Category Archives: Ask the Sexpert

How Abstinence-Only Education May Revictimize the Victim


Posted on May 20, 2013 by

I recently read an article by Elizabeth Smart about her ordeal being kidnapped at the age of 14 and being held in captivity for nine months where she was repeatedly raped. She was found walking down a street with her kidnappers. Numerous people asked her why she didn’t just run away. She recently has addressed this publicly by blaming her conservative upbringing which stresses abstinence until marriage as the only option. She recalled a lesson from school that compared someone who has strayed from this teaching as a piece of gum that had been chewed and thrown away. Since she could no longer be considered untainted by her family, church and community, she felt she was useless, and unlovable. What was the point of trying to run away when no one would see her as anything but a piece of trash?

As a teacher of comprehensive sexuality education for 20 years, I am still occasionally confronted by this thinking and method of trying to scare teens from sexual activity. Several teens have told me they were raped, but were afraid to tell their parents because of how they felt the parents would react. I’ve been asked how to tell really strict religious parents about a pregnancy. By delaying revealing the pregnancy until the parents notice limits options to adoption or keeping the baby and no prenatal care is received. I remember one 8th grader who had sex one time approaching me after class. She knew exactly when sex occurred and since she hadn’t had a period in over 5 months she figured she must be pregnant. What really convinced her was that her “stomach now sticks out when it used to cave in.” I tried to convince her of the importance of telling her parents and how important it was to get prenatal care. She said she wasn’t even allowed to date and her parents would kill her. I saw her several months later and asked how she’d been. She informed me she had been in the hospital after drinking bleach to try to terminate her pregnancy and avoid telling her parents.

When talking to adults I try to express how important open communication is with teens and how trying to use shame, guilt and fear does not necessarily prevent sex but may prevent them from coming to you when they need you the most. Teens desperately need trusted adults in their lives to discuss everything, but especially sexuality. Even if you aren’t a parent, you may be the one person a teen feels safe coming to when in crisis. For help talking to a teen in your life, visit the Planned Parenthood website.

Nexplanon: The Injectable Birth Control


Posted on May 9, 2013 by

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Photo (c) Merck Pharmaceuticals.

Last week, I was helping in one of our clinics when I overheard someone say the next patient was getting Nexplanon inserted. Curious one that I am, I asked the Nurse Practitioner if I could watch, with the patient’s permission, naturally. With her approval granted, I entered the room and tried to be as inconspicuous as possible.

She was in her late teens and accompanied by her mother. Although she was on Depo, so received shots every three months, she was very nervous and afraid she’d pass out. After she lay down on the exam table, the NP gave her an injection to numb the area under her left arm. A plastic device containing the small rod was inserted in the numbed area and the rod was inserted. A few adhesive strips and a pressure bandage were placed over the site. The entire procedure took about 5 minutes. Despite her initial anxiousness, she was chatting and laughing with her mother when she left the room.

Nexplanon works for 3 years. Three years without having to remember to take a daily pill, change a weekly patch, replace a ring once a month or get a shot every 3 months. The failure rate with these methods is greatly increased when human error comes into play.

Nexplanon is 99.9% effective in preventing pregnancy, the same as a tubal ligation or vasectomy (female and male sterilization). Along with the other hormonal methods it works by preventing an egg from being released from an ovary, thickening the cervical mucus and thinning the lining of the uterus.

As with any medicine or medical procedure, there are possible, but rare complications. Before you decide on what method works for you, do your research, know your medical history. And always remember that this method does NOTHING to prevent a sexually transmitted infection. To learn more visit www.nexplanon.org or visit Planned Parenthood’s website.

Part II: How to Make Your Pelvic Exam Less Scary


Posted on May 8, 2013 by

doctor-appointment-PV2006-298x232(Today, part two of our series, How to Make Your Pelvic Exam Less Scary. Did you get your annual for this year, yet?)

Yesterday, “How to Make Your Pelvic Exam Less Scary – Part I,” talked about tips for scheduling your first pelvic appointment. Now I’ll give you some information about what to expect the day of your appointment.

When You Arrive - As with all medical appointments, paperwork comes first. Expect questions about the medications you are taking, allergies, your menstrual cycle and your last menstrual period (LMP), sexual activity, family medical history questions, and any current medical problems. Medical assistants will check your weight and blood pressure. If you have had any sexual trauma or if it is your first exam, please let them know when you schedule the appointment and write something on the form indicating that you need them to be extra gentle, slow, and explain everything they are doing or about to do during the exam. If you like, the medical assistant will hold your hand or you can bring a support person (but they can’t come into the exam room with you).

The Exam - If you are having a complete well-woman exam (pelvic/pap/breast check), you will be asked to remove everything but your socks. You will be instructed to put on a paper gown (opening in front for breast exam) and drape a paper sheet over the lower half of your body. You will then lie down on the exam table. The medical provider (MP) will knock on the door and ask if they can enter the room. You will be asked to move down to the end of the table and put your feet in stirrups. Your MP will then look at the vulva (clitoris, urethra, labia, vaginal opening) and the rectum to make sure they don’t see anything that looks abnormal. They will then insert a speculum made of plastic or metal into the vagina. After it is inserted they will open it wide enough to see your cervix. If you have never seen your vulva or cervix up close and personal, you can ask for the MP to show you with a mirror. If your MP notices any abnormal vaginal discharge or unusual smell they will take a sample of the discharge. If you are having a pap smear the MP will wipe your cervix with a thin Q-tip-like brush to test for cervical cancer.

During the pelvic exam portion of the exam the MP will insert one or two gloved fingers into the vagina and place their hand on your lower abdomen to feel your reproductive organs and make sure they are the right size, not painful, etc. Please let the MP know if you experience any pain during this part of the exam. Some MPs will also perform a rectal exam by placing a gloved finger into the anus to check for anything abnormal. After the exam they will ask if you have any questions and then you will be done!

It sounds like a lot, but the exam is over before you know it. If you have any additional questions, please contact your MP or local Planned Parenthood.

Part I: How to Make Your Pelvic Exam Less Scary


Posted on May 7, 2013 by

(We’re re-running this series today and tomorrow to focus on our “annual” – and truly, how important it is to have it annually, even if it’s scary.)

pelvic examFirst, I want to state that I understand that there are a million things you would rather do than have a pelvic exam, but it is something you shouldn’t put off because it could detect a medical problem or infection, and could even save your life.

In the United States, approximately 12,000 women get cervical cancer every year. If detected early through a pap test, there is a very high survival rate. The new recommendation is for individuals to have the exam at the age of 21, unless there is a medically necessary reason to have it sooner. However, many women will have visited a gynecologist or medical provider before this time to address other concerns related to birth control options, STI information and/or testing, menstrual issues, etc.

Most women will have the exam one time per year, but some will have it more frequently or less frequently depending on age, medical history, and medical or sexual health needs.

Helpful Tips

  • Make sure that you don’t schedule the appointment when you have your period. Your menstrual blood can affect the lab results and you will probably have to reschedule.
  • Do not have vaginal sex or insert anything into the vagina for at least one to two days prior to the exam. This includes feminine products such as douches, feminine sprays, and powders.
  • Remember to write down any questions you have for the medical provider that you would like answered during your visit.
  • Let the receptionist or person scheduling your appointment know if you are uncomfortable with having the exam because it is your first time, you have never had vaginal sex, or you have experienced sexual trauma. This will let the staff know that they need be slower and gentler, explain what they are doing in more detail, and they may also want to use a smaller speculum. You can also request to have a family member or friend in the room with you, or have a staff member hold your hand.
  • If you are unsure whether you should have a pelvic exam or haven’t had one in a while, you can locate a Planned Parenthood near you.

Stay tuned for my next post, where I will discuss what to expect during the exam.

The End of the Yearly Pelvic Exam?


Posted on May 6, 2013 by

Doctors question need for yearly pelvic examsFor the past three generations, bimanual pelvic exams have traditionally been considered a vital part of well-woman visits. But new research is suggesting that they may not always be necessary on a yearly basis.

Pelvic exams are important for screening for cervical cancer, STIs, and a variety of other health issues, and can make life-saving discoveries. But for healthy women, without a family history of cancer and using protection against STIs, is it a yearly necessity? Ask Your Doctor.

A recent study has been released by the Columbia University Medical Center that suggests annual pelvic exams of women without any symptoms could be an overuse of cancer screenings. (http://www.ncbi.nlm.nih.gov/pubmed/21194307) As a young woman, without a family history of cancer, with a low risk of STIs, do I still need a pelvic exam? For me, the answer is yes – at least until my doctor tells me otherwise. But that may soon be changing, as new guidelines are released about the necessity of annual exams.

Planned Parenthood suggests more frequent pelvic exams if you have any of the following:

  • a history of abnormal Pap test results
  • a history of sexual health problems
  • a family history of certain kinds of cancer
  • a sexually transmitted infection or a sex partner with an infection
  • recurrent vaginitis

In some cases, a pelvic exam is needed in order to prescribe hormonal birth control — the pill, the patch, the ring, or the shot. A pelvic exam is always needed for inserting an IUD or fitting a diaphragm.

For some women, a bimanual pelvic exam can be a stressful and anxious experience. In the five years I have been prescribed birth control (and consequently, five bimanual pelvic exams) I have always dreaded my annual visit, even with my wonderful gynecologist. (We have tips on how to make it less scary, though!) Maybe in the future – with further research of course – I will be able to get my prescription without an annual pelvic exam! Until then, I will just keep on making the appointments and keeping this body healthy.

April is Sexual Assault Awareness Month


Posted on April 10, 2013 by

Photo via The Dawn Center.

Photo via The Dawn Center.

Feronians, it’s April once again, which means it’s Sexual Assault Awareness Month. A big part of why SAAM exists is because we don’t often talk about sexual assault – for every Steubenville or Delhi case that involves a prosecution and spurs widespread discussion, there are thousands of assaults that pass by without comment, and without legal consequence.

On the one hand, this year seems like it’s had a lot of good conversations about this topic – and thinking back to 2001, when the national campaign officially began, I think that there’s a ton of progress that we can see. Watching commentators like Melissa Harris-Perry proclaim their support for rape survivors on air and hearing Australia’s Prime Minister Julia Gillard tell survivors ‘we hear you, you’re valued and you’re believed’ as Australia begins an inquiry into child sexual abuse is amazing, and isn’t something that I think we would have seen 12 years ago.

We’ve also seen new approaches in assault prevention that are moving away from the old framing – how potential victims of assault can protect themselves – to how to prevent assaults more broadly. These range from videos about how you should treat people who’ve passed out (don’t assault them, do get them a blanket) to broader campaigns on what bystanders can do. (Trigger warning – that video focuses on an evening leading up to an assault, and various ways that bystanders could have made a difference).

But I also know that these still aren’t the norm when it comes to talking about assault. When multiple CNN commentators spoke to how difficult life will be for two young men convicted of rape, without expressing any similar concern for their victim, many people got upset, but CNN never responded. Judges, educators and journalists still focus on how to change what women wear as a way to control men.

So, in honor of the strides we’ve made, and with an eye towards the work that still needs to be done, here’s some more information on activism opportunities this month, locally and nationally:

Activism / SAAM Events

Local
New College of Florida events (Sarasota)
Tampa events, and events throughout Florida

National
One Student – based out of the Tampa area, this group focuses on campus strategies for preventing sexual violence
Project Unbreakable (trigger warning – this project involves survivors reclaiming words that were used against them through art. It can be very powerful, but is a very emotionally charged space.)

Resources for survivors

National
RAINN
Survivor Project

Local
CARE (Charlotte)
Peace River Center (Hardee, Highlands & Polk)
The Dawn Center (Hernando)
Crisis Center of Tampa Bay (Hillsborough)
ACT (Lee)
Sunrise of Pasco County, Inc. (Pasco)
Suncoast Center (Pinellas)
Manatee Glens (Manatee)
SPARCC (Sarasota & DeSoto)

Protecting Your Child From Sexual Abuse


Posted on April 1, 2013 by

image01One of the most terrifying aspects of parenting is knowing how to protect your child from sexual abuse. Most parents don’t have the luxury of being with their children full-time and need to rely on others for help. Frequently, a family member, friend or trusted adult is used as childcare, but statistically, a child is most frequently molested by someone he or she knows. No parent can protect their child completely, but by establishing an atmosphere where communication starts early and happens often can go a long way to prevent a tragedy or be able to deal with it if it should happen.

We love the following five safety tips from RAINN (Rape, Abuse & Incest National Network) on practical things parents can do to protect children from sexual abuse.

1. Talk. Talk often with your child and set a tone of openness. Talking openly and directly will let your child know that it’s okay to talk to you when they have questions. If your child comes to you with concerns or questions, make time to listen and talk to them.

2. Teach. Teach your child key safety principles. For instance:

  • Teach children the names of their body parts so that they have the language to ask questions and express concerns about those body parts.
  • If your child is uncomfortable or if someone is touching them, s/he should tell a trusted adult immediately.
  • Let your children know that if someone is touching them or talking to them in ways that make them uncomfortable that it shouldn’t stay a secret.

3. Empower. Your child should know that s/he has the right* *to* *speak up if they are uncomfortable, or if someone is touching them. It’s okay to say “no” even to adults they know and family members.

4. Implement. Implement Internet safety protocols, and parental controls through platforms such as the Google Family Safety Center. Work with older children to set guidelines for who they can talk to online, and what information can be shared. For instance, be cautious when leaving status or away messages online and when using the “check-in” feature on Facebook or Foursquare.

5. Educate. Educate yourself about the warning signs of childhood sexual abuse. Know what to look for, and the best way to respond.

If you or someone you know has been affected by sexual abuse, it’s not your fault. You are not alone. Help is available 24/7 through the National Sexual Assault Hotlines (800-656-HOPE and online.rain.org).

The Self-Cleaning Vagina – Discharging the Myths of Discharge


Posted on March 11, 2013 by

Today we are recycling one of our most popular posts. Read on and see why . . . 

botticelli-venus-400x400Recently, I asked the staff at one of our health centers for a story that highlighted a myth about vaginas. They cited a recent story in which a patient came in complaining of vaginal discharge and, once diagnosed with a yeast infection, was convinced it was because she worked in a bakery. Yeast … around you … yes, we get the idea. But no, unless one places a baked good into the vagina, the chances the infection came from a yeasty treat are null and void.

We might chuckle a little at the sticker shock of such seemingly silly logic, but we realize the societal truth that vaginal discharge, along with many other reproductive health issues, is not usually a hot topic in people’s everyday lives. There is a lot of shame and embarrassment surrounding vaginal care, so let me clear a few things up.

Having worked for Planned Parenthood for close to four years, here are a few things I wish I could scream from the rooftops for every vagina-carrying human to hear:

1. Douching is bad for you and can cause the symptoms you’re trying to avoid!

We’ve all seen the boxes of Summer’s Eve tucked between the maxi-pads and pregnancy tests on our local pharmacy shelves. I’ve even seen advertisements that suggest vaginal douching will give a woman the confidence she needs to ask for a raise at work (what the hell?) I’ve heard women say their mothers douched, so they do it themselves. They’ve heard it makes them clean, or that it makes them smell good (with blatant implication that the natural odor is foul). Some do it every so often, while others integrate it into their sexual health routine more frequently. Regardless of the frequency of douching, please do yourself a favor and STOP! Douching, specifically with any agents that contain a fragrance, can drastically alter the natural balance of vaginal flora and acidity needed to self-regulate. Women who douche frequently are more susceptible to vaginal irritation, bacterial vaginosis, STIs, yeast infection or Pelvic Inflammatory Disease (PID). Same can be true for scented soaps and tampons … your temple smells fine the way it is, keep the perfumes outta there!

(**In some rare instances a medical professional may advise douching with water or other banal substance, in which case err on the side of your trusted health care advisor).

2. Healthy vaginas do not smell like fish or any other aquatic sea life!

There is a cultural myth that vaginas smell bad, specifically “fishy.” This myth has been further circulated within our society by some pretty off-color jokes (a blind man and a fish market…) which, while funny to those telling it, can often lead to reinforcing insecurities within women about their bodies. In a culture as dually sexually repressed and exploited as ours, it’s no wonder that this notion reigns “true” in the public arena. I can’t think of anyone else beside my P.P. family who would go toe to toe to argue the damaging ramifications of such a sexist joke as the punch line is delivered, so how else do we stop these dangerous lies from spreading? My thought is: education.

3. Vaginas are independent: When left alone they can clean and manage themselves just fine! 

The Vagina, as stated, is a self-sustaining organ that naturally produces bacteria and acids that cleans itself. It also produces a clear or whitish, generally odorless (sometimes acidic), itchless discharge that can increase and decrease in quantity as the menstrual cycle (28 days) changes. If you’re on a hormonal birth control method, your discharge may differ when on it from your non-hormonal cycles, as ovulation (releasing of the egg from the ovary) may increase discharge for a few days. Sexual arousal can also increase vaginal discharge, as your vagina naturally lubricates (though adding a fragrance-free water-based lubricant can help prevent tearing of condoms).

4. At the end of 6-8 hours, take out your tampon!

Too often a woman will come into our health centers complaining about a terrible vaginal odor, only to have the clinician remove days, weeks, or even months old tampon remnants. We call these “impacted tampons,” and they have the potential for some serious consequences, such as incredible odor (we sometimes have to close down the exam room for the day afterward), infection (bacterial vaginosis or pelvic inflammatory disease), toxic shock, or even death! It is so critical to take your tampons out within the time suggested for use on the package label, but also easy to ignore. Here’s a tip: confirm all tampons are out at the end of your period by placing your finger inside your canal and checking!

5. If your vagina smells abnormal, has colored or thick discharge, itches, or is generally out of the norm, head into Planned Parenthood!

So many times we see clients who incorrectly self-diagnose vaginal symptoms, and end up further irritating their condition, or wasting time and money on incorrect treatments. If I had a dollar for every time over-the-counter yeast medication was used on bacterial vaginosis, I’d create a P.S.A. about this topic and launch it during the Super Bowl. Delaying proper treatment of vaginal infections or sexually transmitted infections does not improve your health or save you money. Contrary, it can worsen temporary symptoms or cause irreversible damage to reproductive organs. Often clinicians can write a prescription that has multiple refills, if you are a person with chronic susceptibility to a specific infection, so you don’t have to pay for every visit to the health center (this rule is very specific to your condition, your health history, and the medical discretion of the clinician).

Here are some helpful links to some info about common vaginal infections, and as always, WE’RE HERE FOR YOU!

Binary, Schminary: Talking about Intersex


Posted on March 7, 2013 by

Intersection. Image found here.

Intersection. Image found here.

Our post the other week referred to the fact that when we talk about anatomy, most of our diagrams, charts, examples and references split all bodies into two sexes: male or female. While this categorization is familiar to all of us, it’s an oversimplification, since a lot of our bodies don’t fit tidily into an either/or modality.

We’ve talked about intersex a bit on Feronia, but we wanted to take a minute to focus on what, exactly, it means. The Intersex Society of North America has a good definition (and a lot of other great resources): “intersex is a general term used for a variety of conditions in which a person is born with a reproductive or sexual anatomy that doesn’t seem to fit the typical definitions of female or male.”

Since pinning down what we mean by ‘typical definitions of female or male’ is a big, sticky, complex issue, there isn’t a simple answer to ‘how many people are intersex.’ We know that 1-2 out of every 100 infants have bodies that differ from the standard male or female, but a lot of variations exist between populations. Additionally, the experience of intersex folks varies dramatically – while some intersex characteristics are apparent in infancy, others don’t become noticeable until puberty. Intersex individuals all have to deal with living in a world that’s very attached to binary sex categories and that often excludes their bodies, but their experiences in what that means vary greatly.

Lastly, there can sometimes be a conflation of intersex and transgender, but they’re very different identities and categories. Intersex is a description of someone’s biological sex, and the fact that it doesn’t match our scientific criteria for a ‘male’ or ‘female’ body – it’s a situation that’s noticed by other people, usually medical professionals. Trans* is a description of someone whose gender identity doesn’t match their body – it’s a situation that people notice internally. Intersex people can also be trans*, but those are two different, although interrelated, parts of who they are.

Self Love is Safe Love: A History of Masturbation


Posted on March 5, 2013 by

Masturbation Doesn't Screw With Your Eyes, Really

Today we are re-running an oldie, but so very goodie: Fosgood’s history of masturbation post. Enjoy!

Masturbation has a long and colorful history.  According to some ancient Egyptian myths, the god Apsu created the Milky Way when he copulated with his fist. (This certainly gives star gazing a new twist!) Greek men and women both were known to masturbate and saw it as a gift from the gods. They believed the god Hermes taught his son Pan how to masturbate to help heal his broken heart when he was rejected by the nymph, Echo.

Some took it a bit too far: the philosopher Diogenes masturbated in public stating that no human activity should be seen so shameful that it must be done in private; his fellow citizens disagreed. The physician Galen felt that the retention of semen is dangerous and leads to sickness while Hippocrates cautioned that loss of excessive amounts of semen could result in physical damage, such as spinal cord deterioration.

Women in ancient Athens commonly purchased dildos known as olisbos, made of padded leather or wood. Greek men saw masturbation as a sign of poverty and if you had the money, you would pay someone to do it for you. A few centuries later, Roman boys were encouraged to deplete their sexual energies through philosophy and gymnastics, the Roman equivalent of a cold shower.

Many of the negative attitudes about masturbation are attributed to the Bible, but no mention of masturbation is found; actually, what is referred to is the story of Onan, who  protested God’s commandment to impregnate his brother’s widow, whom he did have sex with but pulled out and “spilled his seed.”  From here, things went way downhill. An early Christian bishop taught that masturbation was a worse sin than adultery, rape and incest because it was “unnatural” and a form of contraception. On and on the debate went for many centuries. By 1729 the “post-masturbation disease” came with a long list of serious and debilitating symptoms and charlatans made a killing selling cures for this dreaded affliction.

Things became so extreme that be the turn of the 20th century parents were encouraged to have their sons circumcised so as not to be aroused when cleaning their foreskins and daughters to have clitoridectomies (removal of the clitoris).  Parents were encouraged to place their children in straightjackets, or wrap the child in cold wet sheets and apply leeches to remove blood and congestion, or burn genital tissue with hot irons to make sure their child had no access to their genitals at night where the evil deed was likely to happen.

There has been much improvement in the attitudes about masturbation, but there is still a long way to go. On a regular basis, health educators today still hear very negative responses about masturbation. (Female masturbation, in particular, is often greeted with something like, “Eww, that’s nasty!”) I’ve frequently asked parent groups concerned about masturbation if they would prefer their child masturbate or be out having sex, possibly causing a pregnancy or contracting a STI. That gets them thinking – though many would just prefer their child have no sexual feelings at all.

We know masturbation is an important way for people to discover their own sexuality, prevent infection (as long as their hands are clean), and prevent a pregnancy – and we would sincerely hope it’s sex with someone you love!

Edit: Historical facts come from the Planned Parenthood Federation of America’s white paper publication, Masturbation, From Stigma to Sexual Health.