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All You Need to Know About Contraceptives

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Tuesday, September 18, 2018

It's all about contraceptives! The pros, cons and how-tos. Review the options available and how they affect your sex life. Featuring guest, Jenna Perkins, NP

Video transcript

Welcome everybody to Contraceptives and Sex. I am your pleasure professional Reba The Diva and I'm CEO of a company called Sexpert Consultants, LLC., and we host educational events aimed at educating adults about sexual education and sexual health and normalizing the conversations about sex. So today I have very special guest with me. I have Jenna Perkins so I will, go ahead and introduce yourself. Who are you Jenna?

Cool, so I'm a Women's Health Nurse Practitioner, I work in urology and gynecology at the George Washington Medical Faculty Associates and I like to empower women, educate women about our bodies and so I'm very very excited to be here to kind of give more of the clinicians experience and take on things. So, it's always good to be able to talk to as many women as possible. So, I'm excited.

Yes. Today is gonna be so great. So we, as you all know, we are talking all things contraception today. And I just really want to jump right in, I'm so excited to talk about this because I think some of the things that we kind of, the stigma that we have around wanting to know our rights and how to protect ourselves and how to prevent and properly plan for the things that we want in our lives, particularly children. But also, like you know, how to deal with what happens when contraception doesn't work and what the failure rate is for that. So for a second I just want to pause and say, when we talk about failure rates for contraception, we'll give you, we'll cover all of the options today from natural birth control methods to you know, all the drugs that are on the market and solutions available to everyone. So, we'll also talk about ways that they may enhance and or effect your sex life. So when we talk about failure rates we'll be saying, we'll be talking about, well let me--

Yeah.

What's a failure rate?

So a failure rate is the amount of women in one year who have had an unplanned pregnancy. So for instance, the failure rate of no contraceptives would be 85%. Meaning that 85% of women who have no form of birth control, within one year will have a pregnancy.

Wow, so when they say that the failure rate of condoms is less than 1%, that means less than 1% of women who use condoms have an unexpected pregnancy within a year of use.

Right.

Okay, got it. Does that make sense to you guys?

Maybe not.

We'll keep covering it as we go along. Okay, so let's start with, what is contraception, what is that?

Yeah.

That's a big word.

Contraceptives, yeah, it just means pregnancy prevention. So, it's a million different ways to prevent pregnancy so contraceptive is just the word that just means that we are trying not to get pregnant right now.

Now, contraceptives, are they also used to prevent STD's?

Yeah, so contraceptives specifically mean that you are looking to prevent pregnancy but some, one of these ways, two, abstinence and condom use also prevent STD's, sexually transmitted infections or STI's, as we call them.

Awesome, so let's start with, we have a request from Vitamin Kitten. And Vitamin Kitten really hopes that we discuss some science based natural methods like symptothermal target. So let's start with, what's natural contraception?

Yeah, so there are a few ways to do what we call fertility awareness contraceptives or methods, the FAM class. So the first one is the Ovulation Method. So this is the one where you are tracking when you're ovulating. You are looking at your discharge to figure out when you get that kind of egg yolk like sticky stuff to know when you are most likely to get pregnant. So this is very helpful in women who don't want to use any sort of unnatural contraceptives. So that's one type of Fertility Awareness Method.

So Fertility Awareness Methods are basically, you track when you're fertile or when you're ovulating and there are several different ways that you can track that and those are all called FAM.

Yeah, Fertility Awareness Methods.

Fertility Awareness Methods. So the Pull Out Method.

Yes.

Which is the most common method or the Rhythm Method which, for those who aren't familiar, the Pull Out Method basically just means when your partner is about to ejaculate they pull out to avoid ejaculation inside of the body.

I wouldn't recommend doing the Pull Out Method alone, ever.

I was actually talking to a Facebook group that I'm in and they were saying that doctors are recommending two types of birth control. So if you're on pills or some kind of hormone therapy then you should also be using condoms and, or some other kind of method.

I would hesitant to say what you should be doing because what you should be doing is what you want to do, right? If you can only use method, if that is what floats your boat then use that one method. So, all of this is advice. This is not a bible that you have to use two different types of birth control. It's all about risk benefit. So a lot of women like myself, I don't necessarily want to be doing multiple things in order to prevent pregnancy. I want to get one solid thing that I'm confident in and do that. But yeah, in order to have the best results I usually recommend doing more than one. So if it's going be catastrophic for you to have a baby at this time maybe you want to do more than one method.

Be a little bit more protective, right?

Right.

Okay, so let's go back to natural birth control methods. We're talking about Fertility Awareness Methods. We talked about the Ovulation Method, which is also known as the Mucus Method, right?

Yes.

That's when you're like monitoring your mucus and your cycle to know when you're ovulating and know when your fertile window is and when you possibly should not be having sex. So let's talk about that for a second. What's an ovulation cycle?

And ovulation is when you have a egg that is released. So it's when you have peaked. So you have peak amount of mucus. So that mucus coming from the cervix is really like food for the sperm, it kind of helps the sperm travel. And so when you ovulate you release the egg. If the cervical mucus is, and the discharge is conducive to the egg meeting, the egg that you've released, then that is when fertility happens. That's when you get pregnant.

Got it. So during that cycle, which is about how like, 28 days, 30 days?

It depends, every women is different and So I really recommend that everyone monitor your cycle, whether you do paper charting, so literally write on a calendar what you're temperature is, what you're discharge is, where you are within your cycle, if you have bleeding or spotting or whatever. Or, I mean it's 2018 so you can find an app on your phone.

Oh there is an app for that.

There's an app for everything.

So I have a handy dandy Fitbit. They're not paying me for this by the way. But my Fitbit app also, you know, you can track your period and it's been telling me my fertile window in particular the three day, like my three days of that I'll be, that I'd be ovulating. So I definitely recommend finding an app that you can track your period, because it will help you kind of be more aware of your body. So, let's go back because you were talking about ovulation, right? So, monitoring your mucus is one, that's called the Ovulation Method. But then there is the, what other methods are there? So I know you were talking about body temperature.

Yes, so that's the Symptothermal Method.

Symptothermal Method.

Symptothermal Method, yeah.

That one, I've also heard it called the Basal Body Temperature Method or BBT. So, what's that?

So basically you have temperature changes throughout your cycle and once you start to track your period more you'll be able to know what these temperature changes are and then that will just be further help in predicting when you are going to be most fertile. I don't have the failure rates of these.

For the Fertility Awareness Methods?

Yeah, so for the Symptothermal Method, with typical use, so what an average woman will do. Within the first year it's a 2% failure, so about 2% of women using this method will have an unintended pregnancy.

Whoa, that's pretty low!

It's pretty low, and then with perfect use it's only 0.4%.

Wow, so if you really get to know your body you could greatly lower your chances.

Of getting pregnant. Or it increase your chance of getting pregnant if you wanted.

Oh yeah, if that's what you're looking for. That's true, that's true. Let's not talk about babies like they're terrible, crazy, money spending creatures. Even if they are.

I don't have any yet so I'm not educated.

I've got lots.

But I also--

Would you like some?

But I also monitor myself very closely to know when I'm going to be ovulating.

If I had done that maybe I wouldn't be among the 2% of women who had an unplanned pregnancy.

I think that monitoring your cycle is very important even if you're not looking to do it for fertility because you just want to be closer to yourself and be more connected to what's going on with your body. And so even doing things like monitoring my mood along with my cycle can be very helpful. Because I know if it's four days before my period and I'm feeling a little crazy and I kind of, just kind of, discombobulated and all over the place and it's happening every month then I can expect it and when it happens I can step outside of myself and say, okay this is something that I am prepared for and I can kind of watch my emotions from afar. So even if you're not doing this to get pregnant or prevent pregnancy I do think it's important for you to get to know your body and to monitor your discharge, monitor your basal body temperature, everything, acne, mood, everything.

Honestly, it's really just important to know yourself, right? Know your body, know yourself, right?

Yeah.

So, that's kind of the heart of what we're talking about when we're talking about these natural birth control methods. Particularly the Fertility Awareness Method. The more you know your cycle, the more you know your body, the less risk there is involved in you know, having a baby. We're not talking about STD prevention because that's not happening with the Fertility Awareness Method, right? But we are talking about preventing unwanted pregnancies or you know, family planning. Because that's so, the other thing I just want to harp on for a second about knowing your body and knowing your ovulation cycle and knowing your when you're going to menstruate, it also helps you find out if there's something wrong, right? If you notice that every time you have a period or have a heavy period, or every time you've got a period it's been accompanied by cramps or every time when you've had a period you have this bloating and mood changes. That helps you stay in tune with your body and helps prevent, you know, health concerns in the long run. You know, and it can help kind of catch things before they--

Occur.

Yeah, before they become a larger concern.

Yeah, and it's also going to help you save time and money because the first thing I do when somebody comes to me and has problems with my period, I'm like, okay well, what have your last three periods been like? You don't know? You don't have any data? Go home, monitor your cycle, come back and then present me with that data. Because if you are telling me, oh, I have an irregular period. You know, I used to get it on the first of the month every time but now I get it on the fourth and then the fifteenth then that's a different conversation than if you have the data to say, this is when it used to happen and this is what's happening now. That's just a very different conversation. So instead of your provider sending you away and then you have until I collect more data about your period. If you already have that when you go in that's going to save you a lot of time and effort. Someone brought up the Mirena IUD, that has stopped my period and I feel so imbalanced and so not ready for a baby. I can speak from personal experience, I did not have a period when I was on the Mirena IUD and I loved it. I loved it, I loved it. You don't need a period, right? So, let's back it up a little bit. When we talk the period, what the period is is it's the time when you are shedding a layer of tissue inside of the uterus, right? So I like to imagine that my uterus is a big comfy bed in a hotel, right? And so every month you have someone in there that is just adding layers to this comfy, comfy bed, right? You add some sheets and you add another sheet and some pillows and you're trying to get it as comfortable as possible for this future embryo to implant inside of this tissue and if that doesn't happen your body gets very angry at you and you so slough off all of that tissue. Okay, so that's what the period is, it's the sloughing off of that tissue when you don't get pregnant. What the Mirena IUD does is has progesterone in it which is a hormone that stabilizes the lining of that tissue. So those fluctuations you don't have anymore. So you no longer have that building of the bed so that when you do have a period it's going to be a lot lighter, right? Because you haven't built up so much or it won't happen at all. So what's some women will notice within the first three months to a year they'll either have lighter periods or no period at all on the Mirena.

So let's talk about hormonal birth control, right? And I know there was a request for non-hormonal birth control but let's talk about hormonal birth control and then just kind of transition into the non-hormonal. So, hormonal birth controls. Let's list them. Ready?

Okay. So we have the oral contraceptive pills.

The birth control pill.

The birth control pills. There are a million of them. I've stopped even trying to learn the names because there are new ones on the market all the time, they change pharmas. If you've taken the pill then you know sometimes you go to your pharmacy and you're like, what is this? I didn't have this six months ago. So it changes all the time. So the oral contraceptive pill, the most commonly used one is the combination pill. So it's a combination of estrogen and progesterone.

Okay.

The other oral contraceptive pill would be the progesterone only pill and so this is a great option for women who aren't candidates for estrogen use. So women who have like blood clotting disorders or migraines where you see auras or lights, and other things where you wouldn't be a good candidate to use estrogen based products.

Got it, so there's the birth control pills. Then what else?

The IUD, so the hormonal IUD's. There are a bunch on the market now. It's made of progesterone only so again, these are safe in women who do not have any, or who, these are safe in women who cannot use estrogen, who can still use the progesterone only IUD's.

So progesterone only IUD's like?

Mirena.

Mirena.

Is the most common one and it's the oldest one on the market. The Mirena IUD is, the research is now saying it can be used for up to seven years, the FDA has still only approved it for five years I believe, so anywhere from five to seven years the Mirena IUD can be used. The benefits include having that light period or no period at all. It's also easy to use. You get it in once and then you're good for five to seven years. Then there are other ones on the market. The Skyla IUD, which that one is three to five years and the Kyleena, which is three to five years.

So let's go back, IUD?

Okay, sorry. An IUD is an intrauterine device.

Wait a minute, I learned about IUD's when I was growing up, I'm telling my age a little bit, but they were like not on the market and banned.

They were, yeah.

Why are they back now?

There was this one specific type of IUD, it's called The Dalkon Shield. And if you look at it you can see why it was banned in probably should have never been used but it just has a lot of edges in it and it looks kind of sharp. But basically the more surface area in the IUD, the more points of contact it's going to come in to with the uterus, right? So one of the risks of the IUD is that the IUD can embed itself in that uterine lining that I was just talking about. So with the Shield it had all of these different curves and edges so women were having this IUD get embedded and if they had an infection the infection could get pretty serious.

So, and this was--

And so it was taken off the market. That was in the '70's I believe.

And what was it made out of again?

I can't remember, I don't know.

'Cause I thought they, I remember they were copper.

I think it was copper.

They said that the copper IUD's were like terrible for you.

Yeah, and it was the shape of it. It wasn't necessarily the IUD itself.

Got it, okay. So now that that's out of the way. When you get an IUD is it like, you just go to, is it a simple office visit or do they have to like open me up to implant this thing in my?

Yeah, it depends, so every woman is different so every IUD experience is going to be a little bit different but usually what happens is you would go into your provider, so you're nurse practitioner or your doctor and you would talk to them about options, any options that you're thinking about you have to talk to your provider, right? So do not take my advice as--

Law.

As law.

Rule, yeah.

You should be talking on an individual basis with your provider. So if you go in, some places will have the IUD's on hand so you can say, I want an IUD and they'll give you the same one that day. So it usually takes just a couple of minutes. It's not a whole long time. It feels like getting a PAP smear but with usually a bigger cramp, like heavier cramping. When I got my IUD I felt nothing at all. I was very lucky. I actually let a medical student do it because I knew I was going to be a nurse practitioner and I knew that it was important for him to learn, so I was like, let the student do it. And I felt nothing, I was fine. I went home, worked out that same day. No issues at all. But there are some women who have lots of cramping, lots of bleeding for the first couple of days after you get your IUD inserted. So it can be pretty uncomfortable and those first few periods can also be uncomfortable and you can expect to have some irregular bleeding for at least the first three months. But, so you go in, some providers will say, take some ibuprofen before you come to help with the cramping, usually about 800 milligrams of ibuprofen. Some people will give you a pill that will soften the cervix. The cervix is the opening at the bottom of the uterus, so it's a tiny little hole, like the size of the pinpoint in one who's never had a baby. And that is what dilates or opens to allow the tissue to come out when you're having a period and also what opens when you are having a baby.

Having a baby.

So that's when they talk about being dilated. That is the cervix that is going from, you know, tightly closed like that to all--

10 centimeters! 10 centimeters when you have a baby, just FYI.

So, some providers will give you something to soften that cervix so that the IUD can be inserted a little bit easier. A lot of providers will tell you to come in on your period because the cervix is naturally already dilated so getting the IUD in is just a little bit easier. Some providers also think that if you get the IUD while on your period you're less likely to have that irregular bleeding too. I don't know the research on that so I can't say if that's 100% true but anecdotally that's what I counsel people to do. Just 'cause it's easier to go in on your period, you're already expecting to be crampy. You're already open, you don't have to get dilated. If a woman who has never had a baby, who's never had a dilated cervix and is not on her period then the cervical os, the opening can be very tight and so it can be a little bit difficult to get it open to allow the inserter to go in. So the inserter for the IUD is not big at all, it's very small. I would say it's probably a little bit bigger and with the cord that you're charging your computer with right now.

Yeah, this one.

So not very big at all. A little bit bigger than that but sometimes they will dilate women so it's very tight, if the cervix is very tight you can use an instrument to open that canal up a little bit and then it'll allow the IUD to go in easier.

So, birth control, hormonal birth, contraceptives we're talking about. Birth control pills.

Two types.

IUD, lots of types. But there's progesterone only and then there's--

The copper IUD which would, used to be called the copper coil. And it is non-hormonal.

Non hormone, the copper IUD? That's still a thing?

It's still a thing. The ParaGard, it lasts up to 12 years. 10 to 12 years. That's a really good option if a woman doesn't want to use any sort of hormones but want something that's very, very reliable.

So let's talk about, in a second, that's talk about what hormones do. So is that all of the hormonal birth control? So we got birth control pills, IUD's.

Yeah, so then there is the implant.

What's an implant?

So it's a progesterone only method also. It's about the size of a matchstick and it is a little, way smaller than that.

Whoa, okay.

A matchstick, you know.

Yeah, okay, a little matchstick.

Tiny, I do have one. Look at me, I'm so prepared.

Oh, look at you.

So, the implant is about this big, so very small, tiny, tiny. And it goes on the inside of your arm, here. And so it delivers a consistent level of progesterone. So again, it stops that growth and kind of the peak citrous of a normal cycle so then you are way less likely to get pregnant. Nothing is perfect. That also has a failure rate but if you go every three months like you're supposed to do to get your, oh, I'm thinking about the shot now. But if you leave it in for longer than the recommended three years the failure rate will increase.

Oh, so the implant is three years. What's the failure rate on that?

I don't know, I'll have to look that up. It's pretty good though, I mean, it is pretty reliable.

So, birth control, IUD, implant, what else?

The shot, the Depo shot.

Depo-Provera.

So the Depo shot you go every three months and get your shot, you blow up.

Yes honey. Okay, so Depo, let's talk about what it is before we start poo-pooing on it 'cause there's people who--

I think Depo is a great option. Anything that you find easy to use and tolerable is going to be what's good for you.

Depo-Provera is a shot that you get, feels a little bit like tetanus every three months.

In your butt.

In your butt or your thigh or your arm. But large muscle, like fat muscly muscles. Big muscles, okay? You may experience pain at the injection site. Like a tetanus shot, you also may gain a significant amount of weight. You may also--

Are you speaking from personal experience?

Oh, honey am I speaking from experience? Can you tell?

But there are also people who lose weight on Depo, there are women who gain no weight at all.

You also like my skin gotten much better. But also--

And also you didn't even get pregnant.

I bled for 43 days so I was also not having sex for 43 days.

So, in some women it actually can prevent periods too. So your period supposed to slow

Mine did the opposite of that which is made me have my period all of the time. Anyway, I don't want to poo-poo on Depo 'cause it works for some people but for me it was a no no.

It's easy, you don't have to remember, you don't have to take a pill everyday. So, I think it's a pretty good option.

What about the NuvaRing?

So the NuvaRing is a combined contraceptive so it has the estrogen and the progesterone, so the same ingredients that are in the oral contraceptive pill but it is a ring that you can put in and you can leave in for three weeks and then take it out and have a period. Or a bleed or you can leave it in for four weeks and put a new ring in.

Can you sex with it in?

Yes, yeah. Sometimes it'll pop out if you're having intercourse with it in. Sometimes your partner will feel it. So you don't have to have sex with it in but you don't want to take it out. I recommend not taking it out because if you take it out and you forget it then you're gonna--

Well then you're not protected. You better go back, well that's why you use two methods, right?

Right.

Use NuvaRing and know your body honey.

We can barley get people to use a single method so using two methods is like, okay girl, that's wishful thinking.

So is that all for the birth control? So we've got the birth control pills, IUD, the implant--

The patch!

Oh, the patch. Okay, so that's just a patch that you put on your arm for a certain amount of, once a month?

Yep, once a month.

And what are the risks associated with the patch?

Failure, you can have an allergic reaction at the site. Same risks for any of the combined contraceptives. So, risk of bleeding. You don't want to be taking it if you have migraines with aura. If you're obese or overweight it's not a good option for you. The research doesn't look that good for women who have an elevated BMI.

Could it be like potentially dangerous?

No, the failure rate is higher.

Failure rate is higher, got it. So is that everything? Birth control, IUD, implant, Depo-Provera, NuvaRing, patch.

Yeah, I think that's everything.

So let's talk about, 'cause these are all hormonal, right? Some of these have non-hormonal options but what do these hormones do in your body?

Yeah, so, they do a whole lot. They regulate temperature, they regulate mood, they regulate sex drive, libido, they regulate discharge.

But how does it stop the body from having a baby?

So, everyone is different. A lot of them, what they'll do is they change the cervical mucus. So if that cervical mucus is not conducive to carrying sperm than it gets thicker so you're gonna have less a risk for pregnancy. Some of them will also stop ovulation. So if we give your body a little bit of external hormone this cascade happens that basically tells your brain to turn off the changes that need to lead to you ovulating.

So, it kind of tricks your brain into not having an ovulation cycle?

Yes.

Okay, tricks your brain into not letting your body have an ovulation cycle.

Right. So, the other times where you are anovulatory or without ovulation then would be, someone just asked, the patch is combined hormonal right, not progesterone only? Yes, it is combined. So again, that's women who aren't good candidates for estrogen don't want to use the patch. I lost my train of thought.

Yeah, so we were talking about what the hormones do your body and how it prevents pregnancy and you were saying that the only other time that you'll be without ovulation cycle.

Would be pregnancy and menopause. So a lot of the same symptoms that women have with pregnancy and menopause you can also have by being on the pill. So, vaginal dryness, which is seen often times in women who are perimenopausal or going through the change and women who are menopausal, meaning that you no longer have cycles. You can have similar symptoms when you are on the birth control pill. So low libido, vaginal dryness, some pain, some urinary symptoms, so more risk of urinary tract infections, things like that so if you're taking any sort, if you're taking any pill, any method and you have problems you should consult your provider.

I just want to say that again because I think a lot of women internalize the symptoms that they are feeling because they're on birth control as, you know, this is just how my body operates and I want them to know that if you, I'm just going to say it, what she said again, if you are experiencing vaginal dryness, urinary tract and urinary issues, and you're taking a hormonal birth control, any kind of contraception method, you need to see your health care provider, okay?

Yeah, and this connects back to being aware of what your normal is and being aware of your body, right? Because if something changes you're gonna know, this is not normal for me. And if you've never taken the time out to get to know your body and get to know your periods something's going to change and you're going to be like, I don't know.

I guess it's different.

Yeah, if you're not monitoring your cervical mucus and then you start to have vaginal dryness you're gonna be like, well I guess this is the new normal for me.

So Amy asks, in your opinion is it safe to not have a cycle for years?

Yeah, safe? Yes, the research says that it is safe and I think you're talking about how we were talking about the Mirena IUD and I didn't have a period, yeah. So that is safe. There is nothing in the literature that says that you should be concerned. The same thing happens with women who are breastfeeding. So you can go years if you are breastfeeding and you're not having a cycle. And then you get pregnant again and still don't have a cycle. So the research is pretty solid saying that's it's okay. In some cases it's actually protective against things like ovarian cancer. You don't want to be ovulating all the time because that can increase your risk of ovarian cancer, so if you have some sort of genetic disorder that makes you more at risk we do encourage you, sometimes, every case is different, but some women are encouraged to not ovulate as much.

Are there instances where people naturally just don't get periods?

Yeah, so there is a condition called PCOS where you can have very irregular periods, where you can go months without a cycle. Sometimes nothing at all is wrong and you just have a longer cycle than the average bear. So again, it's getting used to what your body is doing.

Yes, very true. I said I asked that question for athletes. I was a dancer growing up and a lot of the dancers that I was with did not have periods or have really irregular periods.

Right, because they don't have the adipose tissue, the fat tissue, that we store a lot of estrogen in and so when you have women with eating disorders or women who are very underweight then if you don't that hormone coming from the fat tissue then it can effect your cycle. So people who are like running triathlons and these very active athletes and elite athletes, a lot of women won't have a cycle.

But if there has been no drastic change to your diet or your exercise plan and for some reason your period has all but disappeared you need to see your healthcare provider, period.

Absolutely.

Don't think, oh my period just disappeared one day and nothing else changed about my body, I'm good.

I don't think I've met a woman in the world who would ever feel that way. I think with women, we obsess over our cycles and our periods so much that if you're five days late you're like, okay, let me go take a pregnancy test, like, what is going on with them. If it is something like that is happening and it's been a couple months, whatever without a cycle and this is different for you and you don't have an underlying diagnosed condition then you absolutely should talk to somebody about that.

Yes.

Yeah.

Awesome, so let's talk about non-hormonal birth control. Let's start with the one we all know. The most popular method which is?

Abstinence? Abstinence is the most effective one.

That was really funny! I was going to say condoms but you're right, abstinence is foolproof.

It is foolproof unless your name is Mary.

Mary Magdalene.

Exactly.

Okay, so yes condoms, I'm sorry, abstinence. I'm a sex educator, you don't come to me for abstinence. I'm sorry guys. So yeah.

So sex isn't only penetrative.

No, you're right. You're right, you're right, you're right, you're right, you're right.

No, you can have abstinence from penis and vagina.

You can have abstinence from penetrative sex in general but, let's talk about abstinence for a second, right? So, what the best way to stay abstinent? How do you, how do we do this?

You just don't have sex. That's pretty easy.

A good masturbation routine would help, right?

Yeah, absolutely, absolutely. I think that one thing we can do to service our young women is to promote masturbation. I think that a lot of women, even if you talk to your girl friends and I talk to a bunch of my girl friends and I say, you know, why did you end up having intercourse? And it was curiosity for me and almost all of my girl friends. We're not like men, we didn't have this raging urge to just go out and just like have sex.

Sow our wild oats.

Yeah, that wasn't a thing. And it might be for some young girls and some young women but for the majority of women having sex you know, when you're super young, it's more curiosity. You want to know what the big idea is, you want to know what these sensations you're feeling, you want to feel good, you want to have an orgasm and when you do have an orgasm you want to replicate that. And so I think that if we were to, you know, share this information with young girls that you can masturbate, that you can achieve orgasm without having to have a partner then I think that it would prevent, it would promote abstinence.

I definitely think we'd see a higher rate of abstinence among young people. So I live in Maryland where the STD rate in people under 21 has skyrocketed.

All over the world.

But it's up like 76%.

That's crazy.

In Montgomery County.

That's is crazy.

Yeah, it's really bad. I want to think about ways that I can help adjust that but anyway, but this is because we're not telling people, we live in such a sexual society, right? Sex is everywhere, everywhere you look. Mario Kart was trending today because of our President's penis. Like, there's a lot of, I know, there's sex everywhere.

I'm doing that face because you just made me think about the President's penis.

I know, anyway, I'm sorry. Sorry guys.

Mind you I work in urology so thinking about a penis should not be weird for me but that one in particular.

Anyway, well so. I'm not going to get into it 'cause it's actually very funny. Everybody should go find out why Mario Kart was trending on Twitter.

I will look immediately after this

But sex is everywhere and it's natural to get curious, right? And it's the first thing we tell them is, no, don't ever have sex and don't have a baby and definitely don't have an STD, it's like, okay well.

How do I do that?

Why do these feelings feel so good then?

Exactly.

Why when my phone was buzzing in my pocket did I almost orgasm, like, what is this feeling?

Yeah, what is this discharge. What is this stickiness that I feel in my legs, so yes. Yeah, so abstinence, you know, I think that if the republican party started talking about masturbation they'd do a much better job.

I think if we all started talking about masturbation, right? 'Cause it's not a bad thing, it's not not pleasurable. But okay, so abstinence is a thing. I'm done talking about abstinence.

Condoms.

Let's talk about condoms. That's where I thought we were going with this. Condoms, failure rate?

I would have to look that up, I'll look that up now and get back to you.

So I keep hearing, you know, in all the condom ads they say, condoms have 99.1% effectiveness rate, which makes me think that, what is there, less than 1% fail rate. Is that what that means?

Yeah, so let's see. The male condom with perfect use is effective 98% of the time.

Oh, so 2%?

Yeah.

The four way is 2% just like the Fertility Awareness Method.

In perfect use.

In perfect use, okay got it.

Okay, meaning that you use the condom throughout the entire act 100% of the time.

Not just use it and then take it off and then cum outside of the condom? Because that happens sometimes.

Here's the kicker. With typical use, 85%.

Whoa! So typically people aren't using condoms properly?

Right.

Oh, let's talk about condoms. Let's talk about incorrect condom usage. I had a man, a boy, in high school tell me, no I didn't have sex with her and if I did I would use two condoms. Well he's and idiot because if you use two condoms you create dry friction and that means both of them are going to break and somebody's going to end up pregnant.

I mean, he's not an idiot, he's just didn't have anybody to teach him.

Uninformed. Just uninformed but also, I'm not even going to--

If he still thinks that way, now I don't think

No, there are grown men, namely on Facebook that say things like, no, two condoms is the best prevention. It's like, you clearly aren't going to have any sex with anyone. Because if you've ever tried to use two condoms, first it's not pleasurable for anyone and they break.

I don't even understand how you would get two condoms on. I just don't understand.

Well, you would need lube obviously or it's going to break, anyway. Anyway, don't try the two condom thing. It doesn't work, just one condom. How do you perfectly use a condom? Okay, let's talk about it.

Yeah, you put the condom on before the genitalia touch, number one. So there's no--

So you don't just put it in and then you put the condom on because that's how you have babies.

Yes, that's how a lot of people get babies. So the best thing to do, this is a time where you could also track your period and know when you're going to be most fertile and so you can say, okay, I'm going to be most fertile on these days so these days I'm going to use a condom 100% of the time, throughout the entire act. So that's how you can boost the rates for the Fertility Awareness Method is by combining the use of condoms and also fertility awareness.

Nice.

Yeah.

So that's one non-hormonal way. Dental dams.

Yeah.

What is that?

A dental dam is not a contraceptive, a dental dam is a barrier method though.

So it's a way to prevent STD's but it's not a way to prevent unwanted pregnancies?

Exactly.

Which makes it not a contraceptive?

Right.

Okay. But there was a question about dental dams. So let's talk about, well what is that?

So a dental dam is.

It looks like this.

A plastic sheet.

A plastic sheet that looks like this and you put it over your mouth.

Or you put it over your partners vulva.

Or over your partners vulva.

And then you lick.

And you, and you.

It looks a lot like a saran wrap.

Yeah, it does, it's a lot like saran wrap.

So it creates a barrier so if you're looking to prevent oral HSV or oral herpes then a dental dam is something that you definitely want to be using.

And where do we get those from?

CVS, honestly in this day and age everything is easy to find online.

Convenience store. Oh, so try your convenience store.

Try your convenience store.

'Cause that's where you look for condoms so look for dental dams in the condom section.

But they won't always have them the same way that they don't always carry female condoms, so if this is something that you want to invest in then I'd recommend looking online.

Wait a minute, female condom? What's that?

So a female condom is bigger than a male condom and it sits on the vaginal opening. It's pretty effective, let me look at the failure rates for that. Don't have it listed here. I'm referring to Contraceptive Technology if there's anybody out there who'd interested in learning more about contraceptives. That's like the handbook that I used in school and that I keep at work too. So, Contraceptive Technology. Yes, so the female condom you put on the vaginal opening and then it's a condom that the woman wears basically. It's kind of hard to explain.

So you put it on top of the vulva and then the penetrative person.

Enters you.

Enters you and then, it's just basically like a larger male condom. But it's built to go inside of the vulva.

Exactly.

Or inside of the vagina from the vulva. Okay, interesting. And are all of those latex?

Yeah, and condoms are usually latex but they can come in non-latex forms too.

Yes, so if you have a latex allergy, how do you know if you have a latex allergy?

So most people who think that they have a latex allergy do not have a latex allergy. Right, because if you have a latex allergy then you have a latex allergy. So latex gloves, anywhere else on your body you're going to be allergic to it. You can have a latex sensitivity in the vagina and on the vulva.

And on the penis.

And on the penis. What is very common is that women who suffer from dryness think that they have latex allergies because it burns because of the friction but it's really not the latex.

It's the dryness and dryness can be caused by a bunch of different things. We just said.

Pregnancy,

Pregnancy, breastfeeding.

Menopause.

Menopause.

Birth control.

Birth control.

Yeah, those are the big ones.

The list goes on. Do you know what helps with vaginal dryness? Lube.

Lube, foreplay. Yeah, I'm a big fan of lube.

I'm a big fan of lube. Uber-lube, I'm sorry. We're not going to do that today. We're not going to do that because there's still not paying me, so. Cool, so that's non-hormonal, well that's condoms.

Yeah, yeah. Then there's also the diaphragm which a lot of women in the '70's used diaphragms, they were pretty popular back then. They are not as popular now and even if you go to your provider and you ask them to write a diaphragm for you a lot of pharmacies don't carry it so the best thing to do if you're interested in the diaphragm or a cervical cap, so this is something that goes inside of the vagina and it covers the cervix so that little opening is now blocked off.

Kind of like the NuvaRing.

The NuvaRing doesn't cover.

Oh, okay.

The NuvaRing is just there giving you the hormones.

The hormone, got it.

So it's a systemic, right? Versus the diaphragm. And the cervical cap, they are local things that basically just prevent the sperm from touching the cervix.

So it just plugs up your baby maker.

Covers it. Covers it.

What's the, is that pretty effective?

Yeah, it's pretty effective. You have to use it correctly and it's hard to get. So if I was to write, the risks are sexually transmitted infections and failure.

Babies. STD's and babies.

STD's and babies. And, where was a going with this? I was saying that, oh, it's hard for us to prescribe it, right? So if someone is coming and saying, I want a non-hormonal option for contraceptive, I want to try out the diaphragm, I can't just write a prescription for it. You are best off going online and finding them. So, Caya, k, sorry, C-A-Y-A, is a diaphragm that's pretty popular. So if you're interested in the diaphragm I'd recommend looking at that as an option.

Cool, now what are the non-hormonal birth control methods are there?

We talked about the Fertility Awareness Method.

Fertility awareness, all of those natural birth control methods we talked about.

Condoms, the diaphragm. Which fall in our favor. The ParaGard, the IUD, the copper coil.

The copper coil.

That's non-hormonal also. So those are the biggest, most effective forms. And of course abstinence.

Of course, abstinence is non-hormonal. Or is it? I'm just kidding, I'm kidding.

If you don't have enough testosterone maybe your libido makes you abstinent.

Maybe, right.

And then, which is a thing. Testosterone's important for libido.

Yeah, definitely. So why does birth control, the hormonal birth control that we talked about, why does that cause or how I guess, like what is it doing to my body to make my vagina dry?

Yeah, interesting question. So, not to get too scientific but--

I'll stop you if I get confused.

Okay, so you take a mini pill with estrogen and progesterone every day. And so your brain thinks that you have a surplus of these hormones and so, if you look at the literature on all of these hormonal methods it'll show that you run the risk of having an increase in something called SHBG, sex hormone binding globulin. So this is a protein that your brain tells your body to make when it thinks that you have too much estrogen, too much testosterone, too much progesterone, so you take the pill everyday, your brain thinks, oh my God, I have a surplus I have to create this protein, SHBG, sex hormone binding globulin.

Okay.

That protein does exactly what it's name says. It binds to the testosterone and the estrogen that your body is making and it makes it functionally unavailable. So, your brain might be making enough testosterone but your body has this elevated protein that's binding to all the testosterone so your free testosterone is greatly decreased.

Got it, so your body is producing extra testosterone.

It's not producing extra, it's producing a protein that binds to the testosterone that's already there.

Got it, so your body is producing a binding agent that basically stops your testosterone from working.

From working, exactly. So at the level of the vestibule, the opening into the vagina, the tissue is very testosterone dependent so it needs a lot of free unbound testosterone to feed the glands that secrete lubrication.

So, what you're saying, is testosterone is part of what helps keep vaginas lubricated.

Absolutely.

And when we take hormonal birth control our levels of testosterone, our testosterone basically stops working.

Yep, your free testosterone, your unbound available testosterone goes in the--

Down, yes. Because the binded testosterone can't work.

Right.

Okay. And so that lowers the amount of lubrication that are bodies can produce. Interesting, just like when your on menopause or when you're breastfeeding.

Exactly.

Interesting. Now you know.

So if you're having pain with intercourse one of the easiest things that you can do is to stop the birth control pill and think about a non-hormonal method to see if your natural lubrication can come back. And if it does not then you would want to come and see me at GW here in D.C. or find a provider who specializes in sexual function and dysfunction in women.

Awesome. So if you're looking to try the Fertility Awareness Method, right? I wouldn't recommend just getting off the birth control and saying f it, I'm God balls to the wind, okay?

Unless you're okay with getting pregnant.

Yeah, unless you're okay with getting pregnant, right? And that's a conversation I think you probably should have with your partner as well.

One thing we didn't talk about was Plan B.

Oh yes, no, that's so important too. What is Plan B?

It's a super dose of birth control pill.

Okay, so it's a birth control pill. And when should I take Plan B?

So you want to take it within three days or 72 hours--

Of unprotected sex.

Of unprotected intercourse.

So within three days.

The closer the better.

Okay.

So, the failure rate increases as time goes on.

And when I take it is it gonna like pull the baby that got formed in three days off of me?

No, so there's no baby formed in you. At the time of unprotected intercourse. What it will do is it will stop that egg from meeting that sperm.

Okay, so will it cause side effects?

Yes, it can cause side effects. So often side effects that you can have from being on the pill you can have from.

So like weight gain.

But if you're only taking it--

Once.

At once, so it's really just those kind of acute side effects.

Well, you're taking it once.

Potentially.

Potentially.

So stomach upset and nausea, vomiting. Irregular bleeding is the biggest one. It throws off your cycle a lot. So if you do something like take Plan B you have an irregular period than doing the Fertility Awareness Method. In the future, it's going to be a lot harder for you because your cycle has reset and so now you have to find your new norm.

Interesting.

Yeah.

So Plan B is a good backup, right?

Plan B is a great backup.

Have we talked about, you know, the advice that, okay maybe you have to maybe you know, your using one that's not hormonal and Plan B is your backup.

Plan B is an awesome, awesome backup.

To stop making an unwanted pregnancy remain.

You can find it over the counter now which is very, very good.

Yes, it's a little expensive.

It's very expensive but it's less expensive than a baby.

What are we talking, like 50 bucks?

I think it's around there. Anywhere between 40 and 80. I think it's cheaper if you get a prescription. So if you have a cool provider that you're okay with you can call and say, hey, I had unprotected intercourse, can you write me a prescription for Plan B, or Ella, it's a branded, a different branded version of that.

Ella, I've never heard of that.

And so we'll write it for you, send it to your pharmacy and you can take it immediately.

Interesting.

So that is an option. So if you can't afford Plan B but you wanted it just call your provider and see if you we can get some insurance coverage to help you out with that.

Yeah, but Plan B over the counter is anywhere from $40 to $80 and you can buy it over the counter so don't think that you need a prescription to get Plan B.

Yeah, you can buy it on Amazon.

Damn, really? But I know you can buy it in CVS.

You can buy it at CVS.

And Walgreens, Rite Aid, your local convenience store pharmacy should carry Plan B, like on hand. You don't have to wait for it to be filled or anything.

And the sooner you take it the better off you are.

Yes. Well, that's a good one. I'm glad you remembered that one.

Yeah, Plan B's a good option.

So I have another question I was asked on Instagram, do we have time?

Before we move, yeah we do have time. You can also the IUD's as a form of emergency contraceptive.

What?

Yes. Isn't that crazy?

No, wait. You gotta explain more about that.

So, okay, you have unprotected intercourse and you are nervous about a future pregnancy and you want a form of emergency contraceptive, IUD's have been indicated to prevent pregnancy so if you can get an IUD inserted.

Within how long?

I believe it's 72 hours too.

Oh, it's just 72. So it takes about three days to get pregnant.

Yeah, yeah, let's see.

So Heidi says, I do want to add, took Plan B after a weekend of sex and waited till the third day to take it and it did not work. So taking it as soon as the unprotected sex is best. Also, not have sex 15 times then take it, I was young. Yes Heidi! But you're right, you're completely right. You want to take it as soon as possible because the longer you wait the higher the failure rate.

Absolutely, absolutely.

And also you don't know when you were conceived, right?

When you're going to ovulate, yeah. So, but don't let that discourage you. If it has been the three days and you're on the cusp of that 72 hours it's better to take it and to at least try then to not take it. But yeah, best is to do it ASAP, as soon as possible.

Yes.

Yeah, thanks for that Heidi. What else?

Oh yeah, so HPV's. So there was a question about how to prevent passing HPV when you're not symptomatic.

Yeah, the best way is to have your partners get the HPV vaccine, period end of discussion. HPV is the most common sexually transmitted infection period and most of the time it's asymptomatic so you don't know that you have HPV versus if you were having abnormal discharge or vaginal warts or herpes then, HPV is a form of genital warts, but if you were able to see something or feel something then you would do a better job of maybe abstaining or using condoms, something to prevent it but HPV is usually asymptomatic so it's very hard to prevent it.

Well, how do you get it?

You get it from skin to skin contact.

So literally, just rubbing my genitals on my partners genitals like this?

Yes, not your hands. I thought--

No, I'm saying my genitals. This is my genitals and this is your, give me your hand, this is your genitals, so this could give us HPV?

It could, now the risk of having HPV transmitted that way is much less than if you were to have fully unpredicted intercourse, unprotected intercourse but it is still possible. So condoms are not 100% effective at preventing HPV. So that's very helpful to know so that if you are having intercourse with someone you always run the risk of having HPV, it's something that is a risk that you have to be okay with taking. So yeah.

Yes, yes.

What else, HPV is super duper common, get your kids vaccinated.

It's also not shameful so if you have it and you got it before the vaccine came out or you didn't know there was a vaccine or whatever, don't feel ashamed. Most of us have it, it's cool.

And if you think that you don't have it who knows, you may have had it last year. Most of the cases of HPV clear within six months. Yep so even if you have HPV and you were to follow up in six months and do a repeat PAP smear, in most cases, it will just clear on it's own. And I think that the research said that 90% of all HPV infections clear within two years.

That's what happened to me. Just gonna share. I was diagnosed, this was before HPV the thing, again, I'm telling my age a little bit, and they said I have, what's it called, precancerous cells and then I went back for them to remove them and they were gone.

Yep, it usually clears itself, that's what happens. And so in that time you probably had intercourse and didn't even know and then it's like when did I get it? I don't know, you know.

They also didn't tell me not to have sex.

Right.

I didn't know, I thought I just had cancer. You can't spread cancer through sex.

There are a bunch of different strains of HPV, the ones that are the high risk type with the types that cause cervical cancer would be type 16 and 18. But there are also HPV types that cause genital warts and some that just don't cause anything at all.

Wow. Well now we know.

Yeah, so get vaccinated.

Get vaccinated!

If you have had a positive HPV test it is still important that you still get the vaccine because it does protect you for multiple strains.

And HPV does increase your risk for cervical and penial cancer.

Absolutely, for a lot of cancers we're recognizing so, throat cancer, a lot different cancers we are seeing that are related to HPV.

What, wow!

Yeah, so get vaccinated.

Get vaccinated. And find some contraception that works for your body. And learn your body!

Learn your body, I think that's the biggest take away from this conversation. Just to get to know yourself. If you have never tracked your fertility start doing it now. Just so that you can get used to yourself. Even if you're on the pill. Even if you have an IUD. Just get used to what your mood is, where your cycle is and what to expect with the next couple months.

And there's apps for that, like we said. Fitbit, if you're already using a Fitbit you can track your periods now. I think there was a suggestion from one of our audience members that Kindara, yeah, Kindara is a good app for tracking your period. K-I-N-D-A-R-A.

Yep.

I use Flo, F-L-O.

I like Flo, Clue is also a good one. But all of those, Flo, Clue, Fitbit, they're all really great for tracking your period. Thank you guys so much for coming.

Oh, one more question.

There's a question. One more question, we can take it.

It's coming.

It's coming.

If you guys have questions you can always find me on Instagram @discovherhealth and I am quite willing to talk about things. I know that there are a couple of different vaccines for HPV.

I think the question's going to be.

Which one to use?

Which one to use.

Yeah, that's a conversation to have with your medical provider.

Are there any side effects to any of the different vaccines?

Yeah, so injection site side effects. Everything has potential risk that we may not know about right now.

Should you get the latest vaccines if you've had an older iterations of it a few years ago?

That's a really good question. I think it would be on a case by case basis so I think you should talk to your provider. If you're at super risk for cervical cancer, like you have an impaired immune system, that might be something that your provider would recommend. For the average person though I would say no, that's not something that you should really worry about.

But if you're concerned, definitely talk to your healthcare provider because they can tell you which one you had and what's different from what's out there now.

Exactly, exactly, exactly. So yeah, if you have an impaired immune system I think that's something that you should definitely bring up with your primary care provider. Maybe a diagnosis of HIV, some other form of cancer or exposure to radiation, chemotherapy, things like that.

Awesome, thank you guys so much for tuning in. We'll be back next month to talk about something awesome. Love you guys. If you want to reach me my stuff is, I posted my links in the description and also links for Jenna as well. You guys are awesome.

Send us your questions.

Send us your questions. See you next month.

Bye.

Bye.

All You Need to Know About Contraceptives

Date
Tue
Sep 18, 2018
|
2:00 pm
|
Calendar
Tuesday, September 18, 2018
|
2:00 pm

It's all about contraceptives! The pros, cons and how-tos. Review the options available and how they affect your sex life. Featuring guest, Jenna Perkins, NP

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