping to itself until you do something to upset its home environment—like take the Pill. The first symptom may be a fishy smell (especially after intercourse) or a discharge, either thin and watery or frothy. It’s cured with antibiotics and not passed on sexually, so he doesn’t need to be treated.
Do-it-yourself relief
Alter the pH balance of the vagina using a gel or vinegar douche (one-third vinegar to two-thirds warm water).
Endometriosis
This is a condition where the endometrial (lining) cells of the uterus grow in places outside the uterus like the ovaries, fallopian tubes, bladder, or large intestine. It’s not understood why but it affects women in their reproductive years (most commonly women in their thirties and forties). Endometriosis doesn’t always cause symptoms but it can stop you from getting pregnant easily, or at all. Symptoms may include pain in your abdomen or while going to the bathroom, during sex, or during abnormally heavy periods. The most common symptom is severe pain just before or during your period that feels like a dull, dragging ache rather than the usual period cramps. It’s diagnosed through an operation called a laparoscopy, where the surgeon looks for evidence inside. Treatment depends on how severe it is and whether or not you’ve had, or would like to have, children. You may be given medicine to relieve painful symptoms or hormonal drug therapy, which is designed to cause the tissue to disappear. In some cases, the tissue needs to be removed surgically. In severe cases, the surgeon will remove your uterus, tubes, and/or ovaries as well.
EVEN IF EVERYTHING’S WORKING JUST FINE…
Look after your body and watch for changes
Get some info on how to examine your breasts for lumps. (He should examine his testicles for lumps on a regular basis, also.) Wash regularly, using mild unscented soap, try really, really hard to wear cotton panties most of the time, and if you notice any abnormal lumps, discharge, or redness, see a doctor.
Don’t use feminine hygiene sprays or “freshening” douches
For a start you don’t need them, and second, they alter the delicate pH (acidity) balance of the vagina and can lead to infections, like yeast. If you’re worried about being “smelly,” get a checkup to rule out infections, then shower regularly, use mild unscented soap, and wear cotton underwear. It’s that simple.
Get regular checkups and Pap smears with a gynecologist or your doctor
If you’re sexually active, go every time you notice something unusual (or visit an STI clinic instead) or once every six months to a year. You’ll probably be advised to get a Pap smear yearly or twice-yearly. They don’t hurt and the payoff is enormous: a Pap smear not only can detect cervical cancer in its earliest stages, it picks up any cell changes that may be caused by infections you don’t know you have.
First, your doctor will visually inspect your genitals and may do an internal exam (put his or her fingers inside to check for swelling or pain). Then he or she will use a speculum to look at your cervix and a cotton swab or cervical brush to scrape off a few cells. The sample is then sent to pathology to check for abnormalities. You may be offered the services of Papnet for an extra fee. If you’ve had abnormal smears in the past, it’s well worth considering because it’s the latest in high-tech screening. If they’ve all been clear, it’s probably unnecessary.