Do I Need Lead-Lined Condoms?

Hi Dr. Kate,

My long term boyfriend recently had radioisotope therapy to treat his hyperthyroidism. He's received all the necessary info about precautions, including no sex for 2 weeks, and using condoms for 6 months thereafter. However, I'm wondering about blow jobs...is the use of condoms to protect any transfer of radioactivity in the event of an accidental pregnancy, or is there a real danger to me? I'm thinking if we're allowed to kiss, oral contact with bodily fluids is okay?

Future X-Woman?

Dear X-Woman,

To the best of my knowledge, the sexual precautions are to prevent an accidental pregnancy - radiation early in pregnancy spells trouble for fetal development (mutant sperm and all that). If his doc has given him the okay to kiss you, I can't see semen exposure being a problem, either. He won't emit radiation through his skin or into his fluids - so you won't turn into a mutant (or develop cancer) by swallowing. But you might want to double-up on the contraception during this time, to make sure that you don't become pregnant.

Men undergoing treatment for cancer have similar sexual issues. Chemotherapy can make spunk taste even funkier, so condoms can be helpful for oral sex aesthetics. Radiation therapy using implants that are left inside the body may halt sex of any kind temporarily, but usually it's due to issues of his comfort (and that he's feeling like crap during treatment, and may not have the energy for sex).

Enjoy being as close as you want--
Dr. Kate

Photo credit: jpeepz

Prolonged Pills = Postponed Pregnancy?

Dr. Kate,

Right now I am absolutely not interested in having children. But in time, all things change. I have been taking birth control pills since I was 18. There hasn't been any period between then and now where I haven't taken a pill. Somewhere down the line (4 to 6 years from now) I may want to have kids and by then I will have been on the pill for 10+ years straight. So my question is, will this affect my chances of getting pregnant? I've heard of women taking a few months to a few years to get pregnant after getting off the pill. Will the time it takes for me to get pregnant be longer than most since I will have been on the pill for so long?

CB

Dear CB,

First, congratulations on being such a successful birth control pill user! Happily, there's no downside of long-term use of hormonal birth control. In fact, if you use the pill for over 10 years, you'll reduce your chances of ovarian cancer by 50 percent, and your chances of endometrial cancer by almost 80 percent. So not only have you avoided an unplanned pregnancy, but you've actually reduced your risk of cancer.

The pill is very effective at turning off your ovaries, but it doesn't put them in a deep-freeze. As soon as you stop the pill, your ovaries will wake up and begin to prepare for ovulation again. Yes, some women have trouble conceiving after they stop their birth control. But be assured: your fertility off the pill is the same as it would have been if you had never taken it in the first place. So if you were always able to get pregnant at age 28, you'll have no difficulty once you start trying. But if you were destined to have fertility trouble at the same age, you'll still have it anyway.

When you're ready to start trying for pregnancy, your ovaries will be there for you. So enjoy your baby-free existence (and happier periods) as long as you want to.

Best,
Dr. Kate

The Pill Is Killing My Libido

Dr. Kate,

I'm a 28 year old married woman who isn't intending on having children. I've been on various birth control pills for about 10 years now. Some have made me moodier than others, but in general I've been satisfied, except for one issue. I feel as though my sex drive is diminishing more and more and more and almost doesn't exist now. I still enjoy sex, but never seem to want it enough to initiate, which has (as you can imagine) caused a few marital issues. Fortunately I have a very understanding husband, but I still want to solve this problem. I've read a lot recently about the hormones in birth control pills having this side effect. I am currently considering switching to an IUD and leaning towards the copper option to avoid ingesting more hormones. Do you think this is a wise choice and could/should help? Do you have any other suggestions?

Thanks,
Desireless

Dear Desireless,

The pill's relationship to libido is a complicated one. Some women report decreased sex drive when they're on the pill, and other women report an increase in their drive. In studies where women using the pill are compared with women not using the pill, women complain about lower sex drive about equally in both groups. In other words, loss of libido is a common complaint, whether or not you're on the pill.

Paragard, the copper IUD, is an excellent birth control choice for many women who don't want to or can't use hormones. It's 99% effective and lasts for 10 years--especially good if you know you don't want children in the near future (or ever). It may make your periods heavier or longer, or increase your menstrual cramps, but taking ibuprofen or naproxen can help.

You may find, though, that stopping the birth control pill doesn't bring your libido back. Heaven knows there are plenty of reasons why you may not want to have sex--stress, illness, not having a very good time when you do have sex. And there's nothing wrong with not initiating as much as your partner, if you respond to his advances as much as you want to. So if changing your birth control doesn't change your libido, try to figure out what would make sex better for you, and enlist your husband in your efforts to achieve it.

Have you felt that your birth control has affected your sex drive?

GynoLingo: Uterine Fibroids

Gynos too often throw around words and diagnoses quite casually. If we know that a condition isn't serious, we don't often take enough time to explain what it is and what it means. So I'm going to write a series of posts about common gyn conditions that you may hear about at your next exam, and what they mean for your gyno-health.

What fibroids are:
Uterine fibroids are benign muscle tumors that grow from the uterine wall. To break that definition down:

• Benign. Not cancerous, and they don't turn cancerous in the future.
• Muscle. Coming from the wall of the uterus, they have both muscle and fibrous tissue, swirled together.
• Tumor. Just means that it's solid, and not a cyst (which is filled with fluid).
  

What do fibroids mean:
Fibroids may be detected on exam, ultrasound or during surgery, but most of the time you'll have no symptoms at all (the silent type). Almost 50% of women will develop a fibroid at some point, and they're even more common among African-American and Latina women. When fibroids act up, they can cause:

• Abnormal bleeding. Periods may get heavier and longer, and sometimes cause bleeding in-between periods.
• Pelvic pain or pressure. This ranges from bad menstrual cramps to lower back pain to generalized pressure all the time.
• Frequent urination. Like a UTI without infection.
• Complications during pregnancy and delivery. If they block the baby's way out.
  

How can you treat them:
Happily, you might not have to treat your fibroids at all. Fibroids need to get treated in only a few circumstances:

• REALLY heavy bleeding. If you're bleeding so heavily with your periods each month that you're severely anemic or even need blood transfusions.
• REALLY bad pain or pressure. If anti-inflammatories are enough to get you out of bed, or if you're having difficulty even walking around.
• Other organ injury. Sometimes fibroids get so large that they press on the ureters (the long tubes that transport urine from the kidneys to the bladder), causing urine to back up and possibly causing kidney damage.
  

Have you been told that you have fibroids? Did you need to be treated for them?

Photo credit: National Uterine Fibroids Foundation

Petite Pelvis?

Dr. Kate,

During intercourse with my girlfriend it feels like her vagina is very tight...too tight! It can actually be painful for me. My girlfriend does not admit to experiencing pain, but sometimes I wonder if it hurts her and she is afraid to admit it. However, I only notice this tightness in certain positions.

I did some research online and thought it was vaginismus; however now I'm starting to believe that isn't the problem. Since we have been together for a long time and I've had a chance to "explore" the area in detail, it seems that it is her pubic bone getting in the way. Can it be possible that her pubic bone is too low? If so, is this causing her pain even though she is not admitting it?

I sometimes wonder if it has anything to do with her being very petite? She is a size 00, so she is very small. But since I am not an overly endowed male I wouldn't think that would make a difference?

I'm also concerned about child birth problems if we get married. I can't imagine child birth going well if her pubic bone is partially blocking the way. Will this cause complications?

Thanks for the help,

Boned

Dear Boned,

It's true that women do have different shapes to their pelvis. The pubic bone may be higher or lower, along with different positions of the hip bones. You can't tell the shape of your pelvis based on your hip measurements or height, though. Your girlfriend being petite doesn't mean her pelvis is any more likely to be different from someone else's. She can ask her gyno at her next exam to perform "pelvimetry"--describing the shape of the pelvis via a vaginal exam--to see if her pelvic shape could be contributing to the difficulty.

But I haven't heard or read of women with a narrow pelvis having more difficulties with intercourse. If her vagina really feels "tight," it's likely because it is - and the most common reason for this is insufficient arousal before sex. While men can achieve arousal in the time it takes me to type this paragraph, the average woman needs 20 to 30 minutes of good foreplay to have enough vaginal engorgement and lubrication to make intercourse comfortable. (By "good foreplay" I mean whatever turns her on and gets her blood moving south.)

Vaginismus is certainly a possibility as well - women's vaginal muscles are quite strong, and can really clamp down before or during intercourse, often unconciously. While there is therapy available for vaginismus, I think your first move is to talk with your girlfriend about how she's feeling during intercourse. She may be reluctant to tell you that she's experiencing pain, too, and your being kind enough to begin the conversation may open the door for her. If she's not feeling pain at all, you may need to try different positions to find the ones that are comfortable and pleasurable for both of you.

If she does turn out to have a narrow pelvis, I wouldn't worry at this point about how she'll experience labor and delivery. My patients have surprised me quite frequently in the past--women I thought would sail through labor aren't able to fit the baby through their pelvis, and really petite women have birthed 9 pound babes without anesthesia (or pelvic damage).

Best of luck,
Dr. Kate

Bumps Down Below

Hi Dr. Kate!

I have a problem that's been bothering me for a while. Ever since the first time I started shaving my private area, I have gotten a bump that was red and tough (fibrous). I've had a few more over the years and I always thought they will just go away, but they did not. I notice when I shave sometimes and accidentally cut it, it will bleed fresh red blood but not drain out fully. After reading your post on possible signs of STDs, I became very nervous since it sounds like they are herpes (acne-like bumps). However, they do not hurt, even if I apply pressure to them and they are not open wounds. The bumps are all on the mons, and I can see hair follicles in and around each. Is there anything else other than herpes that can present that way? Is this something I urgently need to see a GYN about? How can I treat it?

Sincerely,

Nervous girl

Dear Nervous,

Bump identification can be tricky. If the bumps haven't been excruciatingly painful, I doubt it's herpes (and herpes tends to present on your labia and near the entrance of your vagina at SOME point as well). And if the bumps are red, it's not likely HPV/warts, which are flesh colored.

While I can never be sure without seeing you, it certainly sounds like you've got folliculitis--ingrown hairs that lead to mild infections of the hair follicle. This happens more often in women with sensitive skin, but it happens to many women at one time or another. Ingrown hairs are common after shaving, and can be even worse after waxing.

T)o treat the bumps you've got, I would start with hot soaks daily (wet a washcloth with really hot but not boiling water and place on the bumps till the washcloth gets cool). After the soak, apply topical hydrocortisone cream (available over the counter) - apply it 2 or 3 times a day. If the bumps don't improve in two weeks, I'd see a gyno to make sure you're on the right track.

To prevent bumps in the future, change that razor! Most of us use disposable razors way too long--and the older a razor gets, the more it develops nicks in the blades that can snag skin, cause (micro-) cuts, and increase the risk of infection. Use cheapie disposable razors, and change them weekly. Be sure to use a generous amount of shaving cream/gel as well. The best way to prevent ingrowns is to also shave in the direction of the hair growth - it may not make for as close a shave, but it will be nicer to your skin.

Have you developed bumps down below after shaving/waxing? Do you have any tricks for treatment/prevention?

Am I Allergic To My Boyfriend?

Hi Dr. Kate,

I have been in a monogamous relationship with my boyfriend for one year. A few months ago I had a yeast infection, which I treated. About a month later, I started to notice a strong burning pain inside my vagina when he ejaculates inside of me. It lasts anywhere from 10 minutes to an hour, although I feel slight relief if I take a shower afterward. He has since stopped ejaculating inside of me, but I still feel a brief burning pain when I urinate after sex. And the last time I had sex, there were very small red spots on my chest and upper arms afterward.

We have not been using condoms at all since I started the birth control pill. However, I did not notice any problems while we were using condoms in the past. I have not experienced this pain with any other partners, however I have always used a condom with all of my previous partners. I occasionally use KY Jelly as a lubricant, but the pain occurs whether or not lubricant is used. Would a new pill prescription alleviate the pain? (I was also tested for STDs at the beginning of our relationship and the test came back clear.)

Burning Below

Dear Burning,

I doubt very much that the pill has anything to do with your symptoms - it doesn't change the chemistry or the makeup of your vagina. And it doesn't sound like other typical causes: reaction to lubricant or spermicide, a latex allergy, or another yeast infection (even bad ones don't last that long when treated). To be sure, though, your gyno can check you again for yeast or other vaginal infections, just to rule them out.

Since your symptoms only happen with this boyfriend, and not when you use condoms, it sounds like you may be allergic to his semen. It's not common, but women can be allergic to one of the proteins in their partner's semen...often with a particular partner, but some unlucky women have this reaction with all partners.

Symptoms of a semen allergy can include redness, pain, burning, itching, and swelling in areas where the semen has touched, often the vulva or vagina. A small number of women may have a more severe allergic reaction, including rashes, hives, or difficulty breathing. Symptoms usually occur quickly--within 30 minutes of contact--but can last for hours, or even days.

Short-term fix? Condoms, of course. Longer-term fix? If you're going to be with this guy for a long time (perhaps forever), it may be worth seeing an allergist to discuss de-sensitization treatment. This is not something to try on your own, mind you--if you've gotten a rash elsewhere on your body, I wouldn't want your allergy to get worse without a doctor's care. This kind of therapy can be expensive and generally isn't covered by insurance. But a consultation with an allergist likely is covered, and will give you the answers to all of these questions.

With regards to fertility, semen allergy won't make you infertile. If you and your boyfriend want to conceive a child together, you can see a fertility specialist to discuss the possibilities of intrauterine insemination (IUI), where his (washed) sperm are placed directly into your uterus, or in-vitro fertilization.

Have you ever had burning after sex that no gyno could give you an answer for?

Photo credit: Andy Saxton2006

Neverending Periods

Dear Dr. Kate,

For the past six months I've been having never-ending periods. They last almost the entire month, and I only have one or two days of no bleeding each month. My periods never came normally but the longest they used to last was like two weeks. What can I do to get my period normally, or to just last three to five days??

Tired of Going With The Flow

Dear TOGWTF,

It may be nothing, but your bleeding could be a sign of something more serious, and your doctor will likely want to rule out some or all of these conditions:

• Hormonal problems. Thyroid disease and pituitary disease can cause dysfunctional bleeding. Your doctor can check for these with blood tests.

• Structural problems. You can think of these as unwanted house guests in your uterus. Polyps and fibroids can both cause prolonged bleeding, and can usually be detected with an ultrasound.

• Blood clotting problems. Especially if you're young, prolonged bleeding can be a sign of clotting problems. Your gyno may do some blood tests or send you to a hematologist (a blood disorder specialist).

• Hyperplasia. This is a precancerous condition in your uterus. Depending on your age and other risk factors for cancer, your gyno may want to do a small biopsy of the lining of your uterus.

If the tests all come back negative, then the bleeding is probably ovarian dysfunction, and can be regulated with hormonal birth control. The pill, the patch, the ring, or the hormonal IUD can all make your periods shorter, lighter, and (thank heaven) predictable.

Have you ever had out-of-control periods?

Nipple Discharge? But I'm Not Breastfeeding!

Hi Dr. Kate,

Recently I discovered that my nipples have been leaking some sort of substance. At first it didn't occur to me that it came from my breasts, but I've noticed the evidence in my bra cups. It isn't a lot, but it's enough to make me slightly nervous. Is this normal?

By the way, I'm 20 years old.

Thanks!
Freak-a-Leak

Dear FAL,

Nipple discharge can be scary, but isn't always a sign of something dangerous. There are a couple of things that gynos look at to try to tell why the girls are leaking:

• Is it from one side or both? Leakage from both breasts is often a sign of a hormonal imbalance, while leakage from just one side may be a cyst or papilloma (think of a skin tag in a milk duct) in that breast.
• When does it happen? If it's only when you press on the breast or with stimulation (called "expressing"), it's likely minor trauma to the ducts, and should go away with "breast rest" for a few weeks. If it's spontaneous--happening when you don't expect it, and sometimes staining your bra--it's more likely to be hormonal.
• What color is the discharge? If it's white or clear, it's probably a hormonal problem. If it's green, don't panic--that means old blood, and a possible papilloma. If it's freshly bloody, it may also be a papilloma, but may be something more serious.
  

Your gyno will likely check you for thyroid and pituitary problems with blood tests and possibly an ultrasound, depending on the characteristics of your discharge. What does worrisome discharge look like? Spontaneous, bloody, and one-sided...anything else is likely to be benign. My best guess is that if your discharge is two-sided, it may be a sign of thyroid or pituitary problems, both of which can be treated. I DOUBT you have cancer.

Have you noticed anything strange coming from your breast?

Photo credit: scottwills