Category Archives: Ask the Sexpert

To Pull Out or Not to Pull Out? That is the Question.

Today we are revisiting this post because… well, because people are still pulling out.

I am noticing that more of my friends are using the pull-out method when they are in a monogamous relationship versus a hormonal or barrier method. Several of them have asked me how effective the method is at preventing pregnancy so I thought I would share with you what I told them.

If someone used this method their chances of becoming pregnant would be:

  • Perfect Use: 4 out of 100 women will become pregnant within a year if they always use it correctly.
  • Typical Use: 27 out of every 100 women will become pregnant within a year if they don’t always use it correctly.

You may be asking yourself, “Well how hard is it to pull-out before ejaculation?” It can be very difficult to control when someone is going to ejaculate because a male ejaculates at 15-28 miles per hour. Even if he releases a few drops of semen it can contain millions of sperm. The average ejaculation contains 200-500 million sperm! It only takes one ‘Michael Phelps’ out of the group to make it to the egg. The other concern is even if he pulls out in time, there is the possibility of sperm being in the pre-cum/pre-ejaculate. FYI – pre-ejaculate and semen can contain any infection (ex. Chlamydia or HIV) he has in his body and be spread to his partner. There are a lot of people who have gone back and forth on whether there is sperm in the fluid from the Cowper’s gland. The fluid itself doesn’t contain sperm, but because the fluid is going through the same tube (urethra) it may pick up sperm on its way out that was left from a previous ejaculation.

faucetIt is also possible that some men “leak” sperm. According to a small study administered by the NIH, some men repeatedly leak sperm in their pre-ejaculatory fluid while others do not. The study goes on to say that even urinating after ejaculation may not clear the tube and a male could still leak sperm. The study inferred that the use of this method might be more successful for some men because they are less likely to be leakers. In conclusion, if you want to help prevent an unplanned pregnancy or STD, a condom should be worn EVERY time.

Birth Control and Health Conditions

how-to-choose-birth-control-for-irregular-periodsMost people think of hormonal methods of birth control as a reliable way to prevent pregnancy. Obviously, this is their primary function. However, many people either find the side effects of their birth control method help with a medical condition or have contraception prescribed to help with their medical problem. Below are the most common health conditions found in women during their child bearing years. Keep in mind that this article is meant to educate you, not diagnose you. Be sure to discuss your medical history along with your needs from a birth control method with your health care provider.

Painful or heavy periods: All forms of hormonal birth control will decrease or eliminate monthly bleeding. The IUD, implant and shot generally stop bleeding completely. This is especially beneficial for women with anemia and bleeding disorders. For women with conditions that may cause heavy bleeding such as endometriosis, adenomyosis or uterine fibroids, hormonal methods can make periods shorter, lighter and less painful.

Irregular periods: Women who have irregular periods that want a more predictable cycle, the pill, patch or ring can help regulate the cycle. Medical conditions may cause irregular cycle include polycystic ovarian syndrome and thyroid disorders.

Obesity: One in three women in America are considered obese. All forms of birth control are effective for obese women with the exception of Emergency Contraception. At least one study shows that Plan B, ella, and Next Choice are not at all effective in preventing pregnancy in obese women. The copper IUD, aka Paraguard, is the most effective form of emergency contraception in women of any weight.

Diabetes: About one in ten women in the US are diabetic. It’s estimated that half don’t know it. If you are in good health, any hormonal method is ok. If you have medical conditions in addition to diabetes like heart or kidney disease, talking with a medical provider is essential. Usually IUDs, the implant or progestin-only mini pills are safe.

High blood pressure: High blood pressure can increase the risk of a blood clot if taking the pill, patch, or ring because of the estrogen. So the estrogen-free shot, implant, or IUD may be recommended.

Breast cancer: Non hormonal methods like the copper IUD or condoms are best. Women dealing with any form of cancer will probably be encouraged to stay away from any contraception containing hormones. When in doubt, ask your health care provider before you choose a method. Be sure and tell your complete medical history. Condoms are always an easy, inexpensive method.

For more information, check out Bedsider or Planned Parenthood.

The New HPV Vaccine

vaccineHPV (Human Papillomavirus) is a viral infection most commonly transmitted through genital skin-to-skin contact and oral, anal, and vaginal sex. There are approximately 100 strains of the virus that exist in the HPV family but only a few of the strains cause warts and cancer, including cervical, vulvar, anal, head, throat and neck cancer. According to the Centers for Disease Control (CDC) about 79 million are currently infected. Approximately 14 million people will become infected each year. The virus causes cervical cancer in over 10,000 women each year and 360,000 men and women will develop genital warts each year. HPV has now become one of the most common STD’s among men and women.

Merck Pharmaceutical company is now manufacturing an updated HPV vaccine called Gardasil 9. This vaccine will prevent five additional strains of (HPV) than the current (4-strain) vaccine. Gardasil 9 will protect girls and women that are between the ages of 9-26 years old from becoming infected with the HPV stains 31, 33, 45, 52 and 58, which are responsible for about 20 percent of cervical cancers. According to the FDA, adding the protection against the additional strains will help prevent up to 90 percent of cervical, vulvar, vaginal and anal cancers. Gardasil 9 is administered as three separate shots, with the first dose followed by a second two months later and then the third shot six months later.

Situations where the vaccine may not be effective:

  • Gardasil 9 has not been demonstrated to provide protection against disease from vaccine HPV types to a person who has previously been exposed through sexual activity.
  • Gardasil 9 has not been demonstrated to protect against diseases due to HPV types other than 6, 11, 16, 18, 31, 33, 45, 52, and 58.
  • Gardasil 9 is not a treatment for external genital warts and does not protect against genital diseases not caused by HPV.

Ask your health care provider about when they’ll have access to this new vaccine.

Fun Friday: Leave it to the Swedes…

When you’re a sex educator, people send you all sorts of funny things. Two people sent this video to me this week. The Swedes take their sex education very seriously and start educating very young. There’s not stigma, it’s just a matter of fact, health, and science. Perhaps that’s one of the reasons they have one of the lowest teen pregnancy rates in the developed world.

So, enjoy this little jam from Snoppen and Snippan, the peppiest penis and vulva you’ll ever meet. Happy Friday!

Managing your Health Care Experience: Being a Personal Advocate

doctorOne of the reasons people neglect to get the health care they need is fear. Whether it is fear of the doctor, fear of their symptoms, or fear of what could be wrong, anxiety or emotional disturbance surrounding medical care can make people think that simply denying that anything is wrong or ignoring the problem is the best course of action. Unfortunately there is a lot of judgment and shame associated with sex and sexuality, and also a general lack of knowledge about reproductive health, so this problem of avoiding getting help can be even worse when involving reproductive health care. Here are some tips for managing your fear, and getting your health taken care of!

Recognize Your Fear

If you have fear surrounding reproductive health, try to figure out where it stems from. Are you feeling shame associated with showing your genitals to a care provider? Are you having symptoms of an STD, and scared to get a positive diagnosis because you don’t know what that would mean for your life? Have you experienced a past sexual trauma that has made receiving reproductive health care potentially triggering? Recognizing the root of your fear can help you come up with strategies to deal with it, and also moves you away from the phase where you might simply deny that you need to see a clinician. Additionally, if you realize the root of your fear, you can work with your health care provider to help create a space that is comfortable for you to receive health care in.

Ask Questions!

Another area that can cause fear is the unknown. Once you’ve made a commitment to battle your fear, and get the health care you need, you can find that being an active participant in your health care experience can be hugely empowering. Before you go to an appointment, don’t just think of all the questions you want answers to, but write them down! Bring this list of questions and concerns with you to your appointment, and have your provider address them with you.

Rely on Support

Sometimes having a friendly face in an uncomfortable situation can be tremendously helpful. If you are feeling incredibly nervous about getting the health care you need, bring a trusted friend with you! You aren’t obligated to tell them what you are receiving care for, and can simply let them know you need support. If they are a good friend, they’ll be game, and their presence can be a source of comfort.

The Terrific Testicles

Most everybody knows that testicles make sperm and testosterone. Hopefully, you learned that by middle school. However, while reading this book recently, I came across some information I thought might answer some questions that I often get asked during classes.

  1. Testicles_2012While the debate still rages about penis size, does the size of the testicles matter? Apparently this is where bigger definitely is better. The bigger the testicles the more sperm is made, thus making him more fertile. It’s assumed that this also applies to more testosterone also which translates into a stronger sex drive as well.
  2. How can you tell if a testicle is normal or healthy? A normal testicle is oval shaped and at least 1.5 inches long and one inch across. When felt gently while the testicles are relaxed, like after a shower, they should feel very smooth and should slip around easily in the scrotum. Soft or small testicles could cause problems when trying to conceive. Any unusual lumps or bumps could be a sign of testicular cancer.
  3. Is it ok to sit in a hot tub or Jacuzzi? If you are trying to conceive, probably not a good idea. Soaking in hot water for half an hour can temporarily shut down sperm production. The same thing can happen with a fever.
  4. Which is more sensitive to touch, the penis or the testicles? While the testicles are extremely sensitive and most males enjoy the sensation of having them gently touched, the penis, particularly the head, is more sensitive. Also, both are very sensitive to GENTLE pressure. NO squeezing.
  5. Why do testicles change shape? The testicles move closer or farther from the body on a muscular interior cord called the spermatic cord. As sexual tension builds, the cord tightens moving the testicles closest to the body, during ejaculation. Temperature can also move testicles closer or farther from the body to cool or warm the testicles and keep the sperm at a constant temperature of between 92 and 95 degrees.
  6. Why are testicles so hairy? No one knows for sure, but just like with female genital hair and underarm hair, it is believed that pheromones, the musky scents that can either attract or repel someone, are trapped in the hairs around the genital area. Hair also acts as a cushion to protect the testicles.

Hopefully, you will have learned some new and fascinating facts!

Why Do Humans Have Sex? (A Synopsis)

Today’s post is by “Obi,” a Nigerian doctor conducting his field experience at Planned Parenthood as part of his MPH program. He was a general practitioner in his home country with main interest and expertise in maternal and child health.

*This post is a synopsis/simplification of the original paper, Why Humans Have Sex, by Cindy M. Meston and David M. Buss, which was published in The Archives of Sexual Behavior (2007) 36:477–507. If you find this topic fascinating, be sure to read their entire paper.

For a long time, the reasons people have sex have been thought to be few in number and easily discernible. The most commonly stated reasons are: to procreate, to experience pleasure, and to express love and affection.

whyHowever, research on this topic has shown that the reasons why people have sex go beyond just love, pleasure, and making babies, but not a lot of studies have been done to pinpoint these reasons. The studies which have been done have shown significant gender differences and individual differences, which were coherently linked with certain personality traits. These studies have documented more than 200 reasons why people are motivated to have sex. The reasons/motives can be categorized into groups since they can be very similar to each other but just worded or expressed in different ways.

The four groups which most of the reasons fall into are:

  1. The physical reasons: including stress reduction, pleasure, physical, desirability, and experience seeking.
  2. The goal based reasons: including resources, social status, revenge, procreation, and utilitarian.
  3. The emotional reasons: including love, commitment, and expression.
  4. The insecurity reasons: including self-esteem boost, duty/pressure, and mate guarding.

Looking at the gender differences, men generally seek sex because they like how it feels. Women, although they also derive pleasure from the act, are generally more interested in the emotional and relationship enhancement that sex offers. This difference has been named body-centered and person-centered sex.

Body-centered sex is when you have sex because you like the way it makes your body feel. You aren’t concerned with the emotions of your partner. Person-centered sex is when you have sex to connect with the other person. You care about the emotions involved and the relationship between you and your partner. Individuals can switch between body-centered and person-centered sex depending on a lot of factors which include stage in one’s life (which age and life experience is affected by), current situation in life and many more.

Despite these general observations, studies suggest that there has been a convergence in sexual attitudes among men and women in recent years. Instead of men and women being at opposite ends of the (traditional) sexual spectrum, they are now coming together. More women are having sex for physical reasons and more men say they have sex for emotional reasons (or maybe now they just feel safer reporting these feelings?).

Why are these reasons important to know? Well, why people have sex is often tied to the image of themselves and their social relationships, with changes continually happening over time. Understanding the differences in these motivations is very important. It helps us understand what’s going on in our sexual relationship(s). Finding out the reasons for wanting to have sex can aid in addressing certain problems with interpersonal relationships especially between couples and also be used to identify certain issues with sexual behaviors. Very often, you find the source of the problem can be traced to the particular motivation.

STD Mythbuster: Blue Waffle

Please enjoy the last contribution from our wonderful student intern…

A couple of weeks ago, I was facilitating a sexual health class with middle schoolers on viral STDs. I was asking the class to match the STD to its symptoms when a girl raised her hand.

blue-waffle9-290x200“What about blue waffle,” she asked.

“Blue waffle?” I thought I had heard her wrong.

“Yeah, it gives women discharge and makes it all blue and painful on the outside,” she responded.

Luckily for me, my supervisor was able to step in and explain to the class that “blue waffle” is an internet hoax. (READ: BLUE WAFFLE IS NOT REAL.) There are a number of graphic images circulating around the internet that accompany lists of bogus symptoms, and there are a whole host of bogus websites that appear to be real (but aren’t). The graphic images appear to be photoshopped.

Regardless of where the images come from, if you are perusing the internet for health information, always go to reliable websites and triple check your sources. Just because it’s on the internet doesn’t mean it’s real or true. If you are looking for sexual health information and don’t stop by a well-known, reliable website like The Centers for Disease Control and Prevention for verification, you’re doing your research the wrong way.

  • The majority of STD’s are asymptomatic (that means no symptoms).
  • If you are sexually active, or have multiple partners, always use protection and get tested for sexually transmitted diseases, and do it often.
  • Use lubricants to minimize tearing of the condom.
  • When in doubt, see a medical professional.

Sometimes we feel shy or embarrassed talking about sexual health issues with a doctor and the internet is a logical place to search for health information. This simply underscores what we aim to do at The Feronia Project, by providing you with medically accurate sexual health information.

Want more information about STD’s and safer sex? Check out the Centers for Disease Control (CDC) and Planned Parenthood to help you decide whether to get checked!

Or you can Ask the Sexperts! here at The Feronia Project.

SANE: Sexual Assault Nurse Examiner, and How They Can Help You

SANE programAfter experiencing a sexual assault a hospital is often the first place the victim goes for help and medical services. Unfortunately, a hospital is not always well-equipped to provide services for a rape victim. Often they experience long wait times in a busy and crowded place, their trauma is seen as less important than other patient’s trauma, the staff is not sufficiently trained in the type of examination needed for forensic evidence, and worse, the staff may be unsupportive and even judgmental of the victim (from a report by the US Department of Justice.)

The SANE program was created to combat this issue and provide a safe and competent way for the sexual assault victim to receive the care they need. “Sexual Assault Nurse Examiners (SANE) are registered nurses who have completed specialized education and clinical preparation in the medical forensic care of the patient who has experienced sexual assault or abuse.” Planned Parenthood of Southwest & Central Florida operates a SANE program in our private health center in Manatee County, allowing rape victims to receive their care in a quiet, private environment. Typically, the person is referred to the SANE program by police or paramedics, and brought to the center. There, the nurse examiner provides the exam, which in general consists of “the medical forensic history, a detailed physical and emotional assessment, written and photographic documentation of injuries, collection and management of forensic samples, and providing emotional and social support and resources.” After the exam, the nurse also ensures the integrity of the samples is maintained so that they are admissible in court, and may testify in legal proceedings related to the examination.

Overall, the SANE program provides many services: professional forensic evidence collection, documentation, and preservation of evidence, screen for and prophylactically treat for sexually transmitted infection, evaluate for pregnancy risk and offer prevention, document and care for injuries, refer for followup medical care and counseling, and aid law enforcement in prosecution. All of this is done in a private, supportive and nonjudgmental environment by a professional who is trained to provide specialized care.

It should be noted that the program is geared towards prosecution of the rapist, and if the victim is not interested in filing an official report she will be encouraged to discuss her reasons with the nurse examiner. SANE often encourages the victim to go through the criminal justice process. For a lot of victims, going through the process of reporting the rape and dealing with the legal process is stressful and potentially harmful (personally or professionally), and so many rapes are not reported. Still, the SANE program is a more private and emotionally supportive way to receive medical care, pregnancy prophylaxis, STI testing, and other resources after a sexual assault.