Birth Control

Embarrassing Ob-Gyn Questions
Women's Health

13 Questions You're Too Embarrassed to Ask Your Ob-Gyn

No matter how comfortable you are with your gynecologist, some questions can be tough to ask.

No matter how comfortable you are with your gynecologist, some questions can be tough to ask. Whether you have period or libido concerns, you can get your answers right here from Shape!

Coming in for your annual women's health exam can be anxiety-inducing itself, and speaking up about a nonexistent libido, sex on your period, or how you smell down there can be even more uncomfortable (and sometimes scary). While you should never stay mum when it comes to your health, you can make your next convo with your gynecologist easier by coming armed with the following knowledge about common womanly concerns.

1. My Guy Says I Smell "Funny." Should I Be Worried?
We all smell differently. "Everything we consume — food, drinks, medication, drugs, alcohol — changes our vaginal secretions and men's semen," says Justine Shuey, PhD, a professor of human sexuality and certified sex educator. If you're self-conscious about your odor, try drinking more water, eating more fruits and vegetables (other than cruciferous veggies, as their sulfur compounds can give you that distinctive rotten-egg smell), and cutting back on alcohol since it can increase sweating in your crotch. And — no-brainer — quit smoking: the smell permeates everything — and we mean everything.

However, if your scent suddenly varies greatly from your normal scent for no apparent reason, comes with a lot of discharge, or turns "fishy," see your doctor, as all of these are signs of infection. One possible culprit: your birth control method. “Both hormonal and nonhormonal IUDs have an increased risk of bacterial vaginosis, which is characterized by a fishy smell," says Colette Brown-Graham, MD, a board-certified ob-gyn and diplomat of the National Board of Medical Examiners. If you're prone to infection but don't want to change to another birth control, eating a healthy, well-rounded diet and supplementing with a probiotic can help.

RELATED: Sixteen Things That Can Sink Your (or His) Sex Drive

2. Is It Safe to Have Sex During My Period?
There aren't any unique risks about having sex during your red week, except that the chance of pregnancy is more complicated, Brown-Graham says. If you have a 28-day cycle, you ovulate 14 days before the onset of your next cycle, so you would be relatively "safe" from pregnancy. But if you have a 22-day cycle and therefore ovulate on day eight, having intercourse immediately after your period would be decidedly more "risky." "No time is ever perfectly safe, but many women who understand their ovulatory pattern can tell when they have more or less risk of becoming pregnant," Brown-Graham adds. Of course, if you use condoms or another form of birth control, you should be fine, and since some women report increased sensation and pleasure during that time of the month, you may want to consider it.

3. When Should I Worry About Itching Down There?
Since itching down yonder can happen due to anything from sexually transmitted infections or yeast infections to too-tight pants or staying in damp gym clothes for too long, it can be hard to know when to worry, says Allison Hill, MD, a board-certified ob-gyn and coauthor of The Mommy Docs' Ultimate Guide to Pregnancy and Birth. If you're not sure of the source and the itching persists after you shower, she recommends making an appointment with your doctor, stat.

RELATED: Twenty-Five Superfoods For Better Sex

4. What's the Difference Between Normal PMS and Unhinged, Need-Meds PMS?
Moodiness is a common part of PMS, says Gail Saltz, MD, a psychiatrist, and author of The Ripple Effect: How Better Sex Can Lead to a Better Life. What's uncommon, however, is anxiety that makes functioning in your daily life difficult or depression that leaves you highly irritable such that you are exploding at others or feeling hopeless and crying. These symptoms could indicate premenstrual dysphoric disorder (PMDD). If your PMS is interfering with your life, talk to your doctor, as PMDD can be treated with lifestyle changes, therapy, and medications.

Keep reading for more answers!

Answers to Many Common Questions About Quitting Birth Control
Women's Health

What Happens When You Go Off the Pill

Going off birth control can be confusing!

Going off birth control can be confusing! To help answer many of the inevitable questions on the matter, we turned to a board-certified doctor, and here is her advice on the topic.

There have been lots and lots questions and concerns about what happens when you stop birth control pills, from acne to abdominal cramps, from weight gain to the lack of a period following discontinuation. Since the topic is popular and confusing, I thought I would round up my answers to the myriad questions so the various bits of information are all in one place.

First of all, a quick review. The birth control pill works by preventing ovulation. Once you stop taking the pill, the hormones will be excreted from your body quickly, usually within a couple of days, which is why women who miss a couple days of pills on birth control have a chance of ovulating and getting pregnant. It does not matter how long you were on the pill, your body will still be rid of the hormones within a couple of days. Once the hormones are out of your system, the body will begin to start producing hormones to initiate menstrual cycles. Some women will begin to ovulate in a couple of weeks, whereas it may take several months for other women to begin to ovulate. Generally speaking, your body should be back to "normal menstruation mode" within two to three months after stopping the pill.

It is important to emphasize that if you had problems with ovulation prior to starting the pill, you may continue to have irregular ovulation/periods after stopping the pill. Most women with normal ovulation/periods prior to starting the pill will continue to have normal ovulation/periods after stopping the pill. But, some women who had regular periods prior to starting the pill may have irregular ovulation after stopping the pill. The key point here is that everyone’s experience with ovulation/periods after stopping the pill is different!

One of the specific questions we received was whether or not it is normal to have one’s period come late after stopping the pill. There is a condition called post-pill amenorrhea (or lack of menstruation) that can occur after stopping the birth control pill. According to the Mayo Clinic, the reason for lack of menstruation in these women is that the body is just taking longer to produce the hormones necessary for ovulation and menstruation. If you still haven’t had a period after three months, they recommend taking a pregnancy test, as some women ovulate right after stopping the pill without knowing it and are pregnant without ever getting a period. It would be prudent to also schedule an appointment with either your primary care physician or gynecologist for evaluation.

Another specific question that was sent to us was from a reader concerned with developing acne after stopping birth control pills (she mentioned desiring pregnancy), as she had noticed significant improvement in her skin with use of birth control pills. Many women take certain birth control pills to regulate their acne. Once you stop using birth control, you may notice an increase in acne on your face or on other parts of your body. When your body's hormone levels regulate again, the acne can subside in some cases. It is hard to predict if one’s acne will return after discontinuation of the pill and unfortunately, there is not much that can be done about preventing the return of acne should it happen. My only advice is to use good face-washing hygiene and consider seeing a dermatologist if your acne returns and is bothersome. Women who are not on birth control may not be able to take certain acne medications as they can be harmful to a baby should she get pregnant.

Another reader question was regarding some lower abdominal pain (in the area where she normally got menstrual cramps) about 2 weeks after discontinuing birth control pills. Lower abdominal pain/pelvic pain can represent many, many things. Without knowing any further information that would be helpful, my first impression is that she could be experiencing mittelschmerz. According to Mayo Clinic, mittelschmerz is pain with ovulation that can feel like: a dull ache or cramp, sharp sudden pain, and is typically one sided. Approximately one in five women experiences ovulation discomfort. The exact cause of mittelschmerz is unknown but is thought to either be due to stretching of the surface of the ovary when the egg is released or blood/fluid released by the ruptured egg, which can irritate the lining of your abdomen. My advice to the reader who asked this question is to contact your primary care physician or gynecologist, as more information (including a history and physical exam) is needed to make sure that nothing else could be causing this abdominal/pelvic pain.

Some women worry about weight gain or increased pre-menstrual symptoms after stopping the pill. It has been shown that birth control pills that are higher in estrogen may cause weight gain and water retention. Therefore, your body may adjust after stopping the pill and some weight loss may occur due to a decrease in water retention. However, some women do report weight gain after stopping the pill. It is hard to determine whether a woman will gain, lose, or maintain weight after stopping the pill. The most important steps to take to stay healthy are to continue a healthy, balanced diet, and stay active with exercise and fitness. Many birth control pills are designed especially to help treat exaggerated pre-menstrual syndromes or in certain women, pre-menstrual dysphoric disorder. Thus, some women will notice increased breast tenderness and other pre-menstrual symptoms such as nausea, headaches and fluctuating emotions.

DrSugar's posts are for informational purposes only and should not be considered medical advice, diagnosis, or treatment recommendations. Click here for more details.

What Birth Control Does to Your Body
Women's Health

The Most Common Birth Control Side Effects

If your contraception has lead to extra pounds, acne, and other problems, our friends at Shape help explain why — and what to use instead.

If your contraception has lead to extra pounds, acne, and other problems, our friends at Shape help explain why — and what to use instead.

Birth control has one great upside: no pregnancies! (Yes, it’s not a 100-percent guarantee, but it’s pretty darn reliable.) But in order to reap that benefit, you may also have to deal with extra pounds, depression, or other unpleasant side effects. While at times these are just mild irritations, for some women they can become so debilitating that they quit using their BC.

No use resorting to the pullout method, though. There are reasons certain women tend to react differently to each type of contraception—and there’s one out there that’s best for you. Learn what’s up with your body and your alternatives, then talk to your doctor to determine your No. 1 bet.

Depression and/or Anxiety

Even if you were the most even-keeled girl out there before you started taking BC, the onslaught of synthetic hormones found in most birth control methods can wreak havoc with your moods, says Elizabeth Reynoso, M.D., an ob-gyn with Drs. Goodman and Partridge in Arizona. All hormonal options contain some amount of a lab-formulated version of estrogen and progesterone, the two hormones that, along with testosterone, control your cycles. Reynoso says that occasionally traditional hormonal birth control can exacerbate depression and anxiety because of the effect hormones have on the intricate balance of serotonin, dopamine, GABA, and norepinephrine, all "feel-good" neurotransmitters in the brain. Estrogen in particular plays a role in depression, with too little causing a dip in serotonin—and once this happens, the ovaries produce less estrogen, starting a vicious cycle of feeling bad. On the other hand, too little progesterone is associated with anxiety since the hormone has a calming effect.

Who’s at risk? Women who have a personal or family history of depression or anxiety.

The worst offenders: While any hormonal birth control has the potential to make you depressed or anxious, the Norplant (an implant in your upper arm) has the worst track record, possibly because it is a progesterone-only device and further encourages an imbalance of hormones.

Consider switching to: Reynoso recommends first trying a method with no hormones or fewer hormones, such as the ParaGard IUD (intrauterine device) or Mirena IUD, respectively.

Breakthrough Bleeding

Your monthly visit is bad enough, but for some women their cycle is unpredictable. Unexpected vaginal bleeding is one of the most common birth control complaints that Khai Ling Tan, M.D., a gynecologist with the all-female Phoenix practice MomDoc Women for Women, hears. While all the reasons for it aren’t entirely clear, having too little estrogen can cause your uterine lining to build up excessively, leading to random spotting.

Who’s at risk? Smokers, as lighting up breaks down estrogen in the body, causing an increased chance of bleeding, heart problems, and possibly reduced effectiveness of the pill. Women going on the pill for the first time also have a greater risk because it seems to take the body some time to get used to the synthetic hormones, and breakthrough bleeding is part of that adjustment process for many women. Luckily this often goes away within several cycles.

The worst offenders: While any hormonal birth control can cause irregular cycles, the Mirena IUD, Depo-Provera shot, and Nexplanon implant are the most common offenders because they are progestin-only methods. Without estrogen, cycles can become interrupted, intermittent, or even stop completely.

Consider switching to: Tan recommends a pill, patch, or ring with a slightly higher dose of estrogen. Because more is not always better (too high hormone levels can lead to complications), she says that you should only take the smallest amount that you need to regulate your cycles.

Find out how birth control affects weight and more after the break!

The Pros and Cons of IUDs For Birth Control: Paragard vs. Mirena
Women's Health

The Pros and Cons of IUDs

Birth control is always a hot topic, especially IUDs.

Birth control is always a hot topic, especially IUDs. Questions prevail about the Mirena and the ParaGard, so here is a comparison of these two popular IUDs from a board-certified physician. She even explains her personal experience with this form of contraception.

To continue our ongoing series of gynecological topics, I have decided to write about intrauterine devices (IUDs) as a form of birth control. Even though I learned about IUDs through many outlets (sex ed in school, medical school), I decided to research them more thoroughly since the birth control pills I started taking after having my baby negatively affected my milk supply. I had to find an alternate mode of contraception so I could continue to have an abundant milk supply for my little one. I had a Paragard (copper) IUD inserted a couple of weeks ago and I'll share my experience as well as more information about two types of IUDs in today's column! Keep reading for more info.

6 Reasons a Condom Might Break
Sex

6 Reasons a Condom Might Break

Male condoms are one of the best forms of birth control out there because they're cheap, you can buy them anywhere, they prevent pregnancy, and they also prevent the spread of STIs, but they only work if they don't break!

Male condoms are one of the best forms of birth control out there because they're cheap, you can buy them anywhere, they prevent pregnancy, and they also prevent the spread of STIs, but they only work if they don't break! Below are six reasons why a condom might rip, so keep them in mind the next time you're getting busy.

  1. The condom is past its prime. Condom wrappers have an expiration date on them, so be sure to take note.
  2. Storage issues. Heat damages latex condoms, so they shouldn't be kept in a hot place such as a glove compartment or a wallet. Keep them in your medicine cabinet or nightstand instead.
  3. Lack of lubrication. If there is friction while having sex, especially anal sex, not only will it cause pain and irritation to your privates, but the condom can also break. So be sure to use lubricated condoms or use extra lube if you need to.
  4. You're using the wrong lubricant. If you're using latex condoms, oil-based lubricants can weaken the rubber and cause a tear, so use only water-based lubes.
  5. The condom doesn't fit. If the condom is too small or too large, it can rip, so experiment with different-sized condoms to get a snug fit — not too tight and not too loose.
  6. The woman is tight. Some women's vaginal muscles are naturally tight, so to help prevent condom breakage, lubrication (and a lot of it) is a must.

— Additional reporting by Alexis Nordby

What to Do When You Miss Taking a Birth Control Pill
Women's Health

Missed Birth Control Pill! Now What?

Accidentally skipping a birth control pill, or two, can leave you beyond worried.

Accidentally skipping a birth control pill, or two, can leave you beyond worried. We turned to a board certified physician to offer advice on when you've missed a dose, or two, or three, of birth control pills. Keep reading to hear what she has to say on the matter.

We receive countless questions from women who have inadvertently skipped a birth control pill, so I will be giving a general overview on what to do when you realize you have missed a dose. While this column will have general information on oral contraceptives and how to manage missing doses, I stress that it is best to talk with your health care provider who prescribed the pills about what to do. Different brands of pills have varying hormonal formulations and thus different potential effects when pills are missed. In some cases, you may be able to simply resume taking pills at your regular time the day after missing a pill and move on with life. In other cases, skipping even one pill (or extending the placebo week) could result in a serious threat to effective pregnancy prevention; it really depends on the type of pill you take. An additional factor to be aware of is that some brands of pills are multiphasic, meaning that pills in a single pack of birth control have differing levels of hormones. Depending on which pill you missed (or which "phase" pill it was), your health care provider may have different recommendations about how to proceed. This column will provide information from Planned Parenthood on the most common type of birth control pills, the combination pill.

Keep on reading to learn what to do if you miss a pill.

Choosing Permanent Birth Control
Birth Control

How Do You Know When It's Time For Permanent Birth Control?

Here's a post from our partners at BabyCenter!

Here's a post from our partners at BabyCenter! Every week, we bring you the best parenting and lifestyle stories from the experts at BabyCenter, including this one on permanent birth control.


Birth control is a big decision. A big decision.

There are so many options: natural family planning, condoms, the pill, and an IUD. Then there are the big guns. I'm talking vasectomies and having your tubes tied.

How do you know when it's time to go permanent?

Related: Is staying home with the kids a lifestyle choice?

I am 99 percent sure we are done having kids. We've joked about it and had quick, five minute conversations here and there about our family being complete. But we've yet to have that sit-down, come to Jesus meeting.

A few of the reasons we think we're done include:

  • We have both a boy and a girl and have been happy to experience both worlds.
  • Neither of our children slept well during their first year of life. We like our sleep and are not very nice people without it.
  • We are about a month away from moving our daughter to a toddler bed, which means no more crib.
  • She's also about ready to be potty trained meaning no more diapers!
  • Life is good. Our family has a routine. It works for us.

Keep reading for more about the decision.

What is the Mirena?
Birth Control

Birth Control 101: Why You Might Prefer a Mirena IUD Over the Pill

The pill, the patch, the ring — they're all great in theory, but if you constantly forget to take your pills or hate the waiting period for both the patch and ring, these might not be the best choices for pregnancy prevention.

The pill, the patch, the ring — they're all great in theory, but if you constantly forget to take your pills or hate the waiting period for both the patch and ring, these might not be the best choices for pregnancy prevention. For a more long-term form of birth control, many women are using the Mirena.

What it is: The Mirena is a type of intrauterine device (IUD) that is placed inside your uterus by a health-care provider to prevent pregnancy for up to five years. It's a T-shaped piece of soft, flexible plastic less than 1.5 inches long that emits a small amount of progestin directly into your uterus (it's estrogen-free). There are two threads attached to the end that hang down out the opening of your cervix to help you check whether it's in the correct place.

Effectiveness: It's 99-percent effective at preventing pregnancy, but like the pill, it won't protect against STDs such as HIV. It is effective immediately if inserted within seven days after the start of your period, otherwise you'll need a backup form of birth control for the first seven days after getting the Mirena.

How it works: The small amounts of levonorgestrel (a type of progestin) released by Mirena thicken your cervical mucus to prevent sperm from entering your uterus so they can't reach your egg, and thus can't fertilize it. It also thins the lining of your uterus, and may stop the release of your egg from your ovaries. In the unlikely event that a sperm does fertilize your egg and it survives, an IUD causes inflammation of the uterus making it harder for the fertilized egg to implant. To ensure the Mirena remains in place, insert a finger into your vagina, feel for the cervix, and check for the threads once a month.

Keep reading to learn the pros and cons of the Mirena.

I Forgot to Take my Birth Control Pill, What Should I Do?
Sex

I Forgot to Take My Birth Control; What Should I Do?

One of the complaints we hear from women about the birth control pill is that they have a hard time remembering to take it every day.

One of the complaints we hear from women about the birth control pill is that they have a hard time remembering to take it every day. So what happens if you forget? Being even 12 hours late taking your birth control pill could increase your chances of getting pregnant. If you miss any of the first 21 pills in your pack, you need to use a backup method of birth control (condoms) until you have taken seven consecutive days of pills.

  • If you miss one pill: Take it as soon as you remember. Take your next pill at the regular time.
  • If you realize when taking your pill that you skipped one: Take the pill you skipped and the new one together. It's OK to take two pills at once.
  • If you miss two pills: Take two pills each day for the next two days, and then go back to one pill each day at your usual time. You could get pregnant if you have unprotected sex for the next seven days, so make sure to use a backup method.
  • If you forget to take one pill during the third week of your pill pack: Finish the pills for that week, skip the last week (inactive pills), and begin a new pack. Understand that you probably won't have another period until the fourth week of this new pill pack. Use a backup method of birth control until you have taken seven consecutive days of pills.
  • If you forget three or more pills: Call your doctor for advice. She may suggest to take one pill daily until Sunday and then start a new pack, or to discard the rest of the pill pack and start over with a new pack that same day. Be sure to use a backup method of birth control each time you have sex because you are no longer protected against pregnancy. After you've had seven days of pills, then you are protected against pregnancy.

Advice: It's always a good idea to talk to your doctor if you have any questions. If you think there could be a chance that you are pregnant (and you don't want to be), emergency contraception (Plan B) is always an option. And as of last week, the morning-after pill is now available over the counter without a prescription for all ages.

Facts About Types of Nonhormonal Birth Control
Sex

Over the Pill? Facts About Nonhormonal Birth Control

We recently had a reader ask about switching to an IUD after being on the pill.

We recently had a reader ask about switching to an IUD after being on the pill. And with the intrauterine device's rise in popularity, we're thinking she's not the only one with questions about nonhormonal birth control options.

Hormonal options range from the ring to the patch to the pill, but what if you want to avoid the consequences, including mood swings, weight gain, decreased sex drive, or other side effects? You're in luck — different methods of hormone-free birth control exist. And if you have health insurance, almost all forms of birth control are free under the Affordable Care Act, aka "Obamacare."

I've rounded up some basic info — including effectiveness rates and pros and cons — on several different nonhormonal options that will let you enjoy freedom from pregnancy. If one or more sparks your interest, talk to your gynecologist about whether it will work for you.

Source: Thinkstock
IUD How it works: A doctor inserts the small t-shaped device into the uterus, which affects the way sperm moves and prevents it from joining an egg. It also alters the lining of the uterus. Success rate: Less than one out of 100 women will get pregnant while using an IUD. Pros: It's safe, effective, and reversible, and it won't impact your hormones. While an IUD costs between $500 and $1,000 up front, it can last up to 12 years. If you have insurance, it's covered for free under the Affordable Care Act. It might also protect women from endometrial cancer. Cons: An IUD does not protect against STIs. The common myth that it can cause infertility is not true. However, if you have an IUD inserted while you have an STI, you could increase your chance of infertility. The Sponge How it works: The Today Sponge, the only brand available, is a plastic foam sponge that contains spermicide. It covers the cervix while also continuously releasing spermicide. You know it from Seinfeld. Success rate: Among women who have never given birth, nine out of 100 of them will become pregnant using the sponge. If these same women do not always use it correctly, 16 out of 100 will become pregnant. It will not impact your hormones. Pros: You can buy it over the counter, and you can have sex as many times as you like during the first 24 hours of wearing it. It's also included in the Affordable Care Act's free birth control mandate. Cons: It does not protect against STIs, and it can be expensive bought over the counter ($17 for a package of three). Plus, it can be difficult to insert or cause messy or dry sex. Male Condom How it works: A condom prevents sperm from entering the vagina. Success rate: If used correctly, only two out of 100 women will become pregnant. Among women whose partners do not always use them correctly, 15 out of 100 will become pregnant. Pros: Condoms are simple, easy to get, and cheap (free under Obamacare) and prevent STIs. They can also keep your partner erect longer. Cons: They might dull sensation or interrupt intercourse. Female Condom How it works: Placed inside the vagina, the female condom collects semen when a man ejaculates. Success rate: If used correctly, only five out of 100 women will become pregnant. Among women who do not always use it correctly, 21 out of 100 will become pregnant. Pros: It protects against STIs and can be used for vaginal or anal intercourse. If you're allergic to latex condoms, these can be a good option. They cost $6 for a three-pack at the drugstore but are included in the free birth control mandate of Obamacare. Cons: It could cause irritation, slip into the vagina during intercourse, reduce feeling, or cause some noise, much like the male condom. Diaphragm How it works: The dome-shaped cup is inserted into your vagina to cover the cervix. You should use spermicide to increase effectiveness. Success rate: Of women who always use the diaphragm correctly, six out of 100 become pregnant. If it's not used correctly, 16 out of 100 will become pregnant. Pros: It usually cannot be felt by a partner, can be inserted hours before sex, and has no impact on your hormones. It also falls under Obamacare's free birth control mandate. Cons: It does not protect against STIs and requires a fitting by your doctor. It cannot be used during your period, can be difficult to insert, which you have to do each time you have sex, and may move around during sex. Cervical Cap How it works: A cervical cap (FemCap is the only brand available in the US) is a silicone cup you insert over your cervix along with spermicide. Success rate: Of women who have never given birth, 14 out of 100 will become pregnant. For those who have given vaginal birth, 29 out of 100 will become pregnant. Pros: It works similar to a diaphragm, and for $60-$75, a cervical cap will last up to two years. It's also covered by the Affordable Care Act. Cons: It has similar drawbacks as the diaphragm: it cannot be used during menstruation, might be hard to insert, and does not protect against STIs. Plus, it requires a prescription. Spermicide How it works: Spermicides are chemicals that kill sperm, which you insert deep into the vagina right before sex. It can be used along with other forms of birth control. Success rate: When used alone, studies suggest that six to 26 percent of women will become pregnant. Pros: It's easy to get and included in the free birth control mandate. Cons: It's best to use it along with another form of contraception, and it can be somewhat difficult to use correctly.
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