Good-bye, TMI

Not your mom's sex ed. No such thing as TMI.

[plannedparenthood]

Welcome to Advanced Sex Ed. Put on your smarty pants because we’re kicking things up a notch with some higher-level sexual learnin’.

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Advanced Sex Ed: The Science of the Placebo Week

Someone asked us:

Hey PP, this is kind of a science question, but I’m wondering why birth control pills can fail if you accidentally skip a day or don’t take the pills at the same time everyday, yet I have heard it’s fine and safe to have sex when you’re on your period (during the placebo week of pills). That seems weird, how does it work?! Thanks!

First let’s talk about the menstrual cycle and fertility. During a normal menstrual cycle (without any kind of hormonal birth control), your body releases an egg from your ovaries about once a month. During that month, your body prepares for a pregnancy by building up the lining of your uterus. If the egg isn’t fertilized by sperm, then no pregnancy occurs. Your period is your body flushing out the lining of your uterus along with your unfertilized egg. All of this is directed by signals your brain sends to your body via hormones.

Each birth control pill has a small amount of hormones that send signals to your body. Except the hormones in your pills keep your eggs from leaving your ovaries, and thicken your cervical mucus, which makes it difficult for sperm to get through to an egg. It also keeps the lining in your uterus thinner (hence why taking the pill leads to lighter and more manageable periods).

We like to compare the pill to having your own personal security guard that keeps your egg from leaving your ovaries, and stops sperm from reaching your egg. In general, each pill has enough hormones to last until the next pill (plus a little bit longer as a buffer). So if we’re thinking of the pill as a guard, missing a pill means your guard might be off duty. That egg might sneak by, and any sperm that happens to be hanging around in your body from sex in the last 6 days might get the chance to reach your egg.

Your “guard” doesn’t have to be on duty during the placebo week, AKA the week you’re not taking hormones. The window for ovulation occurs during the weeks you’re taking your pill. Once that time has passed, the pill has already done its job to prevent fertilization for the month. By the time the placebo week comes around, the chance for an egg to leave your ovaries has already passed. This is also the week when you’ll get your period. So as long as you took your pills as directed that month and start your next pack on time, pregnancy is incredibly unlikely.

With the combination pill, there’s usually enough hormones in each pill to give you a bit of flex time. It’s still best to try and take it at the same time every day, but if you miss a pill you’ll usually be ok if you follow your prescription’s instructions on what to do next. The mini-pill, or progestin only pill, doesn’t have as many hormones, so it’s really important to take it at the same time every day. If you’re as little as three hours off, you could be at risk of pregnancy.

Hope you enjoyed this heaping helping of science!

-Kellie at Planned Parenthood

[goodbyetmi]

When evaluating birth control options, it’s a good idea to know the difference between efficacy and effectiveness.  They’re often used interchangeably when, in reality, they mean two very different things.

Image from the Canadian Public Health Association.

[goodbyetmi]

Ross finds out the hard way that condoms are “only 97% effective.”

Laughtracks aside, two important notes here:

He kinda has a point that the packaging could be improved to let all users know that condoms are, indeed, not 100% effective at preventing pregnancy

The stat of being 97% effective refers only to condoms’ ability to prevent pregnancy when they are used “absolutely perfectly.”  In other words, condoms do their job 97% of the time if they are not damaged in their packaging before use, if they are not damaged when being removed from their packaging, if they are not damaged when being put on the penis, if they are put on properly, if they are put on before the penis touches the female genitals, and if they are worn all the way through ejaculation.  All of those ifs have to be handled correctly in order for the 97% stat to actually apply.  

In the real world, perfect use can be elusive.  Likely without even realizing it, people could easily cut a corner or two and end up nullifying that 97% “safety net.”  According to the CDC, if 100 women use condoms as their birth control method of choice for one calendar year, with all of the real world realities thrown into the statistical mix, about 18 of those women will have an unintended pregnancy during that 12-month period.

Eighteen.

Noticeably different than both the 3 women who will have an unintended pregnancy with perfect condom use and the 0 women who would face unintended pregnancy if condoms were indeed 100% effective.

[goodbyetmi]

I can't count the number of women I've talked with who assume that because their desire is responsive, rather than spontaneous, they have "low (sexual) desire."

Emily Nagoski, NYTimes

Pretty fascinating and simple concept that not all people experience sexual arousal/desire in the same fashion.  Society generally crams the notion down our throats that the “desire then arousal” pathway is the normal route, which can leave the people who don’t fit into that model out in the cold.

[goodbyetmi]

I <3 My IUD

My IUD is one of my BFFs.  What is there not to love?

Period-free living for 3+ years

As a result, no money being spent on tampons/pads/liners

Also as a result, no PMS (pretty much)!

The most effective contraception on the block

Easy peasy -- aside from a periodic string check, you get all of the benefits of effective contraception with none of the labors associated with remembering to take a pill

When the time is right to bid it adieu, the contraceptive protection terminates immediately so you can (theoretically) get pregnant right away -- no “wash out” period

I feel like I am only a few referrals away from actually going on commission for IUDs.  

[themidwifeisin]

When my gyno stuck the clamp into my vagina before inserting my mirena I got the feeling of needing to fart. Have you ever been farted on? I was so worried about farting it made the experience ten times worse. Should I talk to my gyno about it?

When you say “clamp”, I assume that you’re talking about the speculum, right?

The speculum is a metal or plastic tool that is inserted into the vagina in order to hold back the walls of the vaginal canal for the provider to see and potentially take samples from or do a procedure in the cervix.

Below your vaginal canal is the rectum and above it is the urethra and bladder, so its very common for people to feel pressure in both those places once the bills of speculum are opened.  

Y’all know that I worked as a GTA (Gynecological Teaching Associate) for a couple years during midwifery school.  I taught medical, nursing, PA, NP and ND students how to provide comfortable pelvic exams using my own body.  So trust me when I say that I’ve had more pelvic exams than all of you put together.  

Yes, I did fart.  I farted on students and I farted on my coworkers and I’ve farted on practitioners before.  It’s just part of the pelvic exam.

I’ll also add that patients fart on me all the time.  They fart during pelvic exams, they fart during labor, they fart as I’m suturing up their tears after they’ve given birth.  Birth and vaginas are beautiful things, but they’re awfully close to the rectum, and there’s absolutely no way to separate the two.  Trust me, there’s nothing you can do - farting, pooping, peeing - that your provider hasn’t seen already and hasn’t gotten all down the front of their scrubs.

If you’re so worried about this that you can’t handle the anxiety, just make sure that you go to the bathroom right before you leave the house and then again when your provider finally comes in the room.  Just say, “Do you mind if I run to the restroom real quick before we start?”  That’ll take the pressure off a bit (emotionally and physically) and you don’t have to worry too much.

Meblrs, nurblrs midwife-blrs - amirite or amirite??

[goodbyetmi]

Pelvic exams can already be a step outside the comfort zone.  The added “OMG I think I have to fart” paranoia is a nice little cherry on top.

[submissivefeminist]

Condoms are only 98% effective when used correctly.

Sugar can cause infections in the vagina. This means things like chocolate sauce, honey, and lubricants with glycerin can be harmful.

Having sex with an intoxicated person is legally rape in most US states, even if the person verbally consents. In the eyes of the law, drugs and alcohol impair your ability to consent to sex.

Unprotected anal sex is the most dangerous sex act when it comes to spreading STIs.

Not everyone can climax from oral sex or even likes oral sex. Don’t assume—ask your partner what they want!

Condoms expire! Check the date on the wrapper. Also, storing them in wallets is not a good idea (see #8)

If someone with a vagina has unprotected anal sex, semen can drip down into the vagina and pose a (slight, but still real) risk for pregnancy.

Do not keep condoms in your wallet. The friction and heat exposure of keeping them there can make them ineffective. Keep them somewhere cool, dry, and out of sunlight.

You should be tested for STIs with each new partner you have. Annual appointments are not enough protection if you have multiple partners in that time.

Having anal sex does not lead to a gaping asshole unless your partner is literally an elephant.

Sex with elephants is illegal. Don’t do that.

Masturbating while wearing a condom can help people with penises get used to wearing them before sex.

Penis size does not define your worth. It is not the be-all, end-all factor for most people.

In fact, lots of people with large penises have trouble having sex without hurting their partner since the average vagina size is 6”-8” when aroused (it’s only 3”-4” when not aroused!).

Your first time will almost definitely not be your best time. That’s okay, I promise.

Herpes and pubic lice can still infect you if a condom is used if testicles come in contact with a vuvla.

Only one out of three people can orgasm from receiving vaginal penetration alone. You’re not broken.

People with penises can orgasm without ejaculating.

The muscles in a vagina can be abnormally tense and cause intense pain when penetrated with a toy, penis, or tampon. This is called vaginismus and treatment for this includes relaxation therapy and using medical rods to help the muscles relax.

The number of sexual partners you have does not define you. This rule applies to all genders.

A diet of lots of dairy and meat can cause ejaculate to taste bad. Fruits that are very sweet (like pineapple) help combat this for some people. However, due to body chemistry, medications, and other factors, it might not always do the trick.

Dental dams make oral sex with someone with a vulva safer. They are thin sheets of latex and can be home-made by cutting the ends off a condom and slitting it lengthwise to make a alternative option if you don’t have access to dental dams.

The clitoris has 8,000 nerve endings in it. That’s twice that of a penis! So, go gently until encouraged to do otherwise.

Sex does not have to stop when someone ejaculates. Remove any condoms or clean up any mess, and keep going until everyone is satisfied!

Communication is the number one factor to a better, healthier sex life.

The hymen is not a bone, and does not break. It is a membrane layer that stretches. It can tear, which can lead to pain and bleeding. However, sex for the first time (or ever!) should never hurt. Go slower and focus on foreplay to increase natural lubrication.

Sexuality is fluid for a lot of people. Don’t worry about labels until you’re sure in your sexual and romantic interests. Explore freely and worry about terms later.

Orgasms release hormones that are natural pain-killers. This is why some menstruating people masturbate when they have cramps, because the body naturally reduces pain after an orgasm.

The hormones released also account for why some people cry or get very emotional after an intense orgasm. It’s totally normal.

There are limitless kinks in the world and so long as they are safe and consensual, there is nothing wrong with them.

Medications and mental health disorders can mess with your sex drive. Talk to your doctor if your sex drive has suddenly increased or decreased after starting a medication—there may be alternatives.

There is nothing “un-manly” or “gay” about enjoying anal play. Most men who try anal enjoy a little sensation in that area. People with penises also have a p-spot (prostate) and can have intense orgasms through anal penetration.

Always use lubrication generously to avoid vaginal or anal tearing.

Urinating after sex can reduce the risk of a UTI in people with vaginas.

Enjoying casual sex does not make you a bad person if you are up-front with your intentions and don’t maliciously seek to hurt others.

Condoms come in multiple sizes! It should never be loose or painfully tight.

Being sex-positive does not mean that everyone needs to enjoy sex. It simply promotes the happiness and sexual exploration (or non-exploration) of others.

Porn is not an educational guide to sex.

Certain positions feel better than others. Switch it up and find out what works for you and your partner(s).

Condoms are more likely to break if you don’t leave a reservoir tip for ejaculate.

Labia are often asymmetrical. Your long/uneven/poofy/dark labia are beautiful and there is nothing wrong with your body.

Up to 80% of people with a vagina can squirt with either g-spot or clitoral stimulation.

Drug store pregnancy tests are just as effective as brand name ones. In some cases, they’re even MORE effective.

Elevating your butt with pillows can make missionary sex easier for those of us with a big tummy or thick thighs.

Plan B does not work on people over a certain weight (160-175lbs).

There are safe alternatives to condoms or oral contraceptives. Talk to your doctor about your options.

Sex toys can open up a whole new world to folks willing to explore.

Orgasms can be highly psychological. Most people can’t climax when they’re upset or distracted.

Birth control can cause people to miss periods or spot in between periods.

Sex doesn’t have to be gentle if you don’t want it to be. There are healthy ways to explore rough sex or BDSM.

[sexetc]

Wondering about the clitoris? You’re not the only one! Here’s what our expert has to say.

[goodbyetmi]

Interested in an IUD but not sure which one is the best fit for you and your life?  Check out this handy comparison from Bedsider.

[goodbyetmi]

I know I said when this tumblr started that I don’t want to politicize this space, as that takes the conversation into a different territory than what Goodbye, TMI is supposed to be about.  I realize this post toes the line, as the photo is from a Buzzfeed article about legislation related to IUDs, but I felt that it was worth sharing here because these earrings (and their corresponding lapel pins for people who want to go that route), at the very least, help people realize what an IUD looks like and that, in and of itself, is progress.  Gotta start somewhere, right?

You can read the full piece here - http://www.buzzfeed.com/emaoconnor/wear-your-iud-on-your-sleeve#.blbbJworL

(Also, IUD lapel pins > flag lapel pins, every day of the week.)

[themidwifeisin]

If I get an exam, do I have the right to refuse to get my legs into the stirrups? Can I instead just part my legs and rest my feet on the table? The thought of having any kind of gynaecological exam genuinely makes me want to cry as it is, and I know that if I were to have my feet up in those things it would make me feel very small, vulnerable and not in control of the situation.

Well, let me explain the reason why exam tables are designed this way.

The footrests (I refuse to call them stirrups since we’re not riding any horses) give the patient some stability while moving down far enough on the table to put their bottom over the edge.

There are 2 main reasons why this is important.  The first one is that this position allows the patient to relax their pelvic muscles, making the exam more comfortable.  The second one is that the speculum can’t fit otherwise.  See, I made you a drawing:

Not only does the handle of the speculum fall into the space that the table would otherwise be, but the provider’s hands and arms are in that space as well.  It makes it possible to do a swift, comfortable exam when there is both space above and below the vulva. 

Now, if it’s still totally impossible for you to imagine using the foot rests, there are some other options, though they’re definitely subpar.

While lying on the table, you could use something to elevate your pelvis like a wedge pillow, a bedpan, some rolled up towels, etc.  In the sketch I made below I used a bedpan because that’s what’s usually available to me in the hospital, though that’s not always available in the clinic.  If you want to do something like this I suggest bringing your supplies with you.

Remember, this is far inferior, and it will probably be a less comfortable exam.  Nonetheless, this is one option for you to consider.

Another option that is commonly used for people with disabilities or body constraints is to lie on one side in the fetal position. 

This can also be very vulnerable, though, with the provider standing behind you, and you in a commonly protective position.

Other suggestions to make the position more comfortable:

Bring potholders to put on the ends of the footrests to make them more comfortable

Put the back of the table up to 60 degrees to keep you in a mostly upright position

Bring a friend/partner/family member to hold your hand and make you feel safe

Explain the situation to your provider and ask that they explain everything ahead of time to you, only touch you when necessary, and let you insert the speculum yourself.

Good luck!!

[plannedparenthoodla-deactivated]

In today’s Fact Friday, we answer a question we recently received about condom size.

It is really important to find condoms that are the right size for your body. A condom that is too big could slip off and a condom that is too small could break. Both of these things greatly decrease how well condoms work to prevent STD’s and/or pregnancy.

Some condoms come in larger and smaller sizes and different brands might fit better than others. To find the best fit, look at a number of different brands.

If you need help finding a condom that is the right size for you or your partner, talk to your health care provider.

Condoms—and really any sexual activity—usually feel better when both partners are relaxed, comfortable, and communicating with each other. Once that’s established, lube can also make a big difference. Water-based lube makes sex more slippery, which can make it more enjoyable and help keep condoms from breaking. Put lube on the outside of the condom, and you can also put a drop or two on the inside, which can increase sensitivity. (Just make sure not to put more than that inside, so it doesn’t slip off.)

For more info on condoms, visit the Planned Parenthood website.

[reallymadscientist]

Thought I’d liven up one of the rooms at the OBGYN (via)

[goodbyetmi]

Depending on your sexual health know-how, that last post about UTIs may be a little out of the blue

but here’s the deal.  A woman’s anus, vagina, and urethra are pretty neighborly.  Having sex can kind of jump-start a bit of an anatomical block party, facilitating the spread of fecal bacteria that normally chills in/around the anus to the other openings.  When that bacteria gets acquainted with the urethra (and, subsequently, the bladder), you find yourself face-to-face with a UTI.  

In order to avoid this, a best practice is to urinate after intercourse, turning your urinary system from a staircase into a giant slide, preventing those bad guys from showing up where they don’t belong.

Do it.

[goodbyetmi]

A urinary tract infection, according to the Mayo Clinic, is “an infection in any part of your urinary system — your kidneys, ureters, bladder and urethra.(http://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/basics/definition/con-20037892)

On a related note, when you Google for information on UTIs, you get this auto-response with information about the prevalence of UTIs, symptoms, treatment options, etc.  I am legitimately impressed by this, but I’m also admittedly amused by the image of the woman in pain/discomfort.  A nice extra touch, Google.

[goodbyetmi]

If you’re still struggling, just imagine instead of initiating sex, you’re making them a cup of tea.

Rockstar Dinosaur Pirate Princess (http://rockstardinosaurpirateprincess.com/2015/03/02/consent-not-actually-that-complicated/)

Well, that’s a pretty darned useful suggestion (for an amusing but eye-opening series of examples with this tea comparison, click the link!)

[goodbyetmi]

Period Pieces: 27 Movie Menstruation Scenes

Since 1976's Carrie—the first film to graphically depict menstruation—periods have been portrayed in movies as horrific, disgusting, annoying, and occasionally, celebratory. Here, we've collected scenes from over 25 movies that feature the cinematic history of "the curse."

No, no, it’s cool.  It makes total sense that a regular bodily function that routinely happens to half of the global population only be featured in films a few dozen times over the past 40 years, give or take.  Total sense.