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


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

10 Ways to Save Money on Birth Control


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

IUD’s – Not Just for Moms Anymore!



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

Safer Sex is cool, isn’t it?


As college health clinicians, we have been preaching safer sex to students for years.  Are those messages getting through to students that have had HIV as part of their lives since they were born?  An 18 year old first-year student in 2011 was born:

  • 12 years after the HIV epidemic was first detected
  • 3 years after we passed the 1 million mark in persons living with AIDS/HIV globally

By the time that student reached puberty, messages about HIV prevention had become part of the standard vocabulary, using the term “safer sex”.  Knowing that all sexual activity involving more than one person always carries some risk, our efforts are meant to reduce those risks, making sex “safer”.

So, what does the typical college student in 2011 need in terms of safer sex education?  We know that risk behavior still exists, both in sexually-transmitted infections (STI) and unintended pregnancy.  Otherwise, there would be a blank screen whenever you tune into “Teen Mom” and ”16 and pregnant”. The recent increases in syphilis and HPV would not be happening, either.

Want some basic facts about preventing HIV, other STIs and pregnancy?  The GYT (Get Yourself Tested) site has a great table of links to nearly all methods of practicing safer sex, from things that work (barriers, pills, shots, rings), to things that don’t work (peeing after sex??).  Visit the PROTECT page at GYT to learn more. 

Give us your comments about what you think is the most effective messaging to use on campus, and we will take a look at your recommendations.  But be warned, walking around campus in a condom suit has already been taken off the table. 

Stay Healthy!

Roger Miller, MD

Student Health Services

The Ohio State University


Are birth control pills safe?


Q: I’ve seen some scary things about birth control pills in the news lately.  Are they safe to take?

A: Birth control pills are a very popular method of contraception – the CDC reports that since 1945, 80% of women in the United States have used them at some point in their lives.  They are generally a very low risk medication – especially for young, healthy women – but low risk does not equal no risk.  Here’s what you need to know: 

Blood Clots

Many birth control pills contain estrogen, a hormone that makes your blood more likely to clot up.  A blood clot is a good thing when it stops a cut from bleeding, but it’s a very bad thing when it happens in the deep veins of your leg (DVT) or your lung (Pulmonary Embolus).  Fortunately, pills today contain a lot less estrogen than they used to, but taking any form of birth control (pill, ring, patch) containing estrogen can still mean a 3-6 times increased risk of blood clots, especially in women who are obese.

Heart Attack

Heart attacks and strokes are so rare in young, healthy women that there is not a significant risk of these conditions with the use of low-dose estrogen pills.  Certain conditions can increase that risk – high blood pressure, diabetes, certain types of migraines and smoking – so be sure to tell your health care provider if any of them apply to you. 

High Blood Pressure

About 1% of women develop hypertension when they start taking birth control pills.  High blood pressure is associated with an increased risk for heart disease, stroke, and kidney disease so it’s important to get regular checkups while you’re on the pill. 

Liver Disease

Although rare, birth control pills can cause benign tumors of the liver. This usually happens after 4-8 years of use.  High-dose estrogen pills have also been associated with an increased risk of gall bladder inflammation.

So how can you tell if you’re experiencing any of these side effects?  Just remember ACHES.

  • Abdominal pain that is severe. 
  • Chest pain that is severe or associated with shortness of breath or cough
  • Headache that is severe or associated with dizziness, weakness, or numbness
  • Eye problems, like sudden vision loss or blurry vision
  • Severe leg pain in the calf or thigh

We’re not trying to scare you away from birth control pills – like we said; millions of women use them and do just fine.  But now that you’re moving out into the world on your own, it’s important for you to be proactive and take charge of your health. Know your own medical history.  Know your family’s medical history.  And don’t be afraid to ask questions of your health care providers. 

If you have any questions about birth control options, the clinicians in our Women’s Services department are happy to help you figure out which options is right for you.

Cheryl Czapla, Med IV
College of Medicine
The Ohio State University

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

The truth about antibiotics and birth control!


Q: I heard that antibiotics interfere with birth control pills, but I’m on the birth control that gets implanted under my skin – will antibiotics interfere with that too?

A: I’m so glad you asked this question!  This is one of the biggest medical myths of all time; one that gets propagated in doctors’ offices, health clinics, hospitals, blogs, magazines – and OK fine, student health centers – every day.  So now, for the first time ever… in print… online… on this blog… the TRUTH!

The only antibiotic that has ever been shown to interfere with birth control levels and effectiveness is a medicine called rifampin which is used to treat tuberculosis.  Rifampin may also interfere with the birth control patch and vaginal ring so if you are taking it, be sure to use a back-up, non-hormonal (i.e. condom) form of birth control.

There are some other medications that can interfere with your birth control, however, and if you are taking any of them you should always use back-up contraception.

  • Griseofulvin
  • Phenytoin (Dilantin)
  • Carbamazepine (Tegretol)
  • Phenobarbital
  • Topirimate (Topamax)
  • St. John’s Wort (herbal supplement)

But in general, your birth control will not be affected by any run-of-the-mill antibiotic that you might be taking for things like sinus infections, strep throat, urinary tract infections, skin infections, acne, etc.  Some people believe that because antibiotics disrupt the normal bacteria in the gastrointestinal tract, they will interfere with the absorption of the birth control pills from your stomach.  But this is not an issue, and even if it were, it wouldn’t apply to birth control methods that don’t involve swallowing pills like the skin patch or the vaginal ring or Implanon.

Now, there are enough women out there who swear that they have little antibiotic babies running around the house that your health care provider will probably still tell you to use back-up just in case.  And birth control doesn’t do anything to protect you against sexually transmitted infections, so using a condom is a good idea no matter what medications you’re taking.  But you can rest assured that your birth control is just as effective when you’re taking antibiotics as when you’re not. 

John A. Vaughn, MD (OSU SHS)

Smile! You’re on ovulation camera!

click with CAUTION - cool but creepy

Ever been interested in what a human egg looks like when it pops out of an ovary? What YOU looked like – well, half of you anyway – way back when you were only a bunch of chromosomal material and some gelatinous gooey protein?

Okay, I’m speaking to a very narrow group of fellow dorky mega-nerds, but wow, these pictures totally blew me away. Captured accidentally during surgery for a hysterectomy, the surgeon managed to get pictures over about a fifteen minute period while the egg erupted. Well, given that the process took 15 minutes, perhaps “erupted” is a bit too explosive a word. Let’s say the egg was expelled gradually.  How fortuitous that somebody was there with a camera to capture the blessed event.

This is you! This is your brother, mother, dad, sister, kids, if you have any. Along came a sperm and a few months later, here comes baby. Or, if you’re female like, oh, half our readers, and you’re not suppressing ovulation in some way (with oral contraceptives or Depo-Provera) this is what happens every month, about halfway through your menstrual cycle, give or take a few days. Weird but cool.

Read more about it at:

Human Egg Makes Accidental Debut on Camera

Victoria Rentel MD

Photo: newscientist.com

Does starting and stopping birth control affect fertility?

wikimedia commons

Q: Can starting and stopping birth control (pills, patch, etc.) affect fertility?  In what ways?

A: In continuing our birth control theme this week, I have once again gone straight to the experts in our Women’s Services department for the straight scoop. 

The short answer is NO.  As we discussed in our previous post, the hormone levels in birth control medications are just high enough to prevent pregnancy, but low enough that they rarely cause any significant problems for most women who take them.  And once you stop taking them, the hormones leave your system and you return back to your normal state.  There has never been any evidence that stopping and starting birth control has any long term effects on fertility.

However, there is POSSIBLY a rebound phenomenon that takes place right after you stop birth control medication that might actually increase your fertility for a short time.  Basically, the theory goes that once you stop a medication that has been inhibiting your fertility hormones, they’re so excited to get back in action that they overcompensate past their normal levels for a while.  Again, this is kind of theoretical but it certainly can’t hurt to be extra careful with other forms of protection for a couple of weeks after stopping birth control.

As always, if you have any questions about birth control, please make an appointment to see the staff of Student Health Women’s Services.  They are always happy to help you find the option that is right for you.

John Vaughn, MD (OSU SHS)

How long can a woman safely stay on birth control?

click to enlarge

Q: How long can a woman safely stay on birth control?

A:  To get to the bottom of this question, I went right to the experts at Student Health Women’s Services, and I’m happy to report that the news is good. 

While birth control pills can obviously have side effects while you’re taking them, there are really no lingering adverse effects after you stop, no matter how long you’ve been on them.  So whether you take them for 5 months or 15 years, you’ll be in the same (hopefully good) shape once you stop. 

There used to be a concern that women who were on oral contraceptives for a long time were at a higher risk of amenorrhea – i.e. that their periods wouldn’t start back up normally – but that turned out not to be the case.  The levels of the hormones in newer pills are low enough that they don’t cause any trouble for the vast majority of women who take them.

And don’t forget the positives of being on birth control, which greatly outweigh the risks for the vast majority of women who take them.  In addition to the obvious – keeping you from getting pregnant – birth control pills also have the following positive effects:

  • Prevent anemia (low iron levels)
  • Improve pre-menstrual syndrome (PMS) symptoms and menstrual cramps
  • Lessen the frequency and severity of endometriosis flare-ups
  • Lower the risk of Pelvic Inflammatory Disease (PID) and ectopic pregnancies

As always, if you have any questions about birth control, please make an appointment to see the staff of Student Health Women’s Services.  They are always happy to answer your questions and will help you find the birth control option that is right for you.

John A. Vaughn, MD (OSU SHS)

Does the birth control patch have cardiovascular side effects?


Q: Does the birth control patch have cardiovascular side effects like abnormal or fast heart rates?

A: Not really – or at least no more than oral contraceptive pills.  The patch does deliver more estrogen than oral contraceptive pills, so you tend to get more side effects like breast tenderness and nausea with the patch.  These tend to go away after a few months.

Reasons not to use the patch are the same as those for other forms of birth control that contain the hormones estrogen and progestin: history of blood clots, a tumor that responds to estrogen (like some forms of breast cancer) and liver disease (like hepatitis or cirrhosis).  And obviously, women who have a history of sensitive skin or skin diseases like eczema or psoriasis would probably want to avoid using the patch as well.

Research has shown that the most common side effects of the patch (other than unscheduled bleeding) are:

  • Breast symptoms (22%)
  • Headache (21%
  • Application site reactions (17%)
  • Nausea (17%)
  • Upper respiratory tract infection (10%)
  • Painful periods (10%)

Fewer than 2% of the women in these studies felt that these side effects were bad enough to stop using the patch[1].

The Women’s Services clinical staff at Student Health Services can help you manage all forms of birth control, including the patch.  You can make an appointment to discuss your birth control questions with them any time!

John A. Vaughn, MD (OSU SHS)

[1] UpToDate Online 17.3