Gynotalk

Bad From The Bone

noreply@blogger.com (Dr. Kate) — Mon, 03 May 2010 18:37:00 +0000

Dear Dr. Kate,

I'm seriously worried that my pubic bone is in the wrong position, or too low in my body as I can feel it just inside my vaginal wall.

As soon as my finger enters the vagina I only need to slightly push upon the upper wall (less than a cm in) and I can feel the bone there. I know it is a bone, not muscle, as I can hook my finger behind it and it does not move at all as the muscles of the vagina do.

I am concerned firstly because this is not where it is supposed to be for anyone, but also I'm worried that it will be an obstruction for sex (I have not yet had intercourse, but am currently seeing someone who soon I was hoping to lose my virginity to. I am 20 years old. What should I do?

Thanks,
K

K,

Each woman has a differently shaped pelvis; for some women, the pubic bone is more prominent than others, but it doesn't mean that it's "wrong." A midwifery blog has a good explanation of the differences here; if you'd like to see drawings of the different pelvis types, look here. It sounds to me like your pubic bone is exactly where it should be--you may simply have a pelvis shape that makes your pubic bone point a little lower. You'll find that there's more room in your vagina when you push down (towards your rectum) than when you push up, towards your bladder and pubic bone. I think it's likely that you'll be able to have sex without pain, as well as probably deliver a baby in the future.

That said, it's not unusual to have pain with intercourse the first few times - usually because you're anxious enough to not be lubricated or fully relaxed. Make sure you get 20-30 minutes of foreplay, to give your vagina enough time to engorge (it actually gets bigger--longer and wider--to accomodate him), and use a lubricant as well (even if you're wet, using a bit of lube from a bottle will make it much easier).

Best of health,
Dr. Kate

Fifteen and Infertile?

noreply@blogger.com (Dr. Kate) — Mon, 22 Mar 2010 13:00:00 +0000

Hello Dr. Kate,

I'm 15 years old and I'm worried about my irregular periods. My first period was when I was 13 years old and it lasted about 3 weeks! Then it came every 3 or so months, but I then went 7 months. When I finally got my period it lasted 28 days in total. I went to the doctor who prescribed me these birth control pills and then my period actually stopped the next day. But then it didn't come for about another 4 months, and in December 2009 I got a period and that lasted 6 days, but by the end of February I hadn't had my period. I'm so worried over this. I read posts about women having cancer or being infertile and it scares me so much, i just want to be like my friends who have periods every month lasting 7 days. I just want to be normal. I haven't seen a gynecologist, but I'm scared, I don't want anyone to look at my 'private parts' or anything like that. Please can you help me?

Fifteen and Infertile?

Dear Fifteen,

It's REALLY typical to have irregular periods all throughout your teenage years. Yes, you're at the extreme end of what's normal. But your body isn't used to ovulating each month yet--and when you don't ovulate, you don't get a period. If you're otherwise healthy, I doubt anything else is wrong.

I think that the best thing for you to do is to stay on birth control (pills, patches or rings, whichever you find easiest to take). If you use them in the standard way--three weeks of hormones, followed by a hormone-free (pill-free, ring-free, or patch-free) week--you should see a "period" most months. It may be light, and it may be short, but it will generally be something. The fact that you've had periods at all (even if only a few of them), means you have all the right "parts." We just need to wait for your hormones to get in sync, to give you that monthly bleed that you really want.

If you want to see a gynecologist, for more peace of mind, they DON'T NEED to do a pelvic exam to talk with you about birth control and your periods. You have every right to decline one, and still get care. And if you go to a doctor who insists on an exam, go to a different doctor. They can find out all they need to about your health with blood tests and maybe an ultrasound. But I want you to get help without being afraid to go (even though pelvic exams aren't really bad, I promise).

Best of health,
Dr. Kate

IUDs and Odors of Unknown Origin

noreply@blogger.com (Dr. Kate) — Mon, 15 Mar 2010 13:00:00 +0000

Dr. Kate,

About six months ago I upgraded from the pill to a Mirena IUD and it was the best decision of my life. I haven't had any side effects or any weirdness during sex with the strings, etc. However, I've noticed that my vaginal discharge has become particularly pungent since my IUD and I'm rather concerned. Could it simply be some terribly rare side-effect of the IUD my doctor failed to mention? Or is this sign of my body somehow rejecting the implant?

Or (to throw a wrench in the whole scenario) could it be my boyfriend? I began dating my current beau about a month before getting my IUD and because the odor is more noticeable after we've had sex, I'm wondering if somehow our juices don't jive, so to speak, and the IUD is merely a coincidence? Either way I'm torn because I love them both so dearly!

Thanks,
Stand By Your Man & Your Implant

Dear SBYMAYI,

The good news is that the Mirena is not causing your discharge. The only part of the Mirena that's in your vagina are the strings--and these were designed to be bacteria-repellent (or at least, not attractive to them). And if your body were rejecting the IUD, you'd have crazy bleeding or cramping, and it doesn't sound like you've had to worry about that. So the Mirena gets to stay!

The bad news is that the change in your discharge may be due to bacterial vaginosis (BV), which is likely due to the increased amount of sex you're having. It's not so much as a bad mix of juices--sex just changes the pH of the vagina, and makes it more likely to have strange odors or BV (which is overgrowth of one of the native bacteria). See your gyno, and have her do a wet prep test in the office to see if you have BV. If so, a course of antibiotics should clear it up. And if you continue to have recurrent BV, you may want to go on prophylactic antibiotics (or see if using condoms makes a difference). So I think the boyfriend gets to stay as well.

Best of health,
Dr. Kate

Going Commando

noreply@blogger.com (Dr. Kate) — Fri, 12 Mar 2010 01:32:00 +0000

Dear Dr. Kate,

I recently read in a women's health quiz that GYNs encourage patients to go without underwear when their clothing permits. I've tried this out for a couple of weeks and have actually noticed that I have less vaginal itching and irritation (and laundry), but is it really recommended?

Going Commando

Dear Commando,

I do recommend skipping underwear for patients with a lot of itching and irritation, since letting the vagina "breathe" seems to help (as it did for you). If they find it difficult or uncomfortable to do that during the day, they can simply go to sleep without underwear. And the nighttime nudity seems to work just as well. For women without any vulva worries, I don't particularly recommend it. But there's absolutely nothing wrong with going panty-less as often as you want.

Best of health,
Dr. Kate

Photo credit: the queen of subtle

The Scoop On: Bartholin Cysts

noreply@blogger.com (Dr. Kate) — Thu, 11 Feb 2010 01:26:00 +0000

Dr. Kate,

Can you tell me about Bartholin cysts? I found a pea-sized lump under the skin near the entrance to my vagina. It was a little movable and was very, very tender to the touch. It later burst, releasing a bit of blood and leaving the area very sore. The next day you could still feel a smaller, less round pea shape, but it wasn't as tender.

Thank you,
Cyst Boom Ow!

Dear CBO,

The Bartholin's glands are among the many glands that line the entrance to the vagina. They normally secrete fluid that makes up part of your healthy vaginal discharge. But just like the pores on your face, these glands can become blocked, forming a cyst (kind of like vulvar acne). The cyst may be painless, but if it becomes infected, it can be exquisitely tender. These cysts can stay small like yours, but can grow to be giant. I had a patient with a Bartholin cyst that was as big as a baseball--I'm not sure how she managed to walk into my office.

Treatment of a Bartholin's cyst depends on the size and how much it bothers you. A small cyst that's painless will likely resolve on its own with warm compresses to release the blockage. If it becomes large, painful or infected, an incision is made into the cyst and a tiny catheter (called a Word catheter) is placed to allow the fluid to drain. Your gyno will also prescribe antibiotics if she suspects infection. In the worst cases, where the cyst doesn't resolve or recurs multiple times, the entire cyst can be removed during a surgical procedure. There's nothing you can do to prevent Bartholin's cysts, but they don't have any long-term consequences.

Best of health,
Dr. Kate

Photo credit: km6xo

Expiration Dates

noreply@blogger.com (Dr. Kate) — Mon, 01 Feb 2010 14:00:00 +0000

Hi Dr. Kate,

If birth control pills are expired, or about to expire, but they are still in the original sealed, unopened package without punctures and have been stored in a cool, dry area away from heat and humidity, are they still safe to use and still effective at preventing pregnancy if taken correctly? Is an expired but unopened/sealed condom package stored in a cool, dry area away from heat and humidity still safe, usable and effective at preventing pregnancy when used correctly? These types of expiration dates on BC and condom packages confuse me, for example: the expiration info on a package of birth control pills/sealed condom shows the following: Exp. 12/10 (Meaning it expires December 2010). Exactly WHEN does it expire? Does it expire on December 1st, 2010, or on December 31st, 2010?

Thank you so much!
J

Dear J,

The good news is that you have the entire month of the expiration date to use the product (pills or condoms). In your example, the pills/condoms expire on December 31st.

The bad news is that these products really shouldn't be used after this date. Even if you've treated them with TLC (they haven't been baked in high heat or had their packaging damaged), the manufacturer can't guarantee effectiveness after this date. Now, if you're about to have sex, and the only thing you have on hand is an expired condom, I would still use it - an expired condom is better than no condom at all. There's no way to estimate how much less effective the pills or condoms would be after the use-by date, though. So it's best to keep track of your birth control stash, and make sure you're prepared for sex with the freshest contraception you can.

Best of health,
Dr. Kate

Photo credit: Chazz Layne

The Logic Behind Sunday Start

noreply@blogger.com (Dr. Kate) — Thu, 28 Jan 2010 02:20:00 +0000

Dear Dr. Kate,

I recently began taking Ortho-Tri Cyclen again for a variety of reasons and I've always been a Sunday starter, so I wanted to stick with that routine. I began my period on a Friday and, like clockwork, started taking my pills on Sunday morning bright and early. I know I am suppose to use a back up method for the first seven days if I am a Sunday starter. Here's my question...why is this? I understand if I woman starts on Monday and is a Sunday starter that she has the potential to ovulate during the first week of the pills, especially if her follicular phase is short, but if I start on Friday and begin my pill pack on Sunday, what are my odds of ovulating in the first seven days?

Sincerely,

Sunday Starter

Dear Sunday Starter,

The advice about when to start the pill and for how long to use back-up has more to do with simplicity than science. There's no magic to beginning the pill on Sunday - it's been long thought by doctors that it's easier to start the pill pack with the start of the week. It's fine if Sunday works for you - it gives you the whole weekend to get your pills refilled, and you may be more likely to be home on a Sunday night to take them. But in general, you can begin your pill any day you want - even if you're not on your period ("Quick Start").

The issue of back-up birth control has two parts. If you begin your pills within 5 days (some say a week, I'm more cautious) of the start of your period, you're protected. So if your period begins on a Friday, you're right that if you begin your new pill pack on Sunday, you don't need back-up that cycle. But if you begin your pills later than 5 days after bleeding begins...or in the middle of the month...you'll need condoms for a full 7 days after. Because this rule can get complicated, many doctors simplify it to "always use condoms for the first week of the pack." In theory, if it's not really a period when you start your pack (you just think it is), then you'd be at risk of ovulating, and would need the condom back-up. But if your bleeding looks and acts like a period, your chances of ovulating that week are very low.

Best of health,
Dr. Kate

Photo credit: Vincent Caplier

When A UTI...Isn't

noreply@blogger.com (Dr. Kate) — Mon, 23 Nov 2009 14:00:00 +0000

Dear Dr. Kate,

I've been having this recurring problem that my OB/GYN and primary doctor can't seem to figure out. I started feeling like I have early symptoms of a UTI two months ago (I've had a few so I'm familiar with the symptoms). I have an urge to urinate but I don't have pain and sometimes it even goes away if I force myself to go less often, or avoid caffeine. Eventually it stops but then it seems to start again. When my symptoms started I went to my OB/GYN for a UTI test, which showed only an elevation in white blood cells, I took antibiotics and felt better for a while. I know that I don't have an STD, and it doesn't feel like a typical UTI. This has been not only a problem because I am uncomfortable but it also can make sex uncomfortable and even painful. My doctor doesn't seem to have an answer. Any ideas?

Thanks so much,
Sara

Sara,

It sounds like you may have interstitial cystitis, a diagnosis many doctors don't initially think about. IC is basically inflammation of the bladder that gives you all the signs of a UTI but there's no infection present. Bladder pressure, pain, and burning, along with the constant urge to pee, are the most common symptoms. It's a fairly common cause of chronic pelvic pain as well, affecting almost one million women.

You may want to see a urologist - they're the best equipped to do bladder testing and give you a definite diagnosis. Testing may include a potassium sensitivity test (through a slim catheter placed into your bladder) or cystoscopy (where the doctor can actually look inside your bladder through a skinny camera). Treatments vary from oral medications to actual treatment of your bladder, and depends on how severe your symptoms are. But once IC starts to intefere with your quality of life - which sounds like where you are - it's time to get help.

Best of health,
Dr. Kate

Pregnant On My Period?

noreply@blogger.com (Dr. Kate) — Fri, 20 Nov 2009 14:00:00 +0000

Dear Dr. Kate,

Can I get pregnant if I have unprotected sex during my period? I've heard that you can, but what are the odds? Especially if I'm really regular...?

Messing Around During Menses

Dear Messing Around,

Short answer: yes, with low odds.

Long answer: If you're really regular, you likely ovulate around day 14 of your cycle (or 14 days after you start bleeding). This means that you can get pregnant from roughly day 10 to day 15. But you never know when your ovaries decide to go into overdrive and pop out an extra egg one month, that might be around during your period. So the chances aren't high, but it's far from impossible. Add on the fact that bleeding isn't always from a true period (but from an infection, stress, a polyp or fibroid), and you'll see why the chance is there.

Final answer: if you have a uterus, functioning ovaries, and an orgasming penis near your vagina, you CAN get pregnant. Even with birth control, even during your period, even right after a baby/miscarriage/abortion, even the first time you have sex. The odds may not be high, but it's still possible.

One Tube + One Ovary = One Real Chance of Pregnancy

noreply@blogger.com (Dr. Kate) — Wed, 18 Nov 2009 14:00:00 +0000

I’ve come to the conclusion that there’s no reproductive justice. I have patients who are trying anything and everything to have a baby. I have patients who seem to get pregnant when they wink at their guy. Then there’s R. She came to me in disbelief after a home pregnancy test was positive. I confirmed her pregnancy with my own test and an ultrasound, then sat and listened to her story.

R. was convinced that she would never get pregnant again (she has two little ones at home) because of her medical history. She had her left fallopian tube removed for an ectopic pregnancy, and her right ovary removed due to a large cyst. “How in the world did the egg make it all the way across?” she asked. It is pretty amazing, to think that a single cell egg could float across the pelvis, dodging small intestines, and get captured by the other fallopian tube, in time to be fertilized. That’s the body’s imperative to reproduce, I told R. Where there’s any chance of pregnancy, the body takes it.

I’ve never seen a person too sick to get pregnant, despite what their doctors may say about their illnesses. And I’ve seen other patients beside R. where against all anatomical odds, they get pregnant. These cases, of course, happen most to women who weren’t planning pregnancy at all. Like I said, no justice. Yay for the tenacity of our ovaries…but you’d best be using birth control if you don’t want that stick to turn blue. Have any of you known someone who’s gotten pregnant against all odds?

No Name Not the Same?

noreply@blogger.com (Dr. Kate) — Wed, 28 Oct 2009 13:00:00 +0000

Dear Dr. Kate,

A few months ago, I read (on a reputable website) that generic birth control pills can sometimes not be as effective as their name brand counterparts because they do not always contain the same amount or combination of hormones. I am a poor college student, so $5 for pills each month sounds way better than $30, but not if I'm not getting the same amount of protection. I'd gladly pay the extra $25 if it meant significantly higher protection from pregnancy. Is it true that generic pills are less effective? And if they are, are there any certain generics that are better than others?

Scared of Generics

Dear Scared,

That's a great question. The FDA mandates that brand-name drugs and their generic versions need to be chemically the same drug. Generic pills have to have the same active ingredients, the same dosing, and the same kind of absorption. What’s different? Colors, shapes, imprints and preservatives…but the medication is the same.

So why do some women claim to see huge differences when they switch to the generic form of their favorite pill? It may be a reaction to the inactive ingredients in the new pill; these ingredients don’t affect how the pill works to prevent pregnancy, but intolerance of them may cause side effects. The other reason is a bit more high-school-chemistry, and is related to the bioavailability of the drug. Bioavailability is the amount of time it takes the drug to be metabolized by the body. The makers of generic pills must show that the bioavailability of their generic is not significantly different (plus or minus 20%) from that of the name brand. So generics have the same amount of hormones, but it may take a different amount of time for your body to absorb it. This difference shouldn’t change the efficacy of the pill, either, but it may cause side effects in women who are sensitive to small changes in hormone levels.

All pill manufacturers have to guarantee that the hormone doses in each pill are what they claim they are, plus or minus this 20%. So that gets a little scary with ANY pills, especially the ultra-low-dose ones (with 20mcg of estrogen), because what if you get a batch that has a bunch of pills that err on the low side? That's one of the reasons I'm not a fan of the ultra low dose pills...but the same concerns apply to generics AND brands.

My advice is that if the cheaper generic pills don't cause any crazy bleeding or other side effects, stick with them. And if one generic pill makes you feel bad, you can always try another - I'd hate for anyone to stop using the pill simply because of cost.

Photo credit: spentpenny

The 40-Year Old Virgins

noreply@blogger.com (Dr. Kate) — Mon, 26 Oct 2009 13:00:00 +0000

Okay, so she was really 35 years old. But when L., a new patient, revealed to me that she hadn’t yet had sex, she really meant no sex—not the Clinton version of sexual relations, but no penetration or orgasms of any kind with a partner. L. had decided that she was finally ready, but was anxious about what it would be like. Her friends, upon hearing that L. finds tampons uncomfortable, told her, “You’re screwed. You’d better see a doctor for advice.” The irony of “screwed” aside, this was a less than considerate response to L’s concerns.

The average age of first intercourse is around 17 years in the U.S., and roughly 90 percent of us have done the deed by age 24. But that leaves a good number of our sisters who are delaying the first time until their late 20s or beyond. It may be for religious reasons, or cultural, or the mess factor…or one (or more) of a thousand reasons. And given that we’re living in a time when nearly everything is now okay—anal sex, threesomes, vibrators that sing, etc etc—we should be really support all the choices that women make on the subject. Which, of course, includes choosing not to do any of those things, or waiting until the perfect guy, the perfect moment. If a virgin friend asks you for any advice, tamp down your incredulity, be supportive and tell her the following:

* First-time sex may hurt. It may not. For certain, though, nervousness increases tension, which increases the odds that it will hurt. A glass of wine, a massage, Barry White on the Bose—whatever decreases her anxiety is a good thing.

* A test run may help. She can get used to the idea of something in her vagina ahead of time. Her own finger, a dildo or vibrator, two fingers—accompanied with a lot of lubricant.

* Lube, lube, lube. I can’t stress lubricant enough. No matter how wet she thinks she gets, she’ll find lube makes it easier. It’s not just for sex toys and porn stars anymore.

* Set the stage. This is not the time for a quickie; the more time they can spend together, the better she’ll be able to relax, get wet, and enjoy sex.

* Consider being on top. It’s the position she can best control how fast and at what angle he enters her.

* It’s okay to ask a gyno about it. If she’s really concerned, any good doctor should be happy to talk about these issues; many women may not think about a meeting with their doc before they really get down to business.

* Don’t forget the birth control. We can always get pregnant the first time we have sex, whether we’re 14 or 40.

There are some good resources online, but a lot of baloney as well—it’s all another reason an understanding friend can be indispensable. What would you tell the L. in your life?

I Don't Want Him - But Who DO I Want?

noreply@blogger.com (Dr. Kate) — Wed, 21 Oct 2009 13:00:00 +0000

Dr. Kate,

I have only been with one partner, and I've never been abused. My partner is attentive and committed, equally inexperienced but enthusiastically willing to try anything I'm interested in.
Here's the problem: although I started out with very normal desires and expectations, things have really gone south over the course of our three-year relationship, and not in a good way. As far as I can tell, I'm the problem. I hate kissing, especially tongue kissing. I do not enjoy foreplay, although we've read countless books and articles and tried so many different things. I hate cunnilingus; it makes me feel nauseated. I think lingerie is dumb-looking and I feel stupid wearing it, although the idea of him dressing up for me is somewhat appealing. I can climax very easily on my own, but my partner hasn't been able to get me there once. I also don't enjoy cuddling after we have sex. It's the weirdest thing - here is he wanting to linger in the afterglow and share intimate secrets, and I'm the one wanting to roll over and go to sleep. I have a good sex drive and I'm not insecure about my appearance, but for some reason none of the activities we've tried did a thing for me. I always come away frustrated. I'm starting to worry that maybe I'm not straight...I'm from a very religious background and never had the chance to experiment with anything. I don't want to end this relationship because we work together so well on other levels...but I am getting so fed up with our sex life. Any thoughts?

Frustrated

Dear Frustrated,

You're not the problem. Likely neither is he - it may be in the pairing of the two of you. A question: do you ever feel aroused when you're with him? Does a look or a touch from him ever make you tingle or feel turned on or make you want to grab him? If not, it doesn't sound like you're attracted to him. Attraction is different for everyone, but generally leads to some physical feeling in you...if you don't want to kiss him, you simply don't want him.

You say that your sex drive is good - what gets you in gear? Do you get that physical rush from any man? One you know, or one you look at from afar (or even a celebrity)? Is there any fella that you would want to kiss? If not, it's very possible that you're not straight. Have you ever let yourself even think about being with a woman? How do you feel, just thinking about kissing a woman? Give yourself some time to explore thoughts like these. There are many resources out there for you - many are geared towards teens (and you haven't told me your age), but are still really good.

You might want to consider a psychologist or therapist to be able to confidentially talk out how you're feeling. I hope you can at least find a friend to talk to - it's not going to be easy, these next steps. But you're brave to take them - we all deserve to feel physically good with our partner. Your boyfriend sounds wonderful, but he doesn't sound like what you want.

Best of health,
Dr. Kate

The Ultimate User's Guide for the Nuva Ring

noreply@blogger.com (Dr. Kate) — Thu, 15 Oct 2009 13:00:00 +0000

When it comes to hormonal birth control, I get more questions about the NuvaRing than any other method (see for yourself here). It just doesn't seem to be as intuitive as the once-a-day-every-day tyranny of the birth control pill. Most women's questions focus on the timing of the ring, and what happens if their schedule gets thrown off. So this is everything you need to know about using the NuvaRing.

1. When to start it. You can start the ring any time you want:

If you're starting it with your period, put in the ring during the first 5 days of bleeding.
If you're starting it later than that, or totally off your period, take a pregnancy test first. If negative, begin the ring that day.
If you're switching to the ring from the pill or patch, you can place the ring on the day you would have started your new pack of pills or box of patches.

2. How soon you're protected. It dependes on when you started the ring:

If you place the ring on the first day of your period, you're protected immediately.
If you directly switched from the pill or patch to the ring, you're protected immediately.
If you started the ring at any other time, you need to use condoms for 7 days for maximum contraception protection.

3. How long to leave it in. The ring needs to be in your body for 3 straight weeks. Don't take it out early if you start bleeding early than you expect - the ring needs its three weeks to work. If you remove the ring before the three weeks are up, you're at risk of pregnancy that cycle.

4. How long it can stay in. The ring has enough hormones so that it may be left inside for up to 5 weeks and still be effective. So you've got lots of flexibility in how long the ring is in. And you don't need to use the ring for the same amount of time each cycle - some months you may leave it in 3 weeks, some up to 5 weeks - your body will adjust. But if it's left in longer than five weeks, you're now at risk of pregnancy.

5. How long you can leave it out. The ring cannot be out of your body for more than 7 days - in other words, you need to put a new ring back in by the same day of the week that you removed the old one. This rule holds even if you're still bleeding - the new ring must be reinserted within a week.

6. When it's out, you're protected. If you've used the ring following these guidelines, you're still protected against pregnancy during the ring-free week. The ring has suppressed ovulation for that cycle, so you don't need a back-up method of birth control during the ring-free week (though condoms are always a good idea for infection prevention...).

7. Ring holiday. The exception to rule #3: you can remove the ring for up to 3 hours at a time for sex (or any other reason...) and still be protected against pregnancy. There are no studies that tell us how often you can take a ring holiday; I counsel my patients that they can remove the ring once a day for 3 hours and are likely still safe.

8. If the holiday runs long... If the ring is out of your body for more than 3 hours, it's possible that your ovaries will respond with a quickie ovulation. So put the ring back in and use condoms for a week.

9. If you're late putting a new ring in. If the old ring has been out for more than 7 days, put the new ring in anyway. Don't wait for your period to start (so many women become pregnant while they're waiting!). Then use condoms for 7 days.

10. Back-to-back. You can use a new ring directly after taking out the old one - you don't need to leave a ring out for any length of time, you don't need a back-up method, and you can do this indefinitely (no need to ever bleed).

11. Bleeding patterns. It's normal to have irregular spotting or bleeding during your first few months on a new birth control method. Don't pull the ring out if you begin to bleed early - it doesn't mean the ring is "finished," it's just breakthrough bleeding while your body is adjusting.

12. Other things in your vagina. All okay. Including semen.

13. You can't lose it in your body. As long as the ring is all the way in the vagina, and it feels comfortable, you’re good to go. It doesn’t need to be in a particular place to work, and it won't go in too far.

And one final thought - this should go without saying: If you have sex without using the ring correctly, you are at risk of pregnancy. Take a pregnancy test if your period doesn't come when you expect.

The Birth Control Pill Is So Much More

noreply@blogger.com (Dr. Kate) — Wed, 14 Oct 2009 12:00:00 +0000

My new patient J. came into my office with her mother last week, to discuss her awful periods. She's 13, and has been to the emergency room several times (and missed over a week of school this year) because of heavy bleeding and disabling pain. I was excited about offering J. the birth control pill--I don't often have the chance to greatly improve someone's life with a simple prescription. But her mother resisted, because when she was young, "only bad girls went on the Pill that young." Forty-five minutes of conversation later, J.'s mother promised to think about it.
This encounter was a reminder that the birth control pill has a bad name. Sure, it's contraceptive power is fantastic (97% effective when used perfectly). But it's so much more than that:

The anti-anemia pill. You bleed less heavily and for fewer days each month.
The anti-cramp pill. You need less ibuprofen...and maybe none at all.
The pro-clear-skin pill. Dermatologists recommend the pill to help control acne.
The anti-hair-in-the-wrong-places pill. Meaning less hair growth on your face.
The cyst-reduction pill. You reduce the chances of benign ovarian and breast cysts.
The cancer prevention pill. Reduce your risk of ovarian cancer by 50% and your risk of endometrial cancer by 80%.
The mood stabilizer pill. The pill can work wonders in some women with premenstrual dysphoric disorder (PMDD).
The bone strengthening pill. Studies indicate that use of the pill can help ward off osteoporosis.
The pro-fertility pill. The pill provides some protection against pelvic inflammatory disease (PID), a major cause of infertility.

All of these reasons can give you incentive to stay on your pill, even if you don't need the contraceptive benefits any longer.

How Will Her Ring Affect Me?

noreply@blogger.com (Dr. Kate) — Fri, 02 Oct 2009 21:44:00 +0000

Dr. Kate,

I'm in a relationship with another woman who because of health issues has been put on a contraceptive device (Nuva Ring - a low estrogen ring thing that she inserts once a month). She has just started this but obviously none of the common questions included in the package address whether or not this will have any effect on a female partner. Any ideas? Thanks!

F

Dear F,

You're right, the package inserts of vaginal products are woefully short of advice for their user's partners, male or female. The Nuva Ring releases a small amount of hormone every day that will be absorbed through your partner's vaginal walls. The ring should have no affect on you during sex - your fingers or tongue are not going to absorb any significant amount of hormone. If you're both uncomfortable with the idea of the ring still inside her when you're intimate, she can take the ring out for up to three hours. She can then put it back in, and shouldn't see any change in her bleeding patterns or other happy-ring effects.

Best of health,
Dr. Kate

Your Body IS A Wonderland

noreply@blogger.com (Dr. Kate) — Wed, 16 Sep 2009 13:00:00 +0000

The months after giving birth should be magical, relatively speaking—bonding with your new baby, a little time away from work, reveling in the wonders of your body (look at what I just made!). But C., the wife of a dear friend, is now four months postpartum and hating her body. She’s managed to lose her baby weight, but she’s amazed that her pre-pregnancy pants no longer fit. “My hips just aren’t the same,” she says.

Of course they’re not—they’ve just widened enough to allow her darling son to come into this world with the greatest possible amount of ease. But staring at the tabloids at how celebrities magically return to pre-pregnancy form in what seems like a weekend is a taunt to postpartum women everywhere. Many of us are probably conflicted about celebrity-watching in general—“why should we care about these people?!?” vs. “what will she wear/date/look like next?!?” And watching famous bodies around pregnancy—from the first bump to the postpartum runway strut—is even more fascinating. It’s a reminder that these women are mortal, and are “just like us” reproductively-speaking.

You CAN get your body back closer to what it was in healthy ways (and cheaper ones than hiring a chef, a trainer, and a nanny). But the bottom line is that some changes to your bottom half may be there to stay. Even if you lose all of your pregnancy weight—good for you!—pregnancy leaves a mark, in the form of changes to your boobs, belly and hips. I tell my postpartum patients (and friends...and even myself) to wear them proudly, as a badge of honor. You're a goddess for being able to grow and give birth to a complete little person.

Do you know any women saddened by their body's changes after pregnancy?

Photo credit: Shaun Johnston

Jiffy Lube

noreply@blogger.com (Dr. Kate) — Mon, 14 Sep 2009 13:00:00 +0000

One of the best ways to improve your sex life is to add a lubricant. Lube may help prevent condom breakage, and may increase both your comfort and his sensitivity (a good answer if he’s whining about using a condom). Lubes are especially important for back-door play, when you’re more at risk of tears in your tissue. You want to find a lube that’s effective for your needs and non-irritating. Fortunately, there’s a multitude of options in the stores or even in your kitchen. In general, you’ll need to try out a few with your guy to see what’s most comfortable. To help find the one that’s best for you, use the handy guide below.

Water-based: Overall the safest types, non-irritating, but can dry more quickly. Ones with glycerin (Replens) or sugar (many flavored ones— for external use only) may increase risk of yeast infection, so steer clear if you’re prone. AstroGlide has the preservative propylene glycol, which may be irritating if you’re sensitive. Trying to get pregnant? KY Liquid contains chlorhexidine, which is toxic to sperm—but don’t count on it if you’re trying to avoid pregnancy!

Oil-based: Vaseline, mineral oil, baby oil. Not water soluble, harder to rinse off, may stain your sheets. Deadly to latex condoms, diaphragms and dental dams, but fine with polyurethane condoms. May coat the vagina or rectum and increase infection risk, so reconsider if you’re plagued with frequent bouts of vaginitis.

Silicone-based: Safe with all condoms and latex products. Longer lasting but harder to wash off—this makes it excellent in the shower. May cause damage to silicone sex toys (too much of a good thing).

And if you find lube messy, here’s a fantastic tip: buy an oil pump mister that’s usually used for nonstick cooking; fill it with the lube of your choice, then spray away where it’s needed. Presto, no sticky hands. Have you found any fun ways of using lube?

Photo credit: The Truth About...

All That Itches Isn't Yeast

noreply@blogger.com (Dr. Kate) — Mon, 07 Sep 2009 13:00:00 +0000

A patient came into my office last week with the common complaint of itching down below. K told me that she has had multiple yeast infections in the past, but her self-treatment with an over-the-counter remedy wasn’t working this time. I examined K and found not yeast but bacterial vaginosis, or as it’s more whimsically known, BV.

For those of you lucky enough to not ever (yet) had BV, it is a vaginal infection but not an STD. Our vaginas normally have a number of bacteria that merrily reside there and keep us healthy, just like on our skin and in our intestines. Sometimes, and we don’t know all the reasons why, one particular bacterium oversteps its bounds and grows out of balance with the rest. We do know that women who are sexually active are much more likely to get BV, but they don’t get infected directly from their partner—it’s a homegrown bug, as it were. I know it sounds confusing—an infection that you get from having sex, but not one that you catch from your partner.

BV has a classic set of symptoms:

The vaginal discharge is thin, white to grayish, and a bit sticky.
There may be an unpleasant odor, unfortunately fishy in nature.
Some women experience vulvar pain or burning, or like K, itching.

Fortunately, BV is easily treated, but you do need to see a doc for treatment—there’s no over-the-counter remedy. Your doc will likely give you metronidazole, in either the oral (Flagyl 500mg twice daily for a week) or vaginal gel (MetroGel, 0.75% nightly before bed for five nights) form. You won’t hurt yourself using a treatment for yeast if you have BV…but you won’t feel any better either. So if you notice a funky discharge, with or without itching or an odor, head to the gyno.

Pulling Out Is In

noreply@blogger.com (Dr. Kate) — Tue, 01 Sep 2009 02:07:00 +0000

"What birth control method do you use?" I'll ask every new patient. Some will guiltily answer, "Nothing." "Not even condoms, or withdrawal?" I'll reply. "Oh, yeah, he pulls out. But we don't use real birth control."

The withdrawal method of contraception (also known as coitus interruptus, or pulling out before ejaculation) has never received much respect from doctors. Withdrawal as a method requires awareness of imminent orgasm by the guy - and the ability to pull out in time. It's a method classified as "coitally dependent" - you need to use the method when you have sex instead of planning ahead of time...and lust doesn't always allow for clear thinking in the moment. And pre-ejaculatory fluid, or pre-cum, has long been though to contain a small amount of sperm, enough to render the pulling out action virtually useless at preventing pregnancy.

Withdrawal often isn't even considered birth control by its practitioners. It's commonly considered to be better than no method of birth control - but not by much. Many women consider it a last resort, during unplanned sex without a condom, or during a month with missed pills or a forgot-to-replace ring. And even more women may use withdrawal as a back-up to another method. It's estimated that at least one-third of women use withdrawal for at least some acts of intercourse.

Researchers have difficulty estimating exactly how many couples use withdrawal as a method, since if they're not directly asked, women don't often report it - making it difficult to assess its effectiveness. But it may be time to take another look at withdrawal as a viable birth control option. Why?

It's actually pretty effective. Compare pulling out to condoms - both methods are very effective when used perfectly (about 4% vs 2%)...and less good in real practice (about 18% vs 17%). Scary numbers for condom users, maybe, but many couples rely on condoms alone at least sometimes.
Not all sex is planned. And when sex is gonna happen, and there's no condoms around, it's the only option available at the moment (until plan B the next morning).
Pre-cum may be clear, after all. Recent studies indicate that pre-ejaculatory fluid does not contain sperm (your high school boyfriend may have been right!)...increasing the effectiveness of the method when he withdraws in time.

The usual disclaimers: Withdrawal will not protect you against STDs - only condoms will. It's not nearly as effective as an IUD or hormonal methods of birth control. And it puts the responsibility for her not getting pregnant squarely in his hands (or his hips, as it were), which many women may not feel comfortable with. But as a back-up to another method, or for infrequent or surprise sex, consider pulling out to be much better than nothing at all.

Photo credit: zen

The Air Down There

noreply@blogger.com (Dr. Kate) — Tue, 25 Aug 2009 13:00:00 +0000

Dear Dr. Kate,

I was just wondering if all vaginas smell the same. It sounds really weird but I am so insecure about the smell/taste of mine. My boyfriend does not seem to mine going down there, so I figure it must not be bad, but I can't help but think mine smells wrong or different from other women's. I can smell mine after I wipe and on my dirty underwear... I'm just not sure if that is normal or not. I have been tested for STD's and everything, so why does mine have such a distinct scent/taste? Can other people smell it too?

Pungent V

Dear Pungent,

No, all vaginas don't smell, or taste, the same...but they do all smell. Every woman has a different musky scent, and we tend to be very attuned to our own smell, even when no one else is aware of it. No one smells you through your clothes; I will occasionally notice a patient's scent when she's undressed (and I'm doing her Pap smear), but never when she's dressed. Odor tends to come from sweat - the vulva and vagina have sweat glands, like elsewhere on your body. And the scent may change as our menstrual cycle progresses, in response to hormones, or at the end of the day. Noticing vaginal odor, if it's your normal one, does not mean you don't have good hygiene or (god forbid) should start douching. No need to buy those scented sprays, either - the chemicals may give you a bad reaction, or lead to copious amounts of discharge. Your vagina should smell like...a vagina.

Yes, sometimes odor can signify bad things - vaginosis, a lost tampon or condom (don't laugh, it happens), or a bit of urine leakage. But if you've been checked out by your gyno, then rest assured that your scent is healthy. And as your guy's enthusiasm for oral shows you, you're all the sexier for it.

Photo credit: net_efekt

The Top 5 Reasons You Shouldn’t Douche

noreply@blogger.com (Dr. Kate) — Sun, 23 Aug 2009 13:00:00 +0000

1) Douching can make odor and discharge worse. Ironic, since these are the most common reasons women douche in the first place. If you have an infection, douching promotes even more bacterial growth, so you wind up feeling worse than when you started.

2) Douching can’t prevent STDs. It doesn’t clean out the harmful bacteria, just washes away the good ones, which actually increases your risk of infection.

3) Douching may cause pelvic inflammatory disease. It pushes the bacteria into your uterus, where they can travel to your tubes and wreck great havoc. Women who douche have over a 70% greater risk of PID compared with women who don’t.

4) Douching is not effective birth control. In fact, it just lets more sperm surf their way into your cervix. But, I don’t have to tell YOU that, right?

5) Douching may cause ectopic pregnancy. And while the sperm are surfing north, they’ve got a straight shot for your tubes, giving you a 75% higher chance of having a pregnancy land there.

Don't get swayed by product-pushers who imply that you need their chemicals up your wahoo to be healthy. The vagina is a self-cleaning organ, when left alone to do her thing.

Photo credit: Muffet

REALLY Sweet Dreams

noreply@blogger.com (Dr. Kate) — Thu, 13 Aug 2009 11:00:00 +0000

Dr. Kate,

I'll just cut right to the chase: I have orgasms in my sleep, what can be called "wet dreams." When I dream something erotic (even if it's just my husband & I having sex), not only do I become aroused, but I have actual orgasms. I would say I have several wet dreams a month.

Now, I'm not complaining -- it's kind of awesome, to be honest! -- but I want to know how common this is amongst women? Because I've never heard of women having wet dreams. Men, yes...women no. Although, my own husband hasn't ever had a wet dream. I find that strange, because I always thought that men are the only ones to have them.

So what's the deal?

Sexy Sleeper

Dear Sleeper,

Believe it or not, you're not alone. The 1950s sex researcher Alfred Kinsey estimated that 40% of women will experience an orgasm while asleep before the age of 45. And these unconscious orgasms seem to be more common as we get older (something to look forward to!). The going theory is that during sleep, our normal inhibitions don't hold us back, so things that we find erotic--even if disturbing or "forbidden"--will arouse us in a way that wouldn't happen while we're awake. And women may climax faster when asleep, for the same reason. For good or bad, these orgasms are not voluntary or under conscious control - so there's not much point in trying for one (or trying to prevent them).

Having orgasms while sleeping is not a sign of sexual dysfunction, and they're not a comment on the quality (or quantity) of your sex life. While there's some crazy psychoanalytic research out there about what sleep orgasms signify, I think they're just a sign of a highly tuned sexual system, one that's built for our pleasure round the clock. So enjoy!

Best of health,
Dr. Kate

Why Pantiliners Are Evil

noreply@blogger.com (Dr. Kate) — Wed, 12 Aug 2009 13:00:00 +0000

Sometimes a solution can create an even bigger problem. M. came into my office on Monday, worried about her increased vaginal discharge. She had started a new birth control pill several months earlier, and was overall happy with it. But she had noticed several episodes of spotting, and had taken to wearing pantiliners every day. M.’s spotting had stopped, but her pantiliner habit continued. She now has noticed more—and daily—discharge, and fear she may have an infection.

With apologies to Always et al, pantiliners are the bane of a vagina’s existence. Yes, they’re perfect for light flow days during your period when a tampon is not needed. And they’re great after a bout of weekday-morning sex, when you still feel drippy but need to get to work. But there’s no need to slap one on your undies every day. Your vagina is self-cleaning, and a certain amount of discharge (and even odor) are totally normal. Some women, though, use daily liners to “catch” their discharge to “protect” their underwear. Then their vagina can’t breathe (could you, through that weave?), which actually increases the amount of discharge, starting a vicious cycle. Chemical irritants like douching, by the way, make it all worse.

We have this notion that we need to be bone-dry, all the time (except if we’re aroused, then we can’t be too wet). But a little discharge on your vulva is okay—moisture keeps you from sticking or chafing. So don't wear liners to protect your panties - wear panties to protect your clothes (which is actually what underwear is for). Just change them during the day if you feel the need.

Photo credit: Nena P. Love

Girls Just Wanna Have...More Sleep

noreply@blogger.com (Dr. Kate) — Mon, 10 Aug 2009 13:00:00 +0000

Dear Dr. Kate,

I am a 27 year old woman. I have four children and have been very happily married for ten years. My problem is that I have no sex drive whatsoever. I have tried almost everything except pills which I want to stay away from. I know four children sounds like a lot of work and it is but I stay at home with them so it's not as stressful if I was working and being mom. But at the end of the day no matter how much I rest during the day or how many days a week I try not to do to much but just let my body rest, I still have no desire for lovemaking. It has been like this for nine years now after I had my first child. I went to several different doctors and they all tell me a different thing. Anything from over-working myself to being to stressed out. One doctor said I needed to wait at least one year for my hormones to get back to normal. There is at least two years difference between all my children and three between my second and third and still I have nothing. My husband has truly truly been great about this whole thing but it's very frustrating to me. We still have sex but it's just not the same anymore. I don't expected to be perfect every time but at least sometimes. I just don't know what to think anymore or what to do. Can you help???

Thank you,
Tired

Dear Tired,

Of COURSE you're tired. I have a 3-month old at home, and it's more tiring than med school and internship put together...and I only have one child. And you've been a mom for awhile, now. It's not your hormones - it's your life that's different after kids. But cliches aside, sex doesn't have to stop after parenthood begins.

This may sound strange, but I want you to think about why you want to have sex. We all have sex for many reasons, and there may be other things that you can do to also meet these wants:

You want to feel close to your husband. I'm glad he's so understanding; make sure you're getting enough time for the non-sex stuff, like hugs, time on the couch watching a movie, and even making out.

You want to feel like a woman, not just a mommy. I'm sure there are days that you feel like a pair of breasts (if you're breast-feeding) with a wallet and a set of car keys.

You think you should. In survey after survey, people in the US roughly break down into thirds: 1/3 of us have sex twice a week, twice a month, or twice a year. So there's no "normal" amount of sex to have.

You want a penis in your vagina. Okay, there's no getting around this one.

Now you can think about why you think you don't want to have sex these days. Think beyond the fatigue...

You're out of touch with your body. It's funny how the product of sex (your little ones) can make you feel asexual. You may need to take time to see yourself as attractive and sexy again, whether it's as simple as perfumed lotion or a push-up bra, or making time to go to the gym to feel strong in your body. And masturbation may help as well - a few easy orgasms with a great vibrator may make you want to come with your husband even more.

You're afraid of getting pregnant. Your gyno can talk with you about birth control options (the IUD may be perfect) so you don't need to think about having #5.

You're afraid the kids are going to walk in. Nothing kills the mood faster than a little voice at the end of the bed asking, "Mommy, what is Daddy doing?" If you can get good child-care, take an evening in a hotel with your hubby; even if it's just a few hours, you can just be the two of you for a time.

You don't have time. First, there's getting you and your husband in a room, alone, and awake. Then there's foreplay, a good sex prerequisite. Not that quickies are a bad thing, but women on average need 20-30 minutes of good foreplay before sex is comfy. So there's nothing wrong with needing/taking this much time.

Sex outright hurts. Especially when you haven't had sex in awhile, or if you're not getting enough foreplay. If your local drugstore is lacking, or you don't have time to shop, check out the lubricants at Good Vibrations and Babeland.

Sex isn't good for you. Even if it doesn't hurt, sex that doesn't lead to semi-regular orgasms isn't that appealing. So if intercourse isn't your ticket to paradise, make sure that you're getting enough manual/oral/vibe stimulation before/during/after intercourse.

There's never an easy answer for not wanting sex...and there's no pill that will fix this ill, either. Think about what has changed, what you think may make it better, and talk with your husband about it. The two of you together will figure out a way to get the fire back.

Best of health,
Dr. Kate

Photo credit: obo-bobolina