GYNECOLOGICAL AND
REPRODUCTIVE HEALTH
Common Infections and Diseases
Contraception and STI prevention
Sexually Transmitted Infections (STIs)
As we enter college, many of us begin to consider important health issues such as birth control, sexually transmitted infections, and gynecological health. Taking care of ourselves is important but becomes even more complicated if we are sexually active. A life-long habit of self-care begins with education. This means reading whatever we can; learning fom books, friends, counselors, and health care professionals; and staying in tune with our bodies.
One of the best sources of information on these topics is Gannett: Cornell University Health Services. Gannett provides pamphlets, counselors, doctors, and referrals and offers a wide range of confidential services. Armed with these resources, we can take our physical well-being into our own hands.
Everyone (males, females, couples) should make use of the services offered by Gannett. As a peer counselor and a student, I have realized that people need much more information regarding their sexual health. Our peer counseling sessions provide people with vital knowledge regarding STIs, birth control, abstinence, gynecological health, self exams, relationships, and safety issues. Most importantly, they provide students with the opportunity to learn and ask questions in a confidential, one on one setting with a sensitive peer.
---Human Ecology
In order to understand your body, it is vital to know the medical terminology of the female reproductive and sexual organs. Also equally important is to know your partner’s body - whether it be a male or female. Throughout this chapter, we will be referring to both male and female body parts and offer this section as a reference.
Female Sexual and Reproductive Organs
Vulva: the external genitalia, which consists of the clitoris and clitoral hood and the labia majora and minora.
Mons pubis: the soft fatty tissue covered with pubic hair that lies on top of the pubic bone.
Clitoris: the highly sensitive sexual organ made of erectile tissue, located near the top of the vulva within the outer lips. The external part of the clitoris, called the glans, is covered by the hood of skin. It is connected to a shaft which extends down towards the vaginal canal. The entire clitoris is made of erectile tissue. When aroused, it fills with blood, becoming harder and more sensitive. The sole purpose of the clitoris is sexual sensation and, if sufficiently stimulated, can produce orgasm.
Labia majora (outer lips): the soft folds of skin which form overlaps on the outer part of the vulva.
Labia minora (inner lips): the folds within the labia majora which surround and cover the openings of the urethra and the vagina.
Urethra: the tube leading from the bladder to the urinary opening.
Hymen: A thin membrane surrounding and partially covering the vaginal opening, which becomes stretched and/or broken when a finger, tampon, penis, or other object is inserted into the vagina. A common myth is that first sexual intercourse may be painful for the woman due to the rupture or stretching of the hymen. This may be true if the hymen is especially thick and blocks the vaginal entrance.
Vagina: the muscular canal that leads from the vaginal opening to the uterus.
Cervix: the base of the uterus which extends into the vaginal canal. In its center is a small opening into the uterus, called the cervical os.
Uterus: the pear-shaped muscular organ situated in the pelvic cavity that receives and holds the fertilized ovum (egg).
Ovaries: the two small organs located on either side of the uterus in which the ovum (eggs) are stored and grow to maturation.
Fallopian tubes (oviducts): the two small tubes which extend from the ovaries to the uterus, through which ova travel.
Male Sexual and Reproductive Organs
Penis: male organ for urination and the release of semen; associated with feelings of pleasure during sexual stimulation.
Scrotum: a sac that encloses the two testes and maintains the testes at a temperature suitable for sperm production.
Testes: contains the seminiferous tubules and interstitial cells that produce sperm and secrete the male hormone testosterone.
Epididymis: stores slowly maturing sperm until sperm are released into the vas deferens.
Vas deferens: carries sperm from the epididymis to the ejaculatory duct.
Prostate gland: secretes fluid that initiates the movement of sperm and nutritionally sustains sperm.
Cowpers’s gland: secretes fluid that neutralizes the acidity of any urine in the urethra.
MENSTRUATION
It has been said that some women leave their periods at home when they arrive at Cornell and they don’t resume their regular cycle until they leave. Stress, travel, extensive exercise, improper diet, and low body weight can all be reasons for missed periods. There is no exact timetable for the menstrual cycle (normal range is between 21 - 45 days). Some women, especially young women, are naturally irregular. It is a good idea to have a pelvic exam if you are consistently missing your period.
Premenstrual syndrome (PMS) is a complaint of as many as 85% of menstruating women. It is common to sense changes in mood and energy level, as well as bloating, cramps, breast tenderness, back pain, headaches, food cravings, and other personal signals related to the menstrual cycle. The symptoms of PMS are real, although the exact causes are not known.
No single treatment has been shown to be effective for curing all symptoms, but there are a number of ways to lessen them. These include birth control pills, vitamin supplements, eating a balanced diet throughout the month, and getting regular aerobic exercise. During the premenstrual interval, it is best to follow a diet high in complex carbohydrates (bread, pasta, cereals) and low in salt and sugar and to minimize coffee, tea, and caffeine-containing beverages.
I was already 20 when I figured I should schedule my first annual exam. I’d just always put it off, and I wasn’t looking forward to it, but I realized it would be a good thing to start before I got out into the ‘real world’ where it might be even scarier. I’d heard horror stories, and I had absolutely no idea what it would be like. Fortunately, Gannett was great about making sure I knew what to expect. Before my exam, I met with a peer counselor who explained the entire procedure and made sure I didn’t have any questions. When I went for my exam, the clinician told me what she was doing at every step and made sure I was as comfortable as possible. It was still a weird experience, but I’m relieved that I finally know what happens, and I’m glad that I chose to have my first exam while I was in an environment where a lot of people are still learning about their bodies.
---Arts & Sciences ‘04
One of the best ways to start learning about our sometimes mysterious gynecological health is by having an annual pelvic exam. You should begin having pelvic exams when you become sexually active or by the time you turn eighteen. The more informed you are about the exam, the more comfortable and beneficial the process will be. The exam is divided into several parts.
At Gannett, you will often meet with a trained peer counselor who will take your general medical history including your family health history, personal medical history, and sexual history. The peer counselor’s main purpose is to write down vital information in order to aid the clinician. Be honest and complete because it gives your clinician vital information about your health. Don’t let fear or embarrassment be a reason for withholding information. This information is strictly confidential, and peer counselors are under the same guidelines as clinicians. If you feel uncomfortable talking to a peer, you can schedule an appointment with a clinician.
The physical exam begins with a general examination including blood pressure, pulse, weight check, examination of your head (eyes, nose, and throat), and a check of the heart, lungs, and abdomen. The clinician will also check your breasts for any lumps and will explain the procedure for the self-breast exam. (This procedure is also explained later in the chapter.)
The next part of the exam is the pelvic exam. The clinician will ask you to lie on an examining table with your knees apart and your feet in the stirrups; s/he will first visually examine your vulva for discoloration, irritation, swelling, bumps, hair distribution, and unusual vaginal discharge. The clinician will then insert a slender instrument called a speculum into your vagina to hold the vaginal walls apart. This device allows the clinician to view the vaginal canal and the cervix to look for discoloration, abnormal discharge, growths, and signs of infection. You can look at your cervix with a mirror while in this position. Some practitioners will ask if you would like to look, but feel free to ask if they do not offer. The clinician will then take a Pap smear from the cervix or vagina with a small sterile brush while the speculum is in place. A pap smear is a sample of cells which are placed on a slide and examined in a lab for abnormalities which could be a sign of infection or disease. After the pap smear, the speculum is removed.
The final part of the exam is the bi-manual exam. The clinician will insert one or two fingers into your vagina and press the outside of your lower abdomen with the other hand in order to feel your uterus, fallopian tubes, and ovaries for swelling, tenderness, cysts or other growths. During the exam, if you have any questions, ask! This is your body, and you have a right to feel comfortable and to know what is going on.
Generally, the exam does not hurt, although you may feel some pressure in your vagina. If at any point it does hurt, make sure that you let the clinician know. It often helps if you can relax your pelvic muscles, and you can practice this by doing the Kegel exercises.
From— “Your Health and the Ob/Gyn Exam.” The American College of Obstetricians and Gynecologists, 1991.
Kegel Exercises
These exercises are designed to strengthen and to increase control of the pubococcygeal (PC) muscle. This muscle is responsible for retaining urine and feces. It also contracts during orgasm. By performing the Kegel exercises, you are better able to control contraction and relaxation of this muscle during the pelvic exam. In addition, some women feel more sensation during sexual stimulation if they regularly exercise the muscle. The exercises are very discrete. You can perform them in class or in line at the store and no one will ever know!
To perform the exercises, first locate the PC muscle. Urinate with your legs apart; the muscle that you squeeze to stop the flow of urine is the PC muscle. The first Kegel exercise is squeezing the muscle inward and upward for three seconds, relaxing it for three seconds and then squeezing the muscle again. This should be repeated for ten squeezes and releases at three different times in the day. The contractions may be difficult to perform at first, but they will become easier over time.
The second Kegel exercise is a fluttering motion; the object is to squeeze the muscle, relax, squeeze, relax—as quickly as possible. This should be repeated for 10 squeezes at three different times during the day.
The third exercise is called the elevator exercise. You should imagine yourself slowly pulling an elevator upward by contracting the muscles upward along the vaginal canal, starting at the vaginal opening and ending near the uterus. After three or four seconds of raising the “elevator” you should slowly lower it back down. Perform ten contractions three times daily. The last exercise consists of bearing down as if you were pushing a tampon out. This should be held for three or four seconds.
These exercises are very discrete and can be practiced any
where. It is important to isolate the right muscles. If you are grimacing, squeezing your legs together, or holding your stomach in, you are not performing the exercises correctly and you should relocate the muscle as described before.
From— Our Bodies Ourselves, 1992.
Breast cancer is one of the leading causes of death for women. Although the risk of breast cancer is low in young women, it is important for us to become familiar with our breasts now so that we can detect changes and abnormalities early. Some women find performing the breast self exam uncomfortable because they have been taught not to touch themselves. However, the BSE is one of the best ways to detect breast cancer in its early stages. If detected soon enough, breast cancer can often be treated successfully. Your health care provider will perform a breast exam during an annual exam and can show you how to perform a BSE.
Step One: Visual Inspection
1. In good lighting, stand in front of a mirror and look at your breasts from all angles. With your arms relaxed at your sides, look for any change in the size or shape of the breast, dimpling, puckering, or color change. Look for a change in the direction of the nipple or any discharge.
2. Then place your hands over your head and look to see if the breasts move up and down together. Look for any dimpling or sores.
3. Put your hands on your hips and tighten your chest muscles. Again, look for any dimpling or puckering of the skin. Be sure to view your breasts from all sides during this examination.
Step Two: Physical Inspection
1. To examine your right breast, begin by putting your right hand behind your head. Hold your left fingers together and use the pads (not the tips) of your fingers to press firmly on the breast, beginning at the top outer portion of the breast and moving around the entire breast using small circular motions.
2. Move inward one finger’s width and continue to make small circular motions. Continue this pattern until you have reached the nipple. Cover all areas of the breast tissue including the underarm and chest area below the breast. (This portion of the BSE can be done in the shower or bath. Fingers slide over wet soapy skin which makes it easier to feel lumps and tenderness.)
3. Repeat steps one and two while lying down. Place a small pillow or folded towel under your right shoulder and place your right hand behind your head. Use the same circular technique to check your right breast. Repeat this procedure for your left breast.
Do this exam monthly to maximize effectiveness. Breast tissue is naturally lumpy, but BSE helps you become familiar with what is normal for you. You should do the BSE one week after the beginning of your menstrual period because the consistency of your breasts will often change throughout the menstrual cycle. Examine your breasts at approximately the same time every month in order to monitor changes in your breasts effectively.
From— “Breast Self-Examination,” American Cancer Society pamphlet.
Common vaginal infections AND DISEASES
Women are susceptible to a variety of vaginal infections from the overgrowth of organisms such as bacteria, yeast, and fungi. One of the first signs of infection is unusual vaginal discharge. Healthy vaginal discharge is transparent or cloudy white. It may dry onto clothing as a yellow color. Normal discharge causes no discomfort and is part of bodily functions.
Yeast Infections
Yeast is normally present in a healthy vagina but increases to higher levels during a yeast infection (Candida vaginitis). Yeast infections are sometimes more likely to occur when you are taking antibiotics or if you are on the Pill. The infection is often accompanied by a thick white discharge that may look like cottage cheese and may smell like baked bread. It often causes the vulva to itch or burn, and it may be accompanied by a red rash on the vulva. Yeast infections are easily treated with a medicated cream or suppository that you place inside your vagina. The first time you get a yeast infection, see a gynecologist for diagnosis and treatment.
If you have had a yeast infection previously, you can treat it in several ways to reduce chances of recurrence:
• Try nonprescription medication such as Monistat and Gynelotrimin. Aloe Vera gel relieves external itching and burning.
• Drink cranberry juice to help decrease the pH in the vagina to allow for more favorable lactobacillus growth. This is a “good” bacteria that lives in the vagina and eats yeast.
•Promoting general good health, including proper nutrition, sleep, exercise and stress management, is the first step to prevent infections.
• Avoid high-sugar diets which favor yeast growth.
• Wear cotton underwear, wear loose-fitting clothing, and no underwear at bedtime.
• Avoid tights and pantyhose.
• Rinse and dry the vulva after cleansing with mild soap, douche only with your health care provider’s advice, change sanitary napkins and tampons regularly, and wipe from front to back after a bowel movement or urination.
Bacterial Vaginosis
Another vaginal infection is Bacterial Vaginosis caused by an overgrowth of bacteria which are normally present in small amounts in your vagina. The condition may arise spontaneously or may be transmitted sexually (although this is unusual). The symptoms include a white, foamy, thin discharge that has a strong, fishy odor. The discharge may cause an itching or burning sensation. Treatment usually consists of oral antibiotics or intravaginal suppositories or creams.
Urinary Tract Infections (UTIs)
UTIs occur when bacteria, such as Esherichia coli, travel from the vagina or colon into the urethra and bladder. UTIs can be the result of a sudden increase in vigorous vaginal intercourse or by sexually transmitted infections such as trichomoniasis and chlamydia (see STIs in this chapter). Inflammation or infection of the bladder is the most common UTI; this is known as cystitis. The symptoms include frequent urination, burning during urination, blood or pus in the urine, and pain just above the pubic bone. UTIs are diagnosed by a urine test performed by a heath care practitioner and are treated with antibiotics.
To prevent UTIs:
• Drink lots of fluids.
• Urinate frequently and completely empty your bladder.
• Wipe from front to back after urination and bowel movements.
• Empty the bladder immediately after intercourse.
• Avoid caffeine and alcohol, which irritate your bladder.
Ovarian Cysts
Ovarian cysts are relatively common gynecological occurrences. Many are functional and will take care of themselves. Some develop when a follicle has grown large but has failed to rupture and release the mature egg. Symptoms may include irregularity in the normal menstrual cycle, unfamiliar pain or discomfort in the lower abdomen, pain during intercourse, or unexplained abdominal swelling. A pelvic exam and/or an ultrasound will help clinicians evaluate the cyst.
Endometriosis
When endometrial (inner uterine) tissue appears in the ovaries, fallopian tubes, outer surface of the uterus, body tissues in the abdomen, or bowels, it can lead to endometriosis. The endometrium responds to the cycle of hormones: it grows with the uterine lining, and at the end of the cycle it breaks apart and bleeds. Unlike the uterine lining which flows out of the body, the displaced tissue has nowhere to go. The body responds with inflammation of the collected tissue trying to absorb the blood back into the circulatory system and forming scar tissue. Endometriosis may cause adhesions of tissue that bind organs together.
The condition may gradually worsen with time and symptoms may come and go. Endometriosis can lead to sterility if left untreated. This possibly hereditary disease occurs only between menarche and menopause, mostly among women in their thirties and forties. Hormonal treatment, such as oral contraceptives, is often effective, although in some cases removal of the tissue is necessary.
From— “Vaginal Health Concerns.” Cornell University Health Services. & “Important Facts About Endometriosis” The American College Health Associates.
Toxic Shock Syndrome
Toxic Shock Syndrome (TSS) is a disease caused by toxins released from some types of the bacterium Staphlococcus aureaus. About half of the cases of TSS are associated with menstruation, in which healthy, young women use tampons during their periods. TSS symptoms appear quickly and are often severe. TSS is often characterized by a high fever (105°F), aching muscles, sore throat, and symptoms that resemble the flu.
For those women who use tampons, there is a greater risk of TSS for women who use highly absorbent tampons. It is suggested that you follow the manufacturer’s instructions about how long the tampon should be kept inside your body, store tampons in a clean, dry space, and wash hands with soap and water before and after inserting or removing a tampon.
CONTRACEPTION AND STI PREVENTION
Choosing to become sexually active is a personal decision that is often surrounded by a myriad of questions. “Am I ready to become sexually active?” “What kind of contraception is best for me?” “How can I prevent STIs?” “Where can I go for help?” This section addresses these questions and other concerns you might have, as well as provide you with a list of resources (See Relationships & Sexuality).
Abstinence
Abstinence is the only 100% effective method of birth control and is also the best way to avoid contracting sexually transmitted infections (STIs). Women choose not to have sex for many reasons. Some feel that pre-marital sex is contrary to their religious beliefs, while others want to save their virginity for marriage, but there are many other reasons to abstain as well. Removing sex from the equation can help to refocus your energy on other aspects of the relationships. Saying no to sex can be empowering; it confirms to both you and your partner the boundaries and limits you have set.
You, and only you, are responsible for personal choices about sexual intimacy. A person who commits herself to abstinence needs to think about how she will deal with the situations that may test her resolve.
I am 21 years old and I’ve never had sex. I’m not going to lie and say that I’ve never been tempted. In fact, every time I’m with my boyfriend, I have this incredible urge to just get it over with. But I really want to wait until I can lose my virginity to someone that I am truly in love with. I’m very lucky - my boyfriend now sincerely supports my decision.
— Industrial and Labor Relations ’96
While abstinence may be temporary or life long, those who choose to become sexually active have a number of decisions to make. Sexually active people need to make the prevention of STIs a primary concern. Heterosexual relationships involve the added consideration of birth control, but often the two go hand-in-hand. No method, except for abstinence, guarantees the prevention of pregnancy or STIs. Becoming sexually active is exciting but involves careful thought and responsibility. Whether you’re in a monogamous relationship or are interested in casual contact, you have several important decisions to make.
Although I don’t believe in pre-marital abstinence, I do believe in being a little choosy in whom you decide to make love to. There is a reason it’s called making love — you should feel the person is someone special and that you feel comfortable sharing such an intimate experience with them. Sex is not a toy, and strangers who share it will most likely stay strangers, but with even more of a reason to stay away from each other. It’s also possible to become numb to sex. A person does not necessarily have to choose one person and make them their only sex partner for life, but a person should at the very least try to weigh the effects of the decision against the future.
— Engineering (male) ’96
Things to do before becoming sexually intimate:
• talk to your partner frankly about both of your sexual histories
• get tested for sexually transmitted diseases at clinics like Gannett Health Center
• buy contraceptive supplies and PRACTICE beforehand!
I believe in birth control. The pill is very effective, but a pain for women. I believe that condoms are pretty effective, even more so when combined with spermicides. I also believe in premarital abstinence from sex – this view hasn’t changed for the most part since I came to college.
—Engineering (male) ‘96
CONTRACEPTION
There is a wide range of contraceptives on the market, and it is important to look both at the disadvantages as well as the advantages for each contraceptive. This section will give you an overview of the different kinds of contraceptives, how to use them, and the pros and cons for each one. One should realize that not all types of birth control offer protection against STIs.
Condoms/Latex
Not using a condom has never even entered my mind. It’s just always been a part of the experience.
— Human Ecology,’96
Unfortunately, many of us are reluctant to ask our partners to use a condom. Some of us may feel afraid to ask or may think that it would create an awkward situation. Resist the temptation to let it go “just this once.” You have every right to demand that a condom be used each time you have sexual intercourse.
Condoms are the best choice, despite their inconvenience. I’m still not convinced that the Pill is completely effective alone. There’s always that 0.1% chance (or whatever it is).
—Engineering (male) ’97
Although condoms do not provide 100% effectiveness against either pregnancy or STIs, they are highly effective if used properly each and every time you have intercourse. A condom is a thin latex, animal skin, or a polyurethane sheath that is put on the penis as soon as it becomes erect, long before it comes into contact with the vagina. After ejaculation, the semen is caught in the closed end of the condom and the condom is immediately removed while the penis is still erect.
Advantages:
• may enhance sexual (fore)play
• may help to control rapid ejaculation
• available in drug stores, grocery stores, Residence Halls, Gannett, etc.
• reduces mess
• women and men can buy them
• protects against most STIs
Disadvantages:
• may take practice to enjoy using
• may reduce sexual spontaneity
• may leak, tear, or come off if not used properly
• not 100% effective
How to use a condom
1. Talk to your partner about using condoms and practicing safer sex before you become genitally intimate.
2. Buy a supply of condoms. Condoms vary in type, size, and color, so be careful to choose one that is right for you and your partner.
3. Practice putting on a condom in an unpressured situation (men can masturbate, women can use a banana) following the steps below.
4. Check the expiration date of your condom. Always use fresh condoms, since prolonged exposure to sunlight or heat can cause deterioration of latex.
5. Open condom package after your partner has an erection. Be careful not to tear or puncture the condom.
6. A drop of water-based lubricant in the tip increases comfort. Never use oil-based lubricants such as Vaseline, baby oil, or lotion because they cause rubber to deteriorate.
7. Place the condom on the head of the penis while still pinching the tip to create a reservoir for ejaculate. Unroll it all the way down to the base.
8. Immediately after ejaculation, have your partner withdraw his penis to avoid leakage of semen. He should hold onto the condom at the base of the penis during withdrawal.
9. Knot and dispose of used condoms in the trash.
10. Use a new condom and repeat above steps for each act of intercourse.
**If the condom breaks, consider taking Emergency Contraception to prevent pregnancy (available at Gannett).
Dental Dams
A condom cut lengthwise or dental dams (latex squares) should be used to prevent transmission of STIs when there is any mouth-vagina or mouth-anus contact. They are used as a barrier between the body of one partner and the mouth of the other. Carefully hold the latex square in place, and dispose of each sheet after use.
To make things more pleasurable when using latex squares, try the following:
• spread a water-based lubricant on the vagina underneath the dental dam
• use a “hands-free” harness to hold the dental dam in place
• use flavored condoms or dental dams
• put a flavored, edible lubricant on the outside of the condom or dam
Spermicides
Spermicide (nonoxynol-9) is a chemical that kills sperm. In the past, condoms lubricated with spermicide were recommended. However, it should be noted that these condoms give virtually no more added protection than a regular lubricated condom. Additionally, according to the Center for Disease Control and the World Health Organization, recent studies have shown that nonoxynol-9 does not provide protection against STIs, including HIV. In some cases, it may actually increase the risk of transmission by irritating the vagina and anus.
Advantages:
• easy to carry
• are widely available without a prescription
• can be obtained by both men and women
• no removal: spermicides are discharged with natural secretions
Disadvantages:
• may cause irritation to either partner (try switching brands to alleviate symptoms) which may increase the risk of contracting a STI
• may interfere with sexual spontaneity
• protection diminishes after 30 minutes
• may diminish oral-genital pleasure
• must be inserted before genital contact
• increases vaginal discharge
How to use spermicides
1. Read the manufacturer’s directions.
2. Insert 10 to 15 minutes before intercourse (only necessary with film and suppositories.)
3. Suppository spermicides are inserted with a finger into the vagina.
4. Put foam, jelly, or cream spermicide in a plastic applicator.
5. Insert applicator into the vagina and push plunger to cover cervix.
6. Repeat applications may be necessary since spermicides are only good for 30 minutes. Reapplication of spermicide is needed for each act of intercourse.
The Female Condom
This relatively new form of contraception called Reality® consists of two rings, a smaller ring that covers the cervix and an outer, larger ring that lies outside the vagina. The two rings are connected and covered with polyurethane. The female condom acts like a closed tube. When a male ejaculates, the closed end of the condom catches the semen and prevents contact with the vaginal canal and cervix. The female condom is effective in preventing both pregnancy and STIs, but the failure rate is higher than with the male condom due to improper use.
Advantages:
• no prescription needed, widely available in drug stores, grocery stores, etc.
• allows the female to take control of preventing pregnancy and STIs without having to rely on the male using his own condom
• may be a good alternative for both men and women allergic to latex
• may be inserted up to 8 hours before sex
Disadvantages:
• can reduce sexual spontaneity
• requires some extra time and practice to get used to
How to use the female condom
1. Read the package instructions carefully.
2. Hold the condom with the open end hanging down. While holding the outside of the pouch, squeeze the inner ring with your thumb and middle finger.
3. Push the inner ring and the pouch into the vaginal canal. Then, using your index finger, push the condom into the vagina until the inner ring is up just past the pubic bone.
4. You will feel the pubic bone by curving your index finger when it is a couple of inches inside the vagina.
5. Make sure that the condom is not twisted inside and that the outside ring lies against the outer lips.
6. If you feel the outer ring being pushed into the vagina during intercourse, STOP. Take out the condom and put in a new one, using extra lubricant.
7. To take out the condom, squeeze and twist the outer ring to prevent spilling.
From - Reality Condoms
The Diaphragm
The diaphragm is a dome-shaped latex cup that covers the cervix. Spermicidal cream or jelly is placed in the cup before insertion.
Advantages:
• reduces the incidence of some STIs such as gonorrhea, chlamydia, and pelvic inflammatory disease
• may be inserted up to six hours before intercourse
Disadvantages:
• requires clinical visits for fitting and checking for fit at least yearly
• must be refitted during the year if you gain or lose ten pounds; if you have had an abortion, miscarriage, or deliv ery; if you have had pelvic surgery
• must be left in place for six to eight hours after last act of intercourse
• cannot be used during menstruation
• additional spermicide must be inserted into the vagina if you have intercourse more than once
How to use a diaphragm
1. Obtain specific directions for use from your health care provider
2. Place approximately one tablespoon of spermicide into the dome of the diaphragm. Spread it around the inside with your finger.
3. Fold the diaphragm and insert so that the jelly or cream is against the cervix.
4. Check placement of diaphragm - run your finger around the rim of the diaphragm to make sure it completely covers the cervix. In addition, the front rim should be tucked behind the pubic bone.
5. If the diaphragm is uncomfortable, it is probably not in the correct position.
From - “Diaphragm and Cervical Cap.” Cornell University Health Services
The Cervical Cap
The cervical cap is much like the diaphragm in that it also acts as a mechanical barrier over the cervix and it is also used in conjunction with spermicide. The Cap is a thimble-shaped cup made out of soft latex rubber and is kept in place by a suction seal created between its rim and the cervix.
Advantages:
• can be inserted up to 72 hours before intercourse
• offers some protection against STIs
• may be used by women who cannot be fitted for a diaphragm
Disadvantages:
• requires clinical visits for fitting, checking for fit, exam, and pap smear
• requires being able to feel the back of your cervix
• should be inserted at least 30 minutes before intercourse
• cannot be used during menstruation
• abnormal Pap smear may occur
• must be refitted during the year if you gain or lose ten pounds; if you have had an abortion, miscarriage, delivery; if you have had pelvic surgery
How to use a cervical cap
1. Fill the cervical cap approximately 1/3 full with spermicide.
2. Insert the cap, using one hand, by pressing the opposite sides of the rim together and pushing it up towards the top of your vaginal canal.
3. Release the cap so that the cap fits directly over your cervix.
4. Check placement of cap - run your finger around the rim to make sure that it is completely covering your cervix and that a suction seal has been created.
From - “Diaphragm and Cervical Cap.” Cornell University Health Services
The Birth Control Pill
Birth control pills are made of two synthetic hormones, an estrogen and a progestin. Just enough estrogen is provided each day to prevent release of FSH (follicle stimulating hormone), the hormone responsible for ovulation. Thus, the birth control pill prevents an egg from being released by the ovaries. The progestin also makes the lining of the uterus unsuitable for implantation so that even if an egg is fertilized, it will not be able to survive. The Pill is not recommended for women who have circulatory disease, liver disease, kidney disease, blood clotting disorder, high blood pressure, migraine headaches, diabetes, sickle cell anemia, breast cancer, or for women who are obese, over the age of 40, or smokers.
Advantages:
• is one of the most effective contraceptives available
• permits sexual spontaneity
• relieves menstrual problems (decreases days of bleeding, decreases blood loss, minimizes cramps)
• decreases incidence of functional ovarian cysts, fibrocystic breast disease, fibroadenomas of the breast
• lowers risk of ovarian and endometrial cancer
Disadvantages:
• must be taken at same time every day
• requires two visits per year to physician/clinic
• does not protect against STIs
• may not be effective when used in conjunction with other medicines
• may have side effects, such as spotting, nausea, breast tenderness, and weight gain or loss, though all should disappear after 2-3 months or by changing the type of pill
How to use the Pill
1. Different types of pills require different instructions. Find out from your doctor/clinic exactly how to begin, continue, and stop using the Pill. Also find out information about what to do if you accidentally miss a pill or pills.
2. Take the pill every day at the same time. Associate taking the pill with some regularly scheduled activity, such as meals.
Norplant
Norplant is a highly effective, implantable contraceptive consisting of six flexible tubes containing progestin. Once in place, Norplant remains effective in preventing pregnancy for up to five years. They can be removed at any point before that and normal fertility is restored soon after removal. More than 75% of women can become pregnant within one year of removal.
The matchstick-sized tubes are placed on the inside of the upper arm, a little above the elbow bend in a procedure that takes about 15 minutes. Twenty-four hours after insertion, the woman will have full contraceptive protection.
Norplant releases small amounts of progestin, a synthetic form of the female hormone progesterone. Pregnancy is prevented through a combination of the following: inhibited ovulation, thickening of cervical mucus (making it difficult for sperm to enter the uterus), and thinning of uterine lining (preventing implantation of fertilized eggs).
Advantages:
• highly effective, long lasting
• does not affect sexual spontaneity
• no estrogen, no estrogen-related side effects
• no special follow-up clinical visits
Disadvantages:
• initial expense is high
• unpredictable changes in menstrual cycle, such as bleeding or spotting between periods, no periods, and longer and lighter periods
• minor incision needed to insert and remove
• not appropriate for women who have had blood clots in the legs, lungs, or eyes; heart disease or stroke; liver disease; or unexplained vaginal bleeding
• does not protect against STIs
Depo-Provera
Depo-Provera (DMPA) is a very highly effective synthetic progesterone shot given every three months to prevent pregnancy. The hormone prevents pregnancy by stopping ovulation, so each month there are no eggs released by the ovaries. It also works by thickening the cervical mucus, making it more difficult for sperm to enter the uterus.
Advantages:
• highly effective, long lasting
• does not affect sexual spontaneity
• a good alternative for women who cannot take “the pill”, women over the age of 35 who smoke, women who take seizure medication for epilepsy, women who cannot remember to take “the pill” daily
• prevents and treats endometriosis, ovarian and endometrial cancer
• less blood loss during menstruation
Disadvantages:
• often causes reduced or no menstrual bleeding
• rare side effects include weight gain, headache, breast tenderness, depression, abdominal discomfort
• For some women, it may only take 12 weeks after the last shot to get pregnant. For others, it make take up to 18 months.
• cannot be used by women who have a history of liver disease, unexplained vaginal bleeding, breast cancer, or recent blood clots in legs, lungs, or eyes
• does not protect against STIs
New birth control methods that work similarly to the birth control pill and Depo-Provera are: Lunelle, Ortho Evra (also known as the “patch”), and Nuva Ring (also known as the “ring”). Contact Gannett for more information on these methods.
Intrauterine Device (IUD)
The intrauterine device is a moderately effective, small plastic/copper object inserted into the uterus by a clinician. The exact method in which it prevents pregnancy is unknown. It is thought that the IUD may inhibit fertilization by rendering the sperm incapable of fertilization. It may also disrupt normal buildup of the uterine lining and implantation in the uterine lining.
Advantages:
• does not affect sexual spontaneity
• may remain in place for up to 8 years
• does not change hormone levels throughout the body
Disadvantages:
• most clinicians prefer not to insert the IUD in women who have not yet given birth
• insertion may be painful
• may increase menstrual cramps and flow
• may increase risk of pelvic inflammatory disease, infertility, sterility, iron-deficiency anemia
• does not protect against STIs
From - “The Intrauterine Device,” published by the American College of Obstetricians and Gynecologists (1990)
Fertility Awareness (The Rhythm Method)
Fertility awareness is a method of avoiding pregnancy by determining what times during the month you ovulate and not having sexual intercourse during these times. Different methods are employed for determining which days are “safe,” including monitoring basal body temperature, cervical mucus changes, and menstrual calenders. Sperm can be viable up to five days after intercourse, so you must take this into consideration when determining which periods of the month are “safe”. The fertility awareness method requires extensive guidance and instruction from a doctor or health care practitioner. If you feel that this method is the only one open to you, be sure to get professional assistance.
Advantages:
• does not require special contraceptives
• does not inhibit sexual spontaneity (during unfertile periods)
Disadvantages:
• is not very effective
• can be very frustrating for both you and your partner during fertile periods
• does not protect against STIs
BIRTH CONTROL METHODS THAT DO NOT WORK
Withdrawal
Withdrawal refers to unprotected vaginal sex in which the male withdraws from the vagina immediately prior to ejaculation, and ejaculates away from the vagina and vulva. People use this method with the notion that no sperm enters the vaginal canal, and consequently, no fertilization can occur. Unfortunately, there may be small amounts of pre-seminal fluid released from the penis prior to ejaculation that contain up to a half-million sperm. This fluid also may contain organisms responsible for transmitting STIs. Therefore, the withdrawal method is unreliable in preventing pregnancy and STI transmission/infection.
Douching
Douching immediately after intercourse with the intent to flush any semen out of the vagina is not an effective means of birth control. First of all, sperm are very strong and fast swimmers. Thus, they are likely to have already entered the cervical canal before they can be washed away. In addition, douching may actually help push the semen up into the uterus, which would encourage pregnancy, not prevent it.
Light Fare
Talking with each other
Kissing and hugging
Listening to music and dancing
Back rubs, foot rubs, and body rubs
Dressing up in erotic lingerie or costumes
Stroking, brushing, or playing with each other’s hair
Caressing, tickling, and nibbling
Looking at erotic pictures
Reading erotic literature
Watching erotic movies
Dry humping
Undressing each other
Watching each other undress
Showering together
Talking sexy or sharing fantasies
Kissing or licking your partner’s body (except for the genitals and anus)
Talking about sexual histories and desires
Entrees
Stroking, caressing, and fondling your partner’s body
Mutual or simultaneous masturbation
Mutual or simultaneous masturbation with a vibrator or sex toy (cover with a condom or wash with
soap and water before sharing)
Putting a condom on your partner (use only water-based lubricants)
Putting spermicide on or in your partner
Rubbing your vulva or penis against healthy, unbroken skin on your partner’s body, breast, thighs, or buttocks, avoiding contact with your partner’s body orifices
And, if the condom doesn’t leak, tear, or come off:
Oral sex on a man (fellatio) with a condom
Oral/anal contact with a latex square or split condom
Oral sex on a woman (cunnilingus) with a latex square or split condom
Vaginal intercourse with a condom and spermicide with nonoxynol-9
Anal intercourse with a condom and spermicide with nonoxynol-9
Desserts
Massaging with warm oils
Licking whipped cream off your partner’s body
Masturbating while your partner watches or holds you
Making sexy videotapes or taking sexy pictures
Having breakfast, lunch, or dinner in bed
Bubble baths
Body painting
Holding each other
Talking with each other
Falling asleep together
Starting over
If you don’t find your favorites on this menu, ask your partner about them. Improvisation and variations encouraged. Partner’s consent required.
*Sexual toys (vibrators, dildos, etc.) should be cleaned between each use in a 1:10 solution of household bleach to water. If you plan to share sex toys, be sure to both clean the device and use a new condom with each use.
If you have unprotected sex...
Emergency Contraception
Emergency Contraception (EC), previously termed the “morning-after pill,” is used only as an emergency measure to prevent a likely pregnancy. It is not to be used as a form of regular birth control. EC can be taken up to five days after the act of unprotected intercourse, although it is most effective the sooner it is taken. It contains relatively high doses of synthetic estrogen and progestin and works by preventing proper implantation of the fertilized egg. Vaginal bleeding usually occurs within a week of taking the pill, but this is not a sure indicator of effectiveness.