Nerlandes’ Story

Nerlandes Themistocle is a pharmacist and Pharmacy Manager at CVS Caremark, having worked in pharmaceuticals for over 25 years. She is a wife and a mother of two, currently residing in Rhode Island and finds joy with her family, listening to music, dancing, traveling, and exploring new foods. Nelandes Themistocle shares her truth about menopause, from what she experienced to what she wishes she knew about this important part of the reproductive health journey.

Can you tell us a little bit about your menopause experience?

I didn’t experience symptoms or body changes during the perimenopause stage as many others have. All of the symptoms started once my periods stopped very suddenly at the age of 50. What I’ve learned throughout this process and when talking with others is that not everyone experiences menopause in the same ways. Some may experience vaginal dryness, while others may feel more irritable or depressed. No experiences are one and the same.

What symptoms did you experience?

My symptoms were mainly hot flashes and night sweats, as well as trouble sleeping. The hot flashes, however, were pretty severe for me. I’d have to have fans on me at all times at work and when I go to bed.

Were there any other symptoms that caught you by surprise?

The symptom that really caught me by surprise was anxiety. I started to feel anxious about things I normally wouldn’t. For instance, I never felt or experienced anxiousness when it came to my work, especially because I have worked at the same place for years, however, one day I had such an overwhelming experience I had to call my husband. The palpitations were very intense, and this lasted for an entire week. I still feel anxiety from time to time, but I find ways to manage.

Did you feel prepared going into menopause?

Going into menopause is not something any woman can ever be fully prepared for. It took me an entire year to realize that I was going through the change . I definitely was not prepared. I did not have any idea what to expect or even how to identify if I was really experiencing it.

What do you wish more people knew about menopause?

Menopause is not as simple as people think. It is a very complex process that can be long and at times frustrating. The symptoms can last several years after your period stops and can be disruptive to your everyday life. Everyone experiences menopause differently, like I mentioned earlier, no experience is one and the same, so be patient with yourselves.

What do you think is the biggest misconception about menopause?

Menopause is still considered a very sensitive topic. I think that a lot of women struggle with this idea that once they go into menopause, their womanhood is stripped away. They may feel life is going to change forever, and people, including their spouses, will not look at them the same way. I felt that at one point, but my husband still treats me the same. Life may change in some ways, but the most important things don’t. People, not just women, need to be more educated about menopause to help with these feelings.

Is there any message you’d like to give to someone going through or preparing for menopause — maybe someone experiencing the same symptoms as you?

Menopause is not a medical condition but a natural process that will become a part of your life. Our bodies go through a lot of changes during this time, but there are so many ways to manage it. Don’t be afraid of talking about your symptoms; there is absolutely nothing to be ashamed of. Challenge yourself, change your lifestyle, exercise, keep yourself hydrated, lastly and most importantly, seek medical advice or talk to your provider. There are also so many drugs on the market that can help with the symptoms. I have learned to live with it and be happy.

Learn more about menopause

Menopause

Menopause 101

Menopause symptoms

Let’s start with the basics, how often should someone be STI tested? Can you tell us a little more about what exactly to expect?

The guidelines are that everyone who is under 25 and sexually active should be tested at least once a year for gonorrhea and chlamydia. Many STIs can be asymptomatic (particularly in women), so it’s important to make testing part of your annual care. Every annual preventive visit should include a conversation about STIs. Certain people may be at higher risk and require more frequent screening. 

Women 25 years and older with risk factors such as new or multiple sex partners or a sex partner who has an STI should also be tested for gonorrhea and chlamydia every year.

All adults and adolescents from ages 13 to 64 should be tested at least once for HIV.

Everyone who is pregnant should be tested for syphilis, HIV, hepatitis B, and hepatitis C starting early in pregnancy. Those at risk for infection should also be tested for chlamydia and gonorrhea starting early in pregnancy. Repeat testing may be needed in some cases.

Are there other options for testing besides at a primary care visit?

Yes. Urgent care is an option, as are retail health clinics, community clinics and OB/GYN providers. Home tests are also available.

Can you tell us more about specific STIs and how they’re tested for?

Gonorrhea and chlamydia are tested with a urine sample, a cervical sample, or a swab. 

HIV, hepatitis, and syphilis can be tested for with blood tests. 

We’ll test for herpes (HSV1 and HSV2) with a swab of the lesion if you have symptoms. 

What are your recommended best safe sex practices with a new sexual partner?

It’s great if both people can discuss STI testing before they forgo using barrier methods like condoms. This way you know where you’re starting out. 

And what if someone doesn’t feel comfortable having those conversations with a new or more casual partner?

These can be hard conversations, especially early on in a relationship. 

To start off, everyone can empower themselves and at least get testing for themselves. These conversations can certainly sometimes put pressure on relationships about the future of the relationship or expectations around monogamy. If you’re not there yet, that’s a good reason to continue using other methods to protect yourself. Then when you both feel comfortable you can test again. 

What are some common symptoms of STIs to pay attention to? 

Women and people with uteruses will typically experience symptoms like pain with urination, vaginal discharge, and painful bumps or sores. 

Gonorrhea can also infect the throat, this can be asymptomatic or cause a sore throat. 

HIV can look like an acute illness with viral symptoms — think swollen lymph nodes and a fever. These symptoms are often missed because they can be mistaken for another type of virus. 

Can you get an STI from oral sex?

Yes. We commonly see gonorrhea which can present as a very painful sore throat. The good thing is that providers are more informed and educated about this symptom as a potential sign of an STI, so they should be taking a swab and testing. 

Herpes (HSV) is often spread during oral sex as well.

Which STIs are treatable vs. curable?

Gonorrhea, chlamydia, trichomonas, and syphilis are all curable. We give medication and we may recommend a test for cure. HIV, as we know, is a chronic infection, which is treatable and we have great therapies and treatments, but it requires lifelong treatment and monitoring. 

An initial outbreak of HSV is treated with a high dose of an antiviral treatment, which shortens the amount of time a person is symptomatic, and most likely the time they’re infectious as well. And then depending on how often a person has outbreaks, we may recommend that they go on suppressive therapy, which is a daily antiviral medication. This can be a lifelong medication.

After a number of years of being on antiviral medication, most people have very low rates of outbreaks. I say that because when people are told that they have HSV, it can be very upsetting. They might be worried about navigating conversations with sexual partners given some stigma that’s still lingering around HSV. People also worry that they might pass it on if they’re pregnant. But we have great medication that is safe and generally has minimal side effects, so most people can go back to living a normal life. We do recommend that they tell new sexual partners. 

Any tips for how to have these conversations with a partner?

HSV is transmitted through skin contact. And we know that there can be transmission of HSV even when a person doesn’t have an outbreak or an outbreak that’s visible to them. This is particularly true right before they have an outbreak, when there can be a high level of virus. And condoms don’t protect anyone 100%. 

These conversations can be hard with a new casual partner before you have any sexual contact. You might say, “I just wanted to let you know that I tested positive for HSV [X] years ago. I’m on suppressive therapy, which reduces the risk, but I just wanted to let you know.” 

Because it’s such a common virus, many people are in this situation, so hopefully the conversation is met with kindness and appreciation that you disclosed it.

HIV can be a more challenging conversation, but it’s similar in many ways. This is a conversation to have earlier rather than later. In relationships with two people who have discordant HIV infection, the partner who is not HIV positive often chooses to go on PrEP therapy to prevent their chance of being infected. Also, here condoms are very effective, because HIV is not transmitted through the skin. 

There is a lot less stigma than there used to be, but these conversations can be hard.

How long should someone be on suppressive therapy before it kicks in?

Those who are HIV positive need to wait until they’re controlled before having sexual contact. Their HIV specialist or internist will help them manage their treatment plan. 

And for other STIs, how should we think about testing timelines? 

If you were sexually active with a new partner recently, your current testing might not reflect your status. It’s good to get tested when you haven’t been with anyone else for 6 weeks, so waiting until you’re 6 weeks or so into a relationship can make sense. This is because it can take 6 weeks for the body to mount an antibody response to the virus so that it can be detected in blood work. 

Certain STIs have recommendations for follow up — in those cases, we recommend that people get tested for cure to make sure they’re fully treated. If both partners are positive for an STI, both should be treated at the same time and there should be no sexual contact during treatment to prevent transmission back and forth.

Any tips if you don’t feel comfortable talking to your provider about sexual health?

There are on-demand tests that you can use, which can be a great option. You can also email or message your provider to ask for certain tests/labs if you don’t feel you can ask in person. We like to minimize barriers for testing for important health issues.

Read more

• 5 Things you should have learned in sex ed class
• The complete glossary on sexually transmitted infections

Dear Ovia, My husband and I have been trying for a third kid for the last year and a half. He wants to stop trying and says it’s taking away from us appreciating the beautiful babies we do have. But I’ve always dreamed of a big family and I don’t feel ready to give that up. 

First of all, secondary infertility isn’t something we talk about enough — and I hope this answer helps you know for certain that you’re not alone! 

So many families hesitate to talk about fertility struggles. And when you’re already parents you may feel the social pressure to just be grateful for the kiddos you have (which I am sure you are!). I’m here to tell you that feeling like there is an empty seat at your family’s table is a valid feeling whether you have 0, 1, 2, 3 or 9 children. The tough part is that you’re both having valid feelings — and they’re not the same. There may be middle ground in taking a break from TTC for a period of time or continuing to try for “X” number of months before starting a break. 

At the end of the day, it sounds like expanding your family is something that would make you both happy if it could happen with the wave of a wand. So, try to focus your conversations with him around the challenges of the journey (the process of TTC), rather than the destination (the decision to have another baby).

In any case, you need an ongoing and open dialogue, but it can be hard to find a good and private time to talk (especially when you have other children in the house). It’s common for people to either avoid tough subjects or to bring them up at times that are not conducive to conversation (like when you’re getting into bed). 

If you’re avoiding the conversation or one of you is bringing it up at less-than-ideal times, it’s essential that you create a space where you can both actively listen to each other. Try scheduling some time to talk, that way you can both come to the conversation prepared to share and listen. 

Having a disagreement hanging over your heads makes the whole situation more stressful.

Some tips:

• Avoid talking about it before bed when everyone is tired and sex is on the table. 
• Sometimes a drive is helpful because you have a little bit of emotional distance, can break endless eye contact, and sex is (usually) off the table. 
• Agreeing on how to move forward may take more than one discussion, but it should be simple to make a plan for more chats. Breathe, you’ve got this. 
• Fertility journeys start, pause, and end for a variety of reasons, and it often takes a toll. It’s always okay to look for more support from family, friends, or professionals. 

More from this series

• Dear Ovia, My partner isn’t sure if he wants kids
• Male fertility testing

Ever wondered, “What’s the difference between an STI and STD”, “Is HIV the same as AIDS” or “What’s a finger condom”? Rather than taking the query to your search bar, keep reading.

What you should know about sexually transmitted infections (STIs)

Below, you’ll find definitions of all the terms in the sexually transmitted infection lexicon you could possibly need to know, broken down by categories.

First, what’s the difference between an STI and STD

STD: STD stands for sexually transmitted disease. Disease implies symptoms. So, sexually transmitted infections are only diseases when there are symptoms (for example: bumps, itching, or discharge) present.

STI: The now-preferred term in the sexual health space, STI stands for sexually transmitted infection. The switch from disease to infection took place to reduce stigma around these infections and to acknowledge the fact that the majority of these infections are asymptomatic.

All STIs are either curable or treatable

Curable: A curable STI is an STI that can be cleared up completely with the proper medication. Curable STIs include: gonorrhea, pubic lice, chlamydia, syphilis, and trichomoniasis.

Not only can curable STIs be cured, but they should be — leaving an STI untreated puts you at risk for things like pelvic inflammatory disease, infertility, and even death in the case of syphilis. That’s why it’s so important to get tested after every new sexual partner. And, if positive to talk to your provider and come up with a cure plan.

Treated: STIs that cannot be cured can be treated. Meaning, the symptoms associated with that STI can be managed with the help of lifestyle changes, and/or medication. Treatable STIs include: HIV, HSV, and HPV.

An example of treating — but not curing — an STI, might include taking valacyclovir or acyclovir, an oral antiviral medication that can either be taken daily (suppressive therapy) or at the first sign of outbreak (intermittent therapy). What makes most sense for you will depend on factors like cost and frequency of outbreaks. Because research has suggested a link between the number of outbreaks in HSV-positive people and stress, managing stress levels is another example.

Types of sexually transmitted infections, explained

AIDS: Also known as HIV Stage 3, AIDS (acquired immunodeficiency syndrome) develops when the HIV virus severely damages a person’s immune system.

In the U.S., most people who are HIV-positive never develop AIDS because they’re on medications that prevent the infection from progressing to AIDS. Due to lack of access, globally AIDS is much more common, but numbers are dropping.

Chlamydia: Caused by a bacteria, chlamydia is a curable STI that infects 4 million Americans each year, the majority of who are under 25 and women.

When symptoms appear, they usually include abnormal discharge, pain or frequent urination or bleeding after sex and/or between periods — but chlamydia is usually asymtomatic. The infections and accompanying symptoms can be cured up with proper antibiotics.

Crabs: Also known as pubic lice, crabs are itty-bitty parasites that feast on blood that are found on pubic hair (and other course body hair). Typically, crabs are transmitted during intimate contact between the pubes of a person with crabs and the pubes of someone else.

The most common symptoms of crabs is genital itching, but you may also be able to see the white-colored, micro-crabs crawling around between your legs. Crabs can be cured through special over-the-counter creams or shampoos. Important: Because crabs lay eggs (known as nits), after treatment then nits need to be removed with fingernails or comb.

Genital Warts: Genital warts are fleshy skin tags caused by a few strains of HPV (see “HPV” below). These contagious warts may be accompanied by itchiness, but can be treated with topical medication or by being removed by a healthcare provider.

Gonorrhea: Also caused by bacteria and also curable, gonorrhea is an infection responsible for half a million new STI cases in the United States each year.

Much like chlamydia, gonorrhea is hard to recognize due to its often asymptomatic nature. But, when symptoms do pop up they usually include: genital itching, bleeding, abdominal pain, abnormal genital discharge, and soreness and sore throat. To diagnose and get the medicine that will eliminate the infection from your body, go to your local walk-in clinic or healthcare provider.

HIV

Short for human immunodeficiency virus, HIV is a viral infection that attacks the body’s immune system making it hard for the body to fight any other infection, including common, everyday viruses. Wrongly known as a gay man’s virus, HIV is an STI that can affect all people.

Hepatitis A

A contagious viral liver infection caused by the Hepatitis A virus, Hepatitis A typically clears up on its own within a few months. Hepatitis A is not just sexually transmitted — it can also be transmitted through contaminated foods.

Hepatitis B

Hepatitis B is a contagious viral liver infection caused by the Hepatitis B virus that can be transmitted via exposure to the bodily fluids of an infection person. The difference between this form of Hepatitis, however, and the others is that Hepatitis B can be prevented with a vaccine.

Hepatitis C

Hepatitis C is a viral liver infection that can be spread through blood, breast milk, or pregnancy. Untreated, the infection can become life-threatening. But diagnosed and with proper treatment, the infection can be cured 90 percent of the time.

HPV

With more than 100 different strains, human papillomavirus (HPV) is the most common sexually transmitted infection in the world. Symptoms, long-term health risks, and treatment vary strain-by-strain.

HSV

Better-known by its full name, herpes, HSV is a lifelong viral infection caused by the herpes simplex virus that can be managed with proper care.

There are two distinct strains of the herpes infection: HSV-1 and HSV-2. Often, these are incorrectly re-named as “oral herpes” or “genital herpes” but both strains can affect areas like the vagina, anus, penis, or mouth.

Molloscum Contagiosum

Molloscum contagiosum is a viral infection spread through skin-to-skin contact, that causes benign bumps along infected areas. Sometimes the bumps will fade away on their own, other times they are removed through cryotherapy, laser therapy, or topical therapy with the help of  a healthcare professional.

Trichomoniasis

Often called “trich”, trichomoniasis is a sexually transmitted infection caused by a parasite that can be cured with a dose of antibiotics. Symptoms are trichomoniasis are rare — especially in people with penises. But when symptoms do appear, they often include discharge, genital itching, and pain while urinating.

Syphilis

Syphilis is a progressive bacterial infection spread through sexual contact. The symptoms of the infection vary based on how long it’s been in your system, and range from a skin sore to fatigue and fever to liver dysfunction. If caught early enough it can be cured with a single shot of penicillin, but left untreated for too long the infection can spread to the brain and other organs, becoming life threatening.

Barrier methods and birth control

Here’s some information on protection options people can apply to help stay safe during sex.

Barrier

Barrier is the general terms for a physical barrier that is designed to prevent direct skin-to-skin contact or fluid exchange during a sex act. Most common is the external condom. But there is also the internal condom, dental dam, glove, and finger condom.

Occasionally, certain birth control methods which do not prevent skin-to-skin contact or fluid exchange, but are highly effective at preventing a sperm from meeting an egg during vaginal intercourse — the sponge, cervical cap, diaphragm, and spermicide — are also qualified as a barrier.

Birth Control

Also known as contraception, birth control is designed to help prevent unwanted pregnancy. There’s a variety of different types of birth control options, which all function differently as well as feature  slightly different levels of effectiveness.

Condom

There are a few different types of condoms: finger condoms, internal condoms, and external condoms. But typically when people say “condom” they’re referring to the external variety. (See: “external condom” below).

Dental Dams

Dental dams are sheaths of latex designed to prevent direct contact between a mouth and an anus or vagina, and therefore reduce the risk of STI transmission.

External Condoms

External condoms are tight latex, polyurethane or polyisoprene tubes designed to go over a penis during vaginal, anal, or oral intercourse to protect against STI transmission and/or pregnancy. They are also often used on dildos and other pleasure products to increase ease during clean-up as well as to allow for sex-toy sharing between non-fluid-bonded partners.

Finger Cots

Sometimes called finger condoms, finger cots are micro-sized external condom designed to fit over a single digit. While most commonly worn by doctors sporting paper cuts, they can also be warn during vaginal or anal fingering to keep from or reduce the risk of STI transmission.

Fluid Bonded

Refers to sexual partners who have intentionally decided to forgo barriers and exchange bodily fluids during sex. Prior to becoming fluid-bonded, sexual partners typically discuss current STI status, potential risks, pregnancy prevention (if applicable), as well as relationship rules moving forward.

Internal Condoms

Formerly known as female condoms, internals condoms are soft, long tubes that are designed to line the vaginal or anal canal in order to prevent fluid exchange or skin-to-skin contact during vaginal or anal sex. Bonus: They are typically made out of nitrile as opposed to latex, making them a great alternative for those with latex allergies.

PEP

Post-exposure prophylaxis is a series of pills someone who was (or may have been!) exposed to HIV can begin taking up to 72 hours after exposure to prevent transmission of the virus.

PrEP

Pre-exposure prophylaxis, as the prefix suggests, is a daily oral medication that can be taken by an HIV-negative person at risk of coming into contact with the virus, in order to greatly reduce the risk of the virus being transmitted.

Reviewed by the Ovia Health Clinical Team

Sources

• “Chlamydia – CDC Fact Sheet (Detailed).” January 19, 2021. Centers for Disease Control and Prevention (CDC). CDC. January 19, 2021. https://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm.
• Cohen F, Kemeny ME, Kearney KA, Zegans LS, Neuhaus JM, Conant MA. Persistent Stress as a Predictor of Genital Herpes Recurrence. Arch Intern Med. 1999;159(20):2430–2436. doi:10.1001/archinte.159.20.2430. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/485171.
• “Sexually Transmitted Diseases.” National Institute of Allergy and Infectious Diseases. NIH. August 6, 2015. https://www.niaid.nih.gov/diseases-conditions/sexually-transmitted-diseases.

By Gabrielle Kassel, Contributing writer

PSA: Sexually transmitted infections are not the only infections that can make home in or on your genital area. Yeast infections, bacterial vaginosis, and urinary tract infections are all totally curable infections that can people can get, even if they’ve never ever had sex. Really!

Important things to consider about genital infections

Read on to learn more about the three types of infections — including intel on how they differ from sexually transmitted infections also found in genital areas.

What is a urinary tract infection?

A urinary tract infection takes place when bacteria (usually E. coli) gets lodged in the urethra, occasionally traveling up the urinary tract to the bladder and/or kidneys.

What causes UTIs, exactly? Anytime outsider bacteria gets introduced to the urethra, there’s risk for infection. This could happen in a number of ways, including through sex. A UTI could also be caused from bacteria from the anus being brought forward towards the urethra, for example while wiping or during sex.

While people of all genitals can get UTIs, urinary tract infections are far more common in those with vaginas than penises because the urethra is so much shorter. This means that the distance the bacteria has to travel in order to get to the bladder is shorter, increasing the odds that the infectious agent makes it to the infection-site.

Common symptoms include:

• Frequent urination
• Pain or discomfort while urinating
• Urine that is cloudy or pink in color
• Lower abdominal or pelvic pain or cramping
• Rectal pain

A UTI can be diagnosed with a quick urine sample — for more information on how to properly collect a urine same, head here. If tested-positive, your healthcare provider will prescribe a round of antibiotics which will begin to clear the infection up in as little as 24 to 72 hours. The type of antibiotics will vary based on the type of bacteria found in the sample, as well as the location (urethra, bladder, or kidneys) of the infection.

What is a yeast infection?

Also known as candidiasis, a yeast infection occurs when there is an overgrowth of the fungi “candida” in the body.

Anybody can get a yeast infection. But those with vaginas are far (far!) more likely to be infected — nearly 75% will have a yeast infection at least once in their lifetime. Less than 1% of those with pensises will get a yeast infection in their lifetime.

The health of the internal canal of the vagina is regulated by something called the vaginal microbiome which is made up of millions of bacteria, yeast, and fungi that work the vagina’s bodyguard and janitorial staff, keeping the it clean while also warding off infectious pathogens.

When the vaginal microbiome becomes disrupted — which can occur from a variety of things including antibiotic use, pregnancy, uncontrolled diabetes, sitting in wet or sweaty clothes, oral contraceptives, interaction with another person’s natural genital bacteria, or use fragrant body washes — the owner becomes susceptible to a yeast infection.

Common symptoms include:

• Cottage-cheese-textured discharge
• Itching and irritation on the vulva, penis, or taint, or inside vaginal canal
• Pain or burning while urinating or during sex
• Redness, swelling, or irritation

Yeast infections can be diagnosed with a pelvic exam or lab test. Usually, they can be cured with a one to seven day regimen of anti-fungal topical or oral medication. However, if left untreated long enough the infection can travel elsewhere in the body and require a more rigorous course of treatment to be eliminated.

What is bacterial vaginosis?

Bacterial vaginosis names the condition in which there is an overgrowth of certain bacteria in the vaginal microbiome. As the name suggests, BV is a condition that only affects those with vaginas.

Similar to yeast infections, anything that upsets the vaginal microbiome can result in BV. However, things like douching, having sex with someone new, using fragrant washes and detergents, and smoking can all increase the risk.

Common symptoms include:

• Fishy or foul smelling odor
• Thin or loose discharge
• Vaginal or vulvar itching
• Burning while peeing

Bacterial vaginosis can be diagnosed through a pelvic exam, vaginal secretion or vaginal pH test. To treat bacterial vaginosis, your healthcare provider may prescribe an oral or intravaginal cream that should clear up the infection within a few days.

How are these infections different from STIs?

The main difference is how the infections are classified. Yeast infections, bacterial vaginosis, and UTIs are not classified as STIs.

While sex can increase risk of yeast infection, bacterial vaginosis, and UTIs, they are not considered sexually transmitted infections because they are not infections transmitted from one person to another. All sexually transmitted infections are strictly transmitted from an STI-positive person, to someone who is not positive for that STI through direct skin-to-skin contact or through exchange of bodily fluid exchange.

Another difference is that all of the infections mentioned here are totally curable with adequate treatment. While some STIs are curable (gonorrhea, syphilis, chlamydia, trichomoniasis, and pubic lice), there are also some viral STIs that can be treated, but cannot be cured.

However, all genitals infections can be asymptomatic. Or, result in similar symptoms like itching, burning, or pain during sex or while urinating.

So…how do you know which of the genital infections you have?

Talk to your provider about your concerns and which genital (or other) infections you are worried about. Together you can come up with a plan for testing and treatment to get you feeling better as soon as possible.

Reviewed by the Ovia Health Clinical Team

Sources

• Mayo Clinic Staff. “Urinary Tract Infection (UTI).” Mayo Clinic. Mayo Clinic. October 14, 2020. https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/symptoms-causes/syc-20353447
• Mayo Clinic Staff. “Yeast infection (vaginal).” Mayo Clinic. Mayo Clinic. March 17, 2021. https://www.mayoclinic.org/diseases-conditions/yeast-infection/symptoms-causes/syc-20378999

Sex Ed. class 2.0

Here, we’ve rounded up five things you should have learned from sex ed. class before reading this article, but will be useful to you long after you close it.

1. It is normal and healthy to masturbate

Masturbation is not just expected by boys and men, but encouraged. Yet, common cultural narratives tell girls and women that masturbation is dirty and wrong.

Here’s the thing: Nothing could be further from the truth. For people of all genders, masturbating is both normal and healthy! Benefits of masturbating include: reduced stress, boosted mood, and increased self confidence long term. And beyond being healthy, masturbating also feels good, which is absolutely reason enough to partake!

In summary: You should have been taught that masturbation is healthy. Further, you should have been encouraged to touch yourself in whatever locations, using whatever pressures, at whatever speeds, for however long, and however often you want.

2. STIs can be transmitted during oral sex

Despite the fact that many sex education curriculums rely on fear-mongering, few programs acknowledge sex acts other than penis-in-vagina intercourse exist, and therefore do not touch on potential risks of such acts. Like, oral sex for example.

From fellatio and cunnilingus to analingus, oral sex can bring Big Time pleasure for the giver and receiver alike. Still, important to know the potential risks. Ready?

While the risk is lower than it is during vaginal or anal intercourse, an STI can be transmitted during oral sex from a mouth or throat, to a penis, vagina, vulva, or anus — and vice versa. That means that, yes, an STI can infect body parts other than the genitals.

When oral STI symptoms do appear, they may include: sore throat, pain during swallowing, sores around the lips, sores and blisters in the mouth, and swollen lymph nodes. But as is true with STIs located elsewhere in the body, the most common symptom of an oral STI is no symptom at all. And that’s why it’s so important to get tested for oral STIs, between (oral sex) partners or once a year (whichever comes first). Oral STI testing involves a simple mouth or throat, and treatment typically involves an oral antibiotic or prescription mouthwash.

What can you do to reduce risk of STI transmission during oral hanky-panky? Glad you asked. With a partner who’s STI status you don’t know or who has an STI , you can use an external condom or dental dam to reduce risk of transmission.

3. PReP can be taken by all genders

PReP (pre-exposure prophylaxis) is a daily oral medication that can be taken by HIV-negative people to greatly reduce their risks of contracting HIV, if exposed to the virus. Highly effective, PrEP is one of the best additions to the sexual health space…ever.

While there is more that can be done to spread awareness about PReP to all people, cis-women in particularly tend to be less likely to take PReP. The problem is that people of all sexual orientations, genders, and genitals are susceptible to HIV, if exposed to the virus through sex, intravenous drug use, contaminated blood transfusion, or pregnancy. In fact, globally more than half (52%) of HIV-positive people in the world are women.

No matter your gender, to figure out if you’re a good candidate for PrEP read the federal guidelines put out by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) and/or talk to your healthcare provider.

4. Sex is not supposed to be painful

No, not the first time you have it. No, not during anal sex. No, not postpartum. Pain is the body’s way of telling you that something is wrong — and it’s a message worth listening to.

Sometimes pain during sex is a sign that you need additional lubrication or that your not-yet aroused-enough for what’s happening. In these instances, slowing down and adding lube can turn your sex session from “ouch” into “ooh!”.

When sex is consistently painful, however, or you experience these symptoms outside of sex (for example: while urinating or inserting a tampon) there may be an underlying condition. Pain during sex is a common symptom of conditions like hypertonic pelvic floor, endometriosis, vaginitis, vulvodynia, vaginismus, and pelvic inflammatory disease.

If you’re experiencing pain during sex, stop. If you want to continue having sex, try slowing down and/or add a store bought lubricant. If the pain becomes more chronic, bring it up with your healthcare provider or seek out the guidance of a trauma-informed pelvic floor specialist.

5. Consent is an informed, ongoing, and enthusiastic agreement to engage with someone that can be withdrawn at any time

As of 2020, only 9 states required consent be taught in sex education curriculum. That means that a whopping 41 states don’t teach students the importance of receiving “Y-E-S”, nor validated the decision to say “N-O” at any point during a sexual encounter.

The failure of this absence becomes obvious when looking at the responses from a recent survey of people ages 18 to 25. In it, 53% admitted that they didn’t realize that consent can be withdrawn once someone is already naked (it can!) and just 13% said they’d feel comfortable discussing consent with their sexual partner.

While the staggering sexual assault statistics cannot be blamed on any one thing — curriculums in sex ed. class suffer from widespread avoidance of consent, and it certainly isn’t doing anything to help reduce the number of people assaulted.

If you’re reading this and haven’t yet learned about consent, take the time to read The Consent Checklist by Meg-John Barker and/or Beyond Yes & No by Kai Werder.

Reviewed by the Ovia Health Clinical Team

Sources

• “Facts and figures: HIV and AIDS.” UN Women. UN Women. July 2018. https://www.unwomen.org/en/what-we-do/hiv-and-aids/facts-and-figures. 
• “Pre-exposure Prophylaxis (PrEP) Care System”. CDC. CDC. September 10, 2020. https://www.cdc.gov/hiv/effective-interventions/prevent/prep/index.html#About-PrEP. 

Here’s the latest from the Ovia Health Clinical Team, including answers to your questions and some practical guidance. 

If I’m pregnant and I get COVID-19, will the infection be worse?

It’s possible. Research indicates that pregnant people and recently pregnant people (within 42 days of giving birth) are at higher risk for significant complications from COVID-19 than their non-pregnant peers. This means that while the overall risk for severe illness is low, there is an increased risk of hospitalization, intubation and mechanical ventilation, blood clots, and requiring intensive care. There is also an increased risk of adverse pregnancy outcomes, including preterm birth and possibly an increased risk of pregnancy loss when compared to pregnant women who did not get COVID-19. 

These risks are compounded for Black pregnant people, who have long experienced nearly twice the risk of preterm birth when compared to white people. Many studies have demonstrated that race is likely an independent risk factor when it comes to healthcare outcomes like preterm birth, separate from other risk factors like income or education. That race-related risk may stem from chronic stresses of societal racism as well as the race-related inequalities that have been identified within the healthcare system. 

Pregnant parents who test positive for COVID-19 should be offered a discussion about the medication Paxlovid. You can read more about that here.

What can I do to prevent infection?

Prevention is no different for pregnant people than it is for anyone else. Follow the advice that you receive from your local health department, from the CDC, and from your healthcare provider. Avoid going to public places if you think or know you have COVID-19, to prevent spreading it to others. 

If you know local rates of Covid are high, wear masks when indoors and practice social distancing. Being vaccinated has been shown to provide protection against severe COVID-19 disease. However, you can still get sick and pass the illness on to vulnerable people who aren’t vaccinated or cannot be vaccinated (like newborns).

Is hand sanitizer safe in pregnancy?

Yes, Yes, YES. The CDC reports [3] that handwashing with soap and water is more effective than hand sanitizer. However, you can’t take the sink in your car or on a walk or to the grocery, so make sure you use hand sanitizer regularly in addition to handwashing. Furthermore, it’s often much easier to wipe hand sanitizer on your children’s hands than it is to get them properly washed, so consider this a regular habit as well.

If I get COVID-19, will I pass it to my fetus?

The most recent research on the topic says that transmitting COVID-19 while pregnant is very rare – for moms in North America, the rate was about 0.1%. This does not include the risk of passing it to your newborn during routine care postpartum. However, studies suggest that people who tested positive for COVID-19 during pregnancy are more likely to have complications, such as preterm birth [6]. There is no evidence that cesarean delivery reduces the risk of infection for Baby, so this is not recommended.

What about during and after birth?

It is extremely important that you call your healthcare provider before you go to the hospital if you think you have COVID-19. Once at the hospital, your provider knows what to do to reduce the risk that your baby (and the healthcare professionals who care for you) will become infected.

Keep in mind that testing positive for COVID-19 when in labor may cause changes to your birth plan and hospital stay. You may want to consider extra precautions in the last weeks of pregnancy to avoid this.

What is the risk to my baby? And what about the risk to my other children?

Children seem to be at less risk of becoming really sick with COVID-19 than adults are, but infants make up the bulk of serious cases and hospitalizations in children under 17. Current evidence suggests that babies are not likely to get COVID-19 from their mothers as long as preventative steps are taken, such as wearing a mask around your baby, washing your hands for 20 seconds prior to holding your baby, and having them sleep 6 feet away from you. You should still do everything you can to reduce the risk of exposure. Children with certain underlying conditions are at risk for complications from COVID-19, so it is important to keep them safe and communicate with their pediatrician.

Is breastfeeding safe if I think I have COVID-19?

There are many benefits to breastfeeding for parents and babies. It appears unlikely that COVID-19 can be transmitted through breast milk, though helpful antibodies can be passed along! 

If you test positive for COVID-19, this may impact the care of your newborn. In-hospital, the CDC recommends discussing with your provider the risks and benefits of caring for your newborn while sick. Mildly ill people generally room in and care for their newborns. If you are seriously ill, this may not feel like a physically possible or safe option. Once you are home, wash your hands frequently — and always before touching your baby. Wear a mask when you are within 6 feet of your baby or another person. If you have a caregiver who lives with you, they should also wear a mask whenever caring for your baby.

We know that with other illnesses, you pass antibodies to your baby through your breast milk. Antibodies are what your body makes to help fight off illness. The research into COVID antibodies in breastmilk is really encouraging and suggests that antibodies are passed through breast milk after infection or vaccination. 

What if I’m trying to conceive and not yet pregnant?

There’s no evidence that COVID-19 or any similar viruses impact conception or cause birth defects if you are sick when you conceive.

Should pregnant people get the COVID-19 vaccine?

Multiple well-respected clinical organizations, including the ACOG (the American College of Obstetricians and Gynecologists) and the ACNM (American College of Nurse-Midwives), recommend the vaccine to people who are trying to conceive, pregnant, and breastfeeding [11].

The first clinical trials for the COVID-19 vaccines manufactured by Pfizer-BioNTech, Moderna, and Novavax did not include participants who were known to be pregnant or breastfeeding. This is typical for pharmaceutical research. Recent studies have included pregnant people and show that there is no increased risk and that vaccines given in any trimester do not negatively impact pregnancy outcomes. In addition, vaccinating in the second or third trimester may offer additional protection to your newborn.

Additionally, none of these COVID-19 vaccines contain a “live” virus. This means you cannot get COVID-19 from the vaccines. In general, vaccines that do not contain “live” viruses are safe during pregnancy and do not have increased risks for infertility, miscarriage, fetal anomalies, or stillbirth. Side effects of the COVID-19 vaccines include pain at the site of injection, fever, fatigue, and chills. These typically go away after a couple of days. These side effects are normal and expected and are indicators of your immune system doing its job to learn to protect you from the virus. There have been very rare reports of unexpected, adverse reactions from the vaccines. A severe allergic reaction called anaphylaxis can happen in very rare cases. The incidences of these adverse events are so low that getting vaccinated remains safer than potentially getting infected with COVID-19. [12].

You can also reach out to the experts at Mother to Baby for more information. Your midwife, doctor, or other healthcare professional is also a great resource for more information about the COVID-19 vaccine. Ultimately, you are the one who knows what is best for your body and your family.

Reviewed by the Ovia Health Clinical Team

Sources:

Dara D. Mendez, Vijaya K. Hogan & Jennifer F. Culhane “Institutional racism, neighborhood factors, stress, and preterm birth”. Ethnicity & Health. 19:5, 479-499. October 18, 2013.

Jasmine D. Johnson et al., “Racial Disparities in Prematurity Persist Among Women of High Socioeconomic Status,” American Journal of Obstetrics & Gynecology 2. 2(3), 100104. Nov 10, 2020

James W. Collins Jr et al., “Very Low Birthweight in African American Infants: The Role of Maternal Exposure to Interpersonal Racial Discrimination,” American Journal of Public Health. 94(12), 2132–2138. December 2004.

Braveman Paula, et al. “Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes” Frontiers in Reproductive Health. Vol. 3. 684207 September 2, 2021.

(If you’re already taking the pill or have an IUD, add it to your Ovia profile!)

Start with your priorities

Everyone has different preferences – and what’s important to one person might be less important to another. 

Some people gravitate toward options that they don’t have to think much about, or toward those that are easy to use. Some want help managing period symptoms. Some want a method that’s highly effective at preventing pregnancy. Some want a long-lasting option, while others are looking for shorter term use.

To work through all of these considerations, you might find that it’s helpful to narrow your focus by considering each question when thinking about the right birth control method for you.

Choosing a birth control method? Ask yourself these questions before making the decision

• How effective is it at preventing pregnancy?
• How convenient is it — do you have to take it every day or can you think about it less frequently?
• How easy is it to use the right way?
• How long-lasting is it?
• How affordable is it?
• How will it affect your period and cycle health?
• What kind of benefits or side effects might you expect — with your health history and other health concerns taken into account?
• Does it protect against STDs?
• Is it discrete?
• Will using it interrupt intercourse?
• How soon can you potentially get pregnant after you stop using it?
• Do you need a healthcare provider to get it?

Given the range of options available, even if you have a lot of specifics that are important to you, chances are you can still find a method that will meet all or most of your preferences.

Talk to your provider

Some birth control methods are available over the counter, but many need to be prescribed. To consider all of your options, have a medical professional walk you through which ones could be best for you. They’ll be able to consider your medical history, your general health, your period and cycle health, your past experience with birth control, your lifestyle, your plans to have children, and your preferences. It will also give you a chance to learn more about your options from a medical professional and ask questions.

Try, try again

Once you decide on a method of birth control, if it turns out that it’s not a good fit, you should reconsider your options. The same is true if you’ve tried birth control in the past that you didn’t like. And sometimes what works for you at one stage in your life just isn’t a good fit for you later on. If you’re frustrated with the method you’re using, or if you just want to try something new, there are an encouraging number of options. A healthcare provider can help you figure out what didn’t work out for you, reassess your wants and needs, and recommend what might be a better choice.

Reviewed by the Ovia Health Clinical Team

Read more about birth control methods

• Unveiling birth control myths
• Are LARCs more popular than ever?

Sources

• “Birth control methods.” Office on Women’s Health.” U.S. Department of Health and Human Services, April 24 2017. Retrieved March 31 2020. https://www.womenshealth.gov/a-z-topics/birth-control-methods.
• “Choose the Right Birth Control.” MyHealthfinder. U.S. Department of Health and Human Services, February 5 2020. Retrieved March 31 2020. https://health.gov/myhealthfinder/topics/everyday-healthy-living/sexual-health/choose-right-birth-control.
• “What do I need to know about birth control?” Planned Parenthood. Planned Parenthood. Retrieved March 31 2020. https://www.plannedparenthood.org/learn/teens/preventing-pregnancy-stds/what-do-i-need-know-about-birth-control.

Common misconceptions and facts about birth control

How many of these facts did you already know? Take a look at common misconceptions and vital facts about birth control.

“The pill” doesn’t just describe one single kind of pill.

The name might suggest that it’s just one single medication, but “the pill” actually includes a number of different kinds of oral contraceptives. There are two main varieties of the pill — combination pills, which contain estrogen and progestin, and the minipill, which contains only progestin. And each type comes in a variety of doses, brands and generics. Conventional packs lead to a period every month, whereas continuous dosing/extended cycle packs lead to a period once every three or more months. With so many options to choose from, many people can find a form of the pill that’s a good fit.

Most birth control doesn’t protect against sexually transmitted infections (STIs).

Many types of birth control do a fantastic job at preventing pregnancy — IUDs and the birth control implant are 99% effective! — but most birth control doesn’t protect against STIs. Male and female condoms are the only types of birth control that provide protection against STIs. They are not the most effective at preventing pregnancy — 85% and 79%, respectively — so it’s often a good idea to use more than one contraception in order to both prevent pregnancy and protect against STIs. Just don’t use male and female condoms together. They can rub against each other and break or slip, making them much less effective at protecting against both pregnancy and STIs.

You can use the pill to skip your period.

And it’s safe to do so. Essentially, you can skip taking the hormone-free “reminder” pills found at the end of a pack and instead take the first week of active pills in the next pack to skip your period. Some people do this so they don’t have to deal with getting their period on a special occasion or during travel. Others do it to skip out on pain or discomfort during their period. If you take the pill and are interested in skipping your period, just be sure to check in with your healthcare provider to understand how to do so with your specific brand.

The morning-after pill isn’t just for the morning after.

The name may suggest that you need to use the morning-after pill (or “emergency contraception”) right away to lessen your chance of getting pregnant after unprotected intercourse. But, technically, you have a little more time to do so — some brands of morning-after pill can be taken up to 72 hours (or 3 days) after intercourse, others for up to 120 hours (or 5 days) after. It is worth noting that the morning-after pill is most effective the sooner it’s taken because the hormones in it keep your body from ovulating — no ovulation, no pregnancy. Depending on where you live, the morning-after pill may be available over the counter or as a prescription. Just be aware: some studies suggest that these pills may be less effective at preventing pregnancy for people with higher body weights. In addition, many combination birth control pills can be used as emergency contraception if you have them at home. Talk to your provider about what option is best for you.

Some birth control is approved for use for up to 10 years.

The copper IUD is approved for use for 10 years to prevent pregnancy! The small T-shaped device is inserted into the uterus, and once in place, it can safely stay there for a decade. It can always be removed sooner, after which, it is possible to get pregnant right away. Because many people use this as a long-acting, reversible form of birth control, depending on your insurance, it may also come with the added perk of being cost-effective.

Hormonal birth control can be used for much more than just to prevent pregnancy.

42% of people who take the pill do so exclusively to prevent pregnancy. The other 58% take the pill for other reasons as well. Hormonal birth control can be used to help with irregular or particularly uncomfortable periods — heavy periods, lengthy periods, heavy cramping and discomfort, or pain and other health problems related to endometriosis — or even mood disorders and acne. Hormonal birth control can improve quality of life for those suffering from some of these conditions.

That’s the overview of important birth control facts and common misconceptions. If you want to learn more, or have questions about what sort of birth control might be right for you, be sure to speak with your healthcare provider.

And if you’re taking the pill or have an IUD, add it to your Ovia profile!

Read more about your birth control options

• Which birth control option is right for you?
• Finding the birth control method that works for you

Sources

• “Barrier Methods of Birth Control: Spermicide, Condom, Sponge, Diaphragm, and Cervical Cap.” American College of Obstetricians and Gynecologists. American College of Obstetricians and Gynecologists, May 2018. Retrieved March 31 2020. https://www.acog.org/patient-resources/faqs/contraception/barrier-methods-of-birth-control-spermicide-condom-sponge-diaphragm-and-cervical-cap.
• “Birth Control.” American College of Obstetricians and Gynecologists. American College of Obstetricians and Gynecologists, May 2019. Retrieved March 31 2020. https://www.acog.org/patient-resources/faqs/especially-for-teens/birth-control.
• “Combined Hormonal Birth Control: Pill, Patch, and Ring.” American College of Obstetricians and Gynecologists. American College of Obstetricians and Gynecologists, March 2018. Retrieved March 31 2020. https://www.acog.org/patient-resources/faqs/contraception/combined-hormonal-birth-control-pill-patch-and-ring.
• “Contraceptive Use.” Centers for Disease Control and Prevention. U.S. Department of Health and Human Services, March 21 2019. Retrieved March 31 2020. https://www.cdc.gov/nchs/fastats/contraceptive.htm.
• “Emergency Contraception.” American College of Obstetricians and Gynecologists. American College of Obstetricians and Gynecologists, May 2019. Retrieved March 31 2020. https://www.acog.org/patient-resources/faqs/contraception/emergency-contraception.
• “IUD.” Planned Parenthood. Planned Parenthood, Retrieved March 31 2020. https://www.plannedparenthood.org/learn/birth-control/iud.
• “Long-Acting Reversible Contraception: Intrauterine Device and Implant.” American College of Obstetricians and Gynecologists. American College of Obstetricians and Gynecologists, January 2018. Retrieved March 31 2020. https://www.acog.org/patient-resources/faqs/contraception/long-acting-reversible-contraception-intrauterine-device-and-implant.
• “Plan B morning-after pill.” Planned Parenthood League of Massachusetts. Planned Parenthood League of Massachusetts, Retrieved March 31 2020. https://www.plannedparenthood.org/planned-parenthood-massachusetts/online-health-center/planned-parenthood-services-birth-control-abortion-std-hiv-pregnancy-health-care/emergency-contraception-plan-b.