Have you been asked the Five P’s??? – April is STD Awareness Month

Wilce Student Health Center

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Use protection

Lets say you are going to Student Health or your private caregiver.  In most cases, they are going to ask you a few questions about your sexual health and sexual practices. These questions are very personal, but they are as important as the questions about other areas of physical and mental health. Your answers are kept in strict confidence. 

So, are you ready to talk about your five P’s?  The five “P”s stand for Partners, Practices, Protection from STDs, Past history of STDs, and Prevention of pregnancy.

Partners

  • Are you currently sexually active? (Are you having sex?)
  • In the past 12 months, how many sex partners have you had?
  • Are your sex partners men, women, or both?

Practices

  • What kind of sexual contact do you have or have you had?
  • Genital (penis in the vagina), Anal (penis in the anus), Oral (mouth on penis, vagina, or anus)?

Protection from STDs

  • Do you and your partner(s) use any protection against STDs? If not, why?  If so, what kind”
  • How often do you use this protection? If “sometimes,” in what situations or with whom do you use protection?
  • Are there other forms of protection that you would like to discuss today?

Past history of STD’s

  • Have you ever been diagnosed with an STD?
  • Have you had any recurring symptoms or diagnoses?
  • Have you ever been tested for HIV, or other STDs? Would you like to be tested?
  • Has your current partner or any former partners ever been diagnosed or treated for an STD?

Prevention of pregnancy (Based on partners noted earlier, conception and contraception questions may be appropriate)

  • Are you currently trying to conceive or father a child?
  • Are you concerned about getting pregnant or getting your partner pregnant?
  • Are you using contraception or practicing any form of birth control?
  • Do you need any information on birth control?

Finally, before you move on to discuss other things with your caregiver, consider:

  • Are there other things about your sexual health and sexual practices that you should discuss to help ensure your good health?
  • Any other concerns or questions regarding sexual health in general?

Student Health Services can offer you expert advice, all the current diagnostic and treatment options, and vaccinations that can protect you long term.  Come see us, and GET YOURSELF TESTED

Can switching birth control cause you to have lighter periods?

birth control pills

Can switching birth control cause you to have lighter periods?

Yes.  In general, hormonal birth control methods that contain both estrogen and a progestin (birth control pills, the patch, NuvaRing) decrease the number of days of bleeding and the amount of blood women lose each cycle.  Since these methods all have varying levels of estrogen and progesterone in them, a change from one kind of birth control to another can also change the days and amount of flow.  

During a normal menstrual cycle, hormones cause the uterus to build up a thick lining with a lot of blood vessels called the endometrium to create a welcoming environment for a fertilized egg to attach.  If conception doesn’t happen, the hormone levels drop, the blood vessels shrink and the endometrium sloughs off.  Voila – you have a period!  Hormonal birth control causes the endometrial lining to be thinner than normal, so there is less to shed each month.  In fact, there may be no fresh blood at all.  A period could be just a drop of blood, or a brown smudge.

On the other hand, if you are using a birth control method that contains only a progestin and no estrogen (Depo Provera, Nexplanon implant, Mirena IUD, or “mini-pill”) you are more likely to experience irregular bleeding.  Many women experience either an increased number of days of light bleeding or no bleeding at all.

It’s a good idea to check in with your health care provider after your first 3 months on the pill to make sure everything is going OK.  If your pattern of bleeding concerns you be sure to see her to rule out the possibility of pregnancy, infection or other medical conditions.  Remember, not all bleeding can be blamed on birth control! 

If you have any questions or concerns about birth control, the clinical staff of our Women’s Services Department is always happy to see you!

Beth Askue, MS, CNP
Student Health Services
The Ohio State University

Depo Provera: A primer

about.com

The Student Health Center

Q: Does Depo-Provera lead to permanent infertility? 

Short A: Nope.

Long A:  Depo Provera (“Depo,” “the Shot”) is one of a family of progesterone-only contraceptive products. It is an injectable product-a shot. It is a really effective and convenient way to prevent pregnancy; you only have to think about it 4 times a year and in clinical studies, less than 1% of women get pregnant on it.  (In real life, about 5% get pregnant – probably because in real-life some women didn’t get their shot on time.)

There are a couple of downsides to Depo Provera. It is, as noted, a shot. Ouch. It can be expensive if your insurance doesn’t cover contraception. (On the other hand, a baby is a whole lot more expensive!) Like most hormonal contraceptive products, some women will feel a little bit pregnant-bloated, queasy, weight changes, headachy-on Depo, especially at first. Some women gain up to 5-10 pounds on Depo, although most gain only 3-5 pounds. (While 3-5 pounds ain’t nothin’ it’s still a whole lot less than a baby!)  It can interfere with bone mineralization, making osteoporosis and fractures slightly more likely down the road.

There are some big upsides, though, too. Periods often stop, although for the first few weeks/months of use there can be some irregular spotting. (Are all you men out there going, yuck, gross, icky?)  The incidence of pelvic inflammatory disease, endometrial hyperplasia, endometrial cancer, and endometriosis pain are all decreased.  And there are also specific medical conditions which benefit from Depo-Provera:

  • Because the metabolism of Depo Provera doesn’t change with anti-seizure medicine, it’s a good choice for women with seizure disorders.
  • Women with sickle cell disease appear to have fewer pain crises while on depo. 
  • Peri-menopausal vasomotor symptoms (the dreaded “hot flashes“) tend to be better compared to birth control that has estrogen in it.    

Depo Provera does not appear to increase the risk of liver, breast, or ovarian cancers. It probably does not affect blood pressure or coagulation, making it sometimes an okay choice for women who have had high blood pressure, heart disease, or a history of blood clots. It unfortunately does not protect women from sexually transmitted infections so you still need to get a condom on your partner.

So to finally answer your question, Depo Provera does not permanently impair your ability to get pregnant. It can, though, take a few months off the medication (sometimes up to 18) to become pregnant.

And by the way, if you are pregnant and accidentally get the shot, there is no evidence to suggest that any harm will come to the baby as a result of the medicine.

Student Health Services offers this and other methods of contraception.  Visit our Services tab to see all the health care services we provide. 

Victoria Rentel, MD

But what if I WANT to get pregnant?

truehealthmedicine.com

We spend a lot of time helping students figure out how to avoid getting pregnant, but there are a fair number of Lady Buckeyes out there who are ready to start planning a family, and they need good information too!  So in the spirit of fair play, here is a checklist of things you should do if you’re planning to get pregnant.

  • Be sure your vaccinations are up to date, especially MMR (Measles, Mumps, and Rubella), Varicella (chickenpox) and Hepatitis B. Your unborn child can be harmed if you contract these infections while you are pregnant. These vaccines are part of the standard childhood immunization schedule, but you can make an appointment with Student Health Preventive Medicine to check your immunity if you aren’t sure whether you received them.
  • If you haven’t received a tetanus shot within the last 10 years, you should receive the Tdap (Tetanus-Diptheria-Pertussis) vaccine.
  • If you have any chronic health conditions, be sure to see your primary health care provider so she can review your medications and make sure your conditions are under optimal control.
  • Schedule a GYN exam. This will give your health care provider a chance to assess your overall health status, screen you for sexually transmitted infections, review your health and family history, and give you proper guidance for pregnancy planning.
  • Stop your birth control at least 3 months before you are planning to get pregnant. If you’ve been taking birth control pills, a pill-free break will allow you to go through several normal cycles before you conceive, which will make it easier to determine when ovulation occurred and to accurately estimate your due date. Your fertility may return to normal as early as two weeks after you stop taking the pill. If you are using Depo Provera, it may take several months for fertility to return.
  • Basal Body Temperature charting is a very useful tool for couples trying to conceive because of its ability to confirm ovulation. You need to use a basal thermometer, which is different than a regular thermometer. You can get them at most pharmacies.
  • Quit smoking, alcohol and recreation drugs.
  • Try to reach a healthy weight. Being overweight or underweight can make things more difficult before and during pregnancy. Ideally, your Body Mass Index (BMI) should be between 19 and 25. Check out this BMI calculator to figure out your BMI.
  • Try to eat a healthy and balanced diet. If you are a vegetarian or vegan, you may need to add a Vitamin B12 supplement to your diet. Be sure to discuss this with your healthcare provider.
  • Start an exercise program now, even if it is just walking every day. You should aim for a goal of 150 minutes of moderate intensity exercise per week.
  • Start taking a prenatal vitamin that contains 400 mcg of Folic Acid at least 3 months before you are planning to get pregnant. Folic acid deficiency can cause birth defects. These vitamins are available over-the-counter so you don’t need a prescription for them.
  • Avoid consuming a lot of fish, especially swordfish, tilefish, king mackerel and shark. These fish contain methyl mercury, which can harm the nervous system of your unborn child. You can eat up to 12 ounces a week of a variety of fish and shellfish, such as shrimp, canned light tuna, salmon, Pollock and catfish. The FDA has a great website that tells you what foods to avoid during pregnancy.
  • Avoid raw and undercooked meat, unwashed fruits and vegetables, and dirty cat-litter boxes. All of these things can be infected with Toxoplasmosis gondii, which is harmful to your unborn baby. If you don’t have a cat, don’t get one. If you do, have someone else change the litter box, or at the very least wear disposable gloves and wash your hands thoroughly with soap and water immediately afterwards. Be sure to wear gloves when gardening.
  • If you or your partner work in an environment where you are exposed to X-rays, lead, mercury or chemicals, you should take extra precautions at work or explore options for moving to a different area. You can check out Ohio State’s Environment Health & Safety office if you have any questions about safety or hazards in your work place.

Li-Chun Liu, MSN
Student Health Services
The Ohio State University

When it comes to “perfect” sex, timing is everything!

menstrual-cycle.info

My doctor put me on an antibiotic for a sore throat, and the pharmacist warned me that it is going to interfere with my birth control pills.  Two of my sorority sisters said they use “pulling out” whenever they need extra protection.  Does this really work?  And should I worry about the antibiotic making my pills less effective?

These are two great questions!  Let’s knock out the easy one first – do antibiotics interfere with birth control pills?

We covered this question in detail a few months ago, but the short answer is that as long as you’re taking your pills at the same time every day (give or take 2 hours) then back-up contraception shouldn’t be necessary.  If you’re having problems taking your pills consistently because of your illness – your sore throat is so severe that you can’t swallow them, or you’re vomiting and having diarrhea to the point that your body can’t absorb them, then you should use some back-up protection just in case. 

Now, on to the question of whether withdrawing the penis from the vagina before ejaculation (“pulling out,” “the withdrawal method,” “coitus interruptus”) will prevent pregnancy. 

Whenever we talk about the effectiveness of any form of birth control, we look at two very important statistics: annual pregnancy rates during typical use and during perfect use.

Perfect use is where everything works according to plan and instructions: you never miss a pill; you use a condom every time and nothing slips off or breaks; your boyfriend pulls out in time, every time. 

But as we all know, life ain’t perfect.  So we also look at the typical use rates of pregnancy – how effective the method is in the real world, where condoms slip and pills get skipped and guys forget to retreat.

For women counting on the withdrawal method alone, 4% will become pregnant each year with perfect use while 27% will become pregnant each year with typical use.  To give you a comparison, 2% of women using condoms alone will become pregnant with perfect use while 15% will become pregnant with typical use. 

As you can see, the withdrawal method isn’t very good.  It puts tremendous pressure on the male partner.  He has to be able to reliably tell when he’s going to ejaculate and have the control to pull out.  This is difficult under the best conditions; throw in extenuating circumstances like alcohol or drug consumption and it gets even harder (no pun intended).  

The big question you have to ask yourself is, “What would a pregnancy mean to my life”?  If it is not an option, then make sure to take your pills consistently, keep a box of condoms close by and forget about withdrawal.  Or better yet – tell your boyfriend to get you some hot soup and himself a cold shower.  You need to take it easy until you feel better!

Beth Askue, MS, CNP
Student Health Services
The Ohio State University

So Do I Need a Pap Test or what?

rho.org

So what’s the deal with the annual gyn (“female”) exam?  Is this the same thing as a Pap test?  When do I have to start having them?  My mom says I should get one every year starting at age 18, but now my friends are telling me I don’t need one until I’m 21.  I’ve never even had sex, so do I need one at all?

These are great questions.  For something as simple as an “annual” exam – just get one every year, right? – it is an awfully confusing topic.  So let’s set the record straight.

A Pap test and the annual gyn visit are actually two different things.

A Pap test (also called a Pap smear) is a specific test that is done to screen for cervical cancer by looking for changes in the cells of your cervix.  It is often a part of the annual gyn exam, but not always. 

The annual gyn exam describes the yearly visit with your women’s health care provider in which she assesses your overall general health, female health specifically (she’ll ask you questions about periods, urinary and vaginal symptoms, breast concerns), and sexual practices.  The actual physical examination portion of the visit (usually referred to as a “pelvic exam“) includes physical examination of the vulva, vagina, uterus and ovaries, as well as the thyroid (a gland in your neck), breasts and abdomen. 

The recommendation for when a woman should receive her first Pap test has changed to age 21.  In addition, nearly every woman age 21 and older needs an annual gyn exam, regardless of whether a Pap test is done or not.  If you are younger than 21, the pelvic exam portion of the annual gyn exam may or may not be done, depending on your sexual history.  Annual testing for Chlamydia is also recommended for all sexually active women up to age 25; this is done as part of the pelvic exam. 

The OSU Comprehensive Student Health Insurance covers the annual exam once a year.  If you have other insurance, please check with your insurance company to see if they will cover the annual exam here.

The clinical staff at Ohio State Student Health Women’s Services is here to take care of all of your women’s health needs.  Come in and see us any time.

Beth Askue, MS, CNP
Student Health Services
The Ohio State University

10 Ways to Save Money on Birth Control

womenshealthmag.com

I just came across a very good article in Women’s Health called “10 Wayst to Save on Your Birth Control.”  (Yes, I was reading Women’s Health.  It was research, OK.  My wife left it next to my Sports Illustrated and I picked it up by accident…)

Anyway, the article is especially timely because we’re coming up on the end of the year and that means prescription benefits are starting to run out.  We often see students this time of year faced with the frustrating situation of needing just a few weeks of pills but being told that they need to pay out of pocket for a full month’s worth.  Some of the tips in this article might help.

No need for me to rewrite the article, but I would add a couple of things. 

They recommend bargain hunting on online pharmacies.  I would just warn you that buying medicine online is a very risky proposition – sometimes you are not getting what you pay for and in the case of birth control, the results can be disastrous.  If you go online, make sure the site is linked to a real pharmacy that you can actually call or go into, and never buy medicine that they are willing to sell you without a prescription.  Better yet, just come in to our pharmacy to make sure you are getting the real deal from someone who can answer all of your questions.

They make a good point about condoms being a cheaper birth control option depending on how frequently you have sex, but many women take birth control pills for reasons besides preventing pregnancy.  If that’s you, be sure to talk to your women’s health care provider before stopping them.

Another option not mentioned in the article, and one that the we do right here at the Student Health Center, is Implanon.  The wonderful clinical staff in our Women’s Services Department can help you decide which birth control option is right for you, including letting you know which one is the easiest on your purse!  

Now, back to my research.  Oooohhh… 6 weeks to my leanest, hottest body ever! 

John A. Vaughn, MD
Student Health Services
The Ohio State University

What’s the Deal with HPV?

genital wart caused by HPV infection

photo: timeinc.net

Use protection

HPV stands for Human Papillomavirus. There are over 100 strains of HPV, about 30 of which can be sexually transmitted. HPV can cause a number of different diseases including genital warts and cervical cancer, as well as other less common cancers of the anus, throat, penis, vulva and vagina. Different strains of HPV cause different diseases; the “low-risk” types are more likely to cause genital warts while the “high-risk” types are more likely to lead to cancer.

The CDC (Centers for Disease Control and Prevention) estimates that about 50% of sexually active men and women will get HPV at some time in their lives.  Some people who have HPV have no visible signs of infection, so they spread it to their partners without even knowing they have it.  HPV is spread by direct skin-to-skin contact so you can get it even if you are using a condom.  There is no medical treatment for HPV but fortunately, in about 90% of cases an individual’s immune system will get rid of the virus on its own within two years. 

It is very important that all sexually active women receive an annual exam.  Your health care provider will examine you for genital warts and/or signs of precancerous changes of the cervix called “cervical dysplasia.” Cervical cancer is most successfully treated when it is caught early.

A vaccine that protects against the four most common strains of HPV is now available for men and women ages 9-26. This vaccine will greatly decrease your chances of becoming infected with one of the viruses that can cause cervical cancer.  If you’ve already been infected with one of these four strains, the vaccine won’t cure you but it can prevent you from getting one of the other types.  Even if you do get the vaccine, it is very important that women still go for regular exams.

The staff at Student Health Services is happy to answer any of your questions, perform all recommended exams and tests, and provide the HPV vaccine.  In the meantime, here are some other good sources of reliable information:

http://www.cdc.gov/std/hpv/    http://www.ashastd.org/hpv/hpv_learn_myths.cfm 

http://www.itsyoursexlife.com/gyt/know/std-low-down/

Angie Walker (Ohio State College of Medicine)

John A. Vaughn, MD (Ohio State Student Health Services)

What can I do if I think I’ve been given a “date rape” drug?

www.silc.ku.edu

While thankfully rare, incapacitated sexual assault does occur on college campuses.  Womens Services at Student Health has put together some really useful information about what Ohio State students can do if they feel that they were the victim of a “date rape” drug. 

Please check it out.  And remember to be careful when going out to bars or parties or any other place where you might be given a drink from someone you don’t know.  Keep your friends close by to make sure you all get home safely.  

Beth Askue, MS, CNP
Student Health Services
The Ohio State University

IUD’s – Not Just for Moms Anymore!

managingcontraception.com

thinkyouknowit.com

Q:   Is it safe for me to use an IUD if I haven’t had any babies yet?

A: Even though they’re not as popular as other forms of birth control, IUD’s (intra-uterine devices) are a very safe and effective option for birth control, especially in women who find it hard to remember to take a pill every day or come in for a shot every 3 months. 

In the past, IUD’s were restricted to women who already had children and were in a monogamous relationship because of concerns that women with multiple partners were at a higher risk of getting a pelvic infection that could lead to future infertility.  But as long as a woman doesn’t have an infection at the time of the IUD insertion, her risk of pelvic infection is no higher than if she used other forms of birth control.  Remember – we’re talking about infection due to the IUD here.  IUD’s do NOT provide any protection from sexually transmitted infections, so always keep the condoms handy. 

The American College of Obstetrics and Gynecology (ACOG) recently recommended IUD’s for all women who seek a safe, effective, long-term contraception option – this includes adolescents, women who haven’t had any children yet, even women with a history of tubal pregnancy or pelvic infection.  You don’t need to take antibiotics at the time of insertion and the copper-containing IUD (there are two types) can even be used up to 5 days after unprotected intercourse to prevent unwanted pregnancy.  Again, as long as there is no pelvic infection at the time of insertion, an IUD really is a safe and easy option. 

ACOG also recommends another good option for long-term birth control – Implanon.  Implanon is a small rod that is inserted just beneath the skin of the inner aspect of the upper arm under local anesthetic.  We do it right here at the Student Health Center.  It works by inhibiting ovulation and thickening the cervical mucus and it lasts for 3 years.  It is about the size of a pencil lead and releases a progestin hormone called etonogestrel.  Implanon is safe, convenient and 99% effective.  It needs to be removed after 3 years, but a new rod can be implanted at the time of removal.

If you have any questions about birth control, come in and talk to the Women’s Services staff at the Student Health Center.  We know how to manage all the various options and will help you find the best one for your lifestyle!

Ryo Choi-Pearson, MD
Student Health Services
The Ohio State University