Contraception

Hi Readers!

Did you know that without the use of contraception, 85 women in every 100 will get pregnant in 1 year. (UCL)

Contraception is a choice and a right. You need to choose the method that works best for you. We will go over multiple contraception choices in the article, but I highly suggest you speak to your doctor before making that choice, ensuring that the method you choose is appropriate for your body based on your medical history. 

You also need to remember that while most of these contraception methods help prevent pregnancy, they do not protect against STIs! Please be mindful of this. It is also suggested that you use these contraceptives in combination with the condom. 

Implant

Fewer than 1% of women will get pregnant in one year. (UCL)

The implant is a small piece of plastic that is put under the skin of the arm. It contains the hormone progestogen, which hormone is very similar to the oestrogen your body produces. It lasts for up to 3 years, but can be taken out at any time

Benefits:

  • It’s extremely good at preventing pregnancy
  • Very convenient; it doesn’t interrupt sex
  • Menstruation can be lighter and less frequent
  • It helps to make menstruation less painful
  • It can help you deal with pre-menstrual symptoms (PMS)
  • Often suitable for people who can’t take oestrogen

Risks:

  • A small injection of local anaesthetic is needed to put it under the skin
  • Irregular bleeding can be a nuisance (1 in 5 women) (UCL)
  • Some women get side effects like mood changes and changes in sex drive
  • No protection against STIs

IUS

Fewer than 1% of women will get pregnant in one year. (UCL)

The hormonal coil (IUS) is made of plastic and releases a small amount of progestogen. It is inserted into the womb by a doctor or nurse and lasts up to 5 years. The IUS can be a great help for heavy or painful periods. 

Benefits:

  • Lasts up to 5 years 
  • No need to remember pills or patches
  • It doesn’t interrupt sex
  • It is extremely good at preventing pregnancy
  • Menstruation is usually lighter and less painful
  • It is a low level of a very safe hormone
  • Often suitable for people who can’t take oestrogen
  • It’s usually quick and easy to take out
  • Can help with pre-menstrual symptoms (PMS)

Risks:

  • The procedure can be painful
  • Some have irregular bleeding
  • The IUS can come out (1 in 20)
  • STI check needed before putting it in
  • No protection against STIs
  • Can cause mood changes, skin problems or breast tenderness

Rare risks:

  • Can go through the wall of the womb when it’s put in (fewer than 1 in 1000)
  • Pregnancy outside the womb (ectopic pregnancy) – possible but very rare

Copper Coil (IUD)

Fewer than 1 in 100 women will get pregnant in one year.

The Copper Coil (IUD) is made of plastic and copper. It’s put into the womb by a doctor or a nurse and lasts 5 to 10 years. The method is popular as it has no hormones

Benefits:

  • It doesn’t interrupt sex
  • It doesn’t contain hormones
  • No need to remember pills or patches
  • Lasts 5 to 10 years
  • It is usually quick and easy to take out
  • It is extremely good at preventing pregnancy
  • Almost all women can use the IUD (speak to your GP)

Risks:

  • Can make menstruation heavier and more painful
  • Having it fitted can be painful
  • The IUD can come out (1 in 20) 
  • STI check needed before putting it in
  • No protection against STIs

Rare risks:

  • IUD can go through the wall of the womb when it is put in (fewer than 1 in 1000)
  • Pregnancy outside the womb (ectopic pregnancy) – possible but rare

Injection

3 in 100 women can get pregnant in one year when using depo injections.

The injection (or depo) is given as an injection into the buttocks or thigh every three months. It contains a hormone called progestogen. It is long-lasting and convenient, it can stop periods temporarily 

Benefits:

  • It doesn’t interrupt sex
  • It helps to make periods lighter and less painful
  • Most women (7 in 10) have no periods
  • Often suitable for people who can’t take oestrogen
  • It’s extremely good at preventing pregnancy
  • It protects against cancer of the womb

Risks:

  • It’s an injection, which some people dislike
  • May cause irregular bleeding
  • Weight gain is fairly likely (3kg in 2 years)
  • Possible changes in mood and sex drive
  • Not suitable for someone who definitely wants a regular period
  • It can take several months to wear off
  • No protection against STIs

Combined Pill

8 in 100 women can get pregnant in one year while using the combined pill.

The combined pill (“the pill” as most people call it) is taken daily and usually with a week off, once a month, to allow menstruation to happen. It contains 2 hormones, which are similar to women’s own hormones. Easy to start and stop, but can be difficult to remember to take

Benefits:

  • Easy to take; one pill a day
  • It doesn’t interrupt sex
  • The pill is good at preventing pregnancy
  • It helps to make menstruation lighter and less painful
  • Menstruation will usually be very regular
  • Easy to know and to control when menstruation will come
  • The pill can help with acne and spots
  • Some users notice enlargement of their breasts
  • It protects against womb and ovarian cancer
  • Protects against pelvic inflammatory disease

Risks:

  • Can be difficult to remember to take the pill
  • No protection against STIs

Possible side effects:

  • Spotting (bleeding in between periods)
  • Nausea
  • Sore breasts
  • Changes in mood or sex drive
  • Feeling more hungry
  • Blood clots in the legs or lungs (1 in 5,000 women)

Mini Pill 

8 in 100 women can get pregnant using the mini-pills.

The progestogen-only pill (mini-pill) is taken every day without any breaks. It contains a hormone which is very similar to one of the hormones produced by a woman’s body. It needs to be taken at the same time every day.

Benefits:

  • Easy to take; one pill a day, every day
  • It doesn’t interrupt sex
  • It’s good at preventing pregnancy
  • Under the user’s control
  • It’s out of the system quickly once stopped
  • Often suitable for people who can’t take oestrogen
  • It can help with heavy or painful periods
  • It may mean that periods stop (temporarily)
  • Can be used when breastfeeding

Risks:

  • Can be difficult to remember 
  • No protection against STIs

Possible side effects:

  • Irregular bleeding
  • Headaches
  • Sore breasts 
  • Changes in mood
  • Changes in sex drive

Patch

8 in 100 women will get pregnant in one year while using patches.

The patch is a square sticker like a thin plaster. It contains 2 hormones (oestrogen and progestogen) which are very similar to women’s own hormones. The patch is changed once a week

Benefits:

  • Easy to use; change once a week
  • It doesn’t interrupt sex
  • The patch is good at preventing pregnancy
  • It helps make periods lighter and less painful
  • Periods are usually very regular
  • Easy to know and control when a period will come
  • The patch can help with acne
  • Some users notice some enlargement of their breasts
  • It protects against womb & ovarian cancer and pelvic inflammatory disease

Risks:

  • It can be hard to remember when to change
  • No protection against STIs
  • Only available in a light colour making it visible on many women

Possible side effects:

  • Spotting (in between periods)
  • Nausea
  • Sore breasts
  • Changes in mood or sex drive
  • Increased appetite 
  • Blood clots in the legs or lungs (1 in 5,000) 

The Ring

9 in 100 women will get pregnant in a year while using vaginal rings

The vaginal ring is a soft plastic ring put in the vagina. It releases oestrogen and progestogen, which are similar to the women’s own hormones. The ring must be changed every 3 weeks with a week off

Benefits:

  • Easy to use; one ring lasts 3 weeks
  • It doesn’t interrupt sex
  • The ring is good at preventing pregnancy
  • It helps to make periods lighter and less painful
  • Periods will usually be very regular
  • Easy to know and to control when a period will come
  • The ring can help acne
  • Some users notice some enlargement of their breasts
  • It protects against womb & ovarian cancer and pelvic inflammatory disease

Risks:

  • Need to remember to change it once a month
  • No protection against STIs

Possible side effect

  • Spotting 
  • Nausea
  • Sore breasts
  • Change in mood or sex drive
  • Feeling more hungry
  • Blood clots in the legs or lungs (1 in 5,000)

Condoms

15 in 100 women will get pregnant in one year when using a condom during sexual activity

There are two different types of condoms, male condoms that are worn on the penis and female condoms which are placed inside the vagina. Condoms are made from very thin latex, synthetic nitrile, polyisoprene or polyurethane and can be used for vaginal, oral and anal sex. For men, the size and fit of condoms are important so that they are comfortable and don’t break or slip off. That being said, condoms are very stretchy and can expand.

Benefits:

  • Easy to obtain; clinics provide them for free
  • Available without the need to see a doctor, nurse or healthcare professional 
  • Protect against STIs
  • Gives men and women control over whether and when to have a baby
  • They may it easier to clean up after sex

Risks:

  • Condoms can interrupt sex
  • Condoms may reduce pleasure for either or both parties
  • It can be difficult to ask men to wear condoms
  • Some men worry about condoms and erections
  • Condoms need some skill; knowing how to stop condoms breaking or slipping off

Diaphragm

16 in 100 women will get pregnant in one year while using the diaphragm.

Diaphragms and cervical caps are cups made of silicone. It is put at the top of the vagina, to cover the cervix (neck of the womb). It’s used with spermicide (a cream that kills sperm). It is necessary to check if it’s in the right place before sex

Benefits:

  • Most women can use a diaphragm or cap
  • They are hormone-free
  • They can be put in up to 3 hours before sex
  • They offer some protection against STIs
  • Can have sex more than once with a diaphragm or cap in place (with extra spermicide) 
  • Skin to skin contact

Risks:

  • Diaphragms and caps are less effective than other methods
  • Technique needs a bit of practice
  • Need to be put in before intercourse
  • They need to be left in for 6 hours after sex
  • The spermicide can be messy
  • Some spermicides can increase the risk of HIV transmission 

Fertility Awareness 

25 in 100 women will get pregnant in one year using natural methods.

Fertility Awareness (natural family planning) is a way of predicting ovulation to work out when pregnancy is more likely. This method involves recording signs of fertility such as body temperature, thickness of fluid in the vagina and calculating fertility from menstrual cycle dates. Fertility awareness can be very effective (with daily monitoring).

Benefits:

  • Non-hormonal method
  • There are no side effects
  • The method involves learning how the body works
  • Skin to skin contact
  • Acceptable in most religions and cultures
  • Can be useful when trying to become pregnant

Risks:

  • It can be tricky to learn and takes a few months to monitor patterns
  • May have a higher risk of pregnancy
  • Daily monitoring is needed (temperature, thickness of fluid in the vagina)
  • Illness, stress or travel can make it hard to interpret signs
  • Unprotected sex must be avoided on the most fertile days
  • No protection from STIs
  • To work best, it should be thought by a qualified fertility awareness teacher, nurse, GP

Withdrawal 

27 in 100 women will get pregnant in one year when using the withdrawal method.

The withdrawal method (pulling out) is when a man pulls out before he ejaculates.

Benefits:

  • No need to see a doctor, nurse or healthcare professional 
  • Free 
  • No hormones
  • Acceptable for women whose religion or culture forbids other methods

Risks:

  • Requires extreme self control and body awareness of the man
  • It’s not a very reliable way of preventing pregnancy
  • There can be small deposits of sperm before orgasm (ejaculation)
  • Some people find withdrawal unsatisfying for sexual pleasure
  • Difficult to do it every time

Now that I have peaked your curiosity in this subject, I strongly recommend you read on the different methods in more detail on public health websites (NHS, etc.) to learn more about side effects, how they work, etc. You should also consult your GP as some methods may not be the right fit for you depending on your medical history.

If you would like to make an appointment to discuss your decision making process and the side effects of these methods please email me at depetrillojulia@gmail.com

Be kind to one another!

Julia, Sexologist

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Endometriosis

Hi Readers!

This weeks article is about endometriosis. Please note that this article is for anyone who has a uterus. This affects women who identify as women as well as trans* men.

This condition can affect individuals with a uterus of any age. 

Endometriosis is a condition where tissue similar to the lining of the womb starts to grow in other places, such as the ovaries and fallopian tubes.

It is a long-term condition that can have a significant impact on your life. This article will touch on the signs and symptoms, cause and treatments of endometriosis. 

How do I know if I have endometriosis?

Some women are severely affected, while others may not have any symptoms. The main symptoms of endometriosis are: 

  • Pain in your lower abdomen or back, usually worse during menstruations
  • Period pain that stops you doing your daily activities
  • Pain during or after sex
  • Pain when urinating or defecating during your period
  • Feeling sick, constipated, having diarrhoea or blood in your urine during your period (it is understandable if you cannot identify this correctly)
  • Difficulty getting pregnant
  • Heavy menstruations, using lots of tampons or hygienic pads, possibly even bleeding through your clothes.                   

For some, endometriosis can have a big impact on their life and may sometimes lead to feelings of depression. 

When should you visit your GP?

It is important to go see your GP or a healthcare professional if the symptoms are having a big impact on your life. Be prepared when you see your GP; it always seems more difficult to remember everything you are going through when you are sitting in front of them. To help with this, Endometriosis UK created a diary for you to fill out.

It can be difficult to diagnose endometriosis because the symptoms can vary and be similar to other conditions. The GP will examine your lower abdomen and vagina. If your GP thinks you have endometriosis, they may prescribe some treatment. If these do not work, they will refer you to a gynaecologist, who will perform ultrasound scans and further investigate. 

What are the treatments for endometriosis?

Unfortunately, there is no cure for endometriosis, but there are treatments that help ease the symptoms and manage the pain such as:

  • Painkillers (Ibuprofen and paracetamol – for my Canadian & American readers this is Tylenol, Motrin and Advil) 
  • Hormone medicines and contraceptives
  • Surgery to remove the patches of endometriosis tissue
  • Removal of part or all of the organs affected by endometriosis (hysterectomy)

Your doctor will discuss the options with you. Sometimes they may suggest not starting treatment immediately to see if your symptoms improve on their own.

What are the complications of endometriosis?

One of the main complications of this condition is difficulty getting pregnant or infertility.

There is a possibility of surgery to remove endometriosis tissue. This can improve the chances of getting pregnant. However, there are no guarantees that you will be able to get pregnant after treatment. Please be sure to speak to your surgeon about possible risks of this surgery. 

Living with endometriosis

Endometriosis affects women physically and emotionally. 

Endometriosis UK has a support group, a helpline (0808 808 2227) and an online community. 

Causes of endometriosis

Unfortunately, the cause of this condition is not known but there are several theories:

  • Genetics: this condition tends to run in the family and affects women of certain ethnic groups more than others
  • Retrograde menstruation: this is when the lining of the womb flows up through the fallopian tubes and embeds itself on the organs of the pelvis rather than leaving the body.
  • Problem with the immune system: the body’s natural defence against illness and infection
  • Endometrium cells spreading through the body in the blood or lymphatic system (a series of tubes and glands that form part of the immune system)

These theories do not fully explain endometriosis. It can be very frustrating for anyone not to have an answer to the question why this is happening? Where is this coming from?

The treatments that are offered for endometriosis, aim to ease the symptoms so they do not affect your day-to-day life. The treatments can be given to relive pain, slow the growth of endometriosis tissue, improve fertility or stop the condition returning. Before deciding which treatment is best for you, your gynaecologist will walk you trough the risks and benefits of each. There are things to consider when choosing your treatment; your age, are you trying to get pregnant, your feelings towards surgery and if you have tried any treatments before. 

If your symptoms are mild, you have no fertility issues or you are nearing menopause, it may not be necessary to have treatment. 

Sometimes endometriosis gets better on its own. Sometimes it can also get worse if it is not treated. This is why it is important to keep an eye on your symptoms and decide whether or not you want treatment if your symptoms do not improve and being to affect your daily activities. 

Fertility problems

Once again, it is not fully understood why it causes fertility problems but it is often suggested that it is due to the damage done to the fallopian tubes. Not all women with endometriosis will have problems getting pregnant, some will be able to get pregnant without treatment. 

Surgery sometimes helps as it removes the visible patches of endometriosis tissues but there is no guarantee that you will get pregnant. Some women and couples will decide to go down the in vitro fertilisation (IVF) route but if the women has moderate to severe endometriosis, they will have a lower chance of getting pregnant through this method. ( I have written an article about IVF treatment affects on your sexuality if you are interested.)

Adhesions and ovarian cysts

Some individuals with endometriosis will develop adhesions (sticky areas of endometriosis tissues that join organs together) or ovarian cysts (fluid filled growth in the ovaries that can sometimes become very large and painful). These can happen when the endometriosis tissue is in or near the ovaries. These can be treated with surgery, although there is a possibility these come back if the endometriosis returns. 

Bladder and bowel problems

If the endometriosis affects the bladder or the bowel, it can be difficult to treat and may require major surgery. You may be referred to a specialist. If it affects the bladder and you need surgery, this may involve cutting away part of the bladder. There is also a possibility of placing a catheter.

Please speak to your GP if you have symptoms or a family history. 

If you would like to arrange a counselling session around the effects it is having on your sexuality or self-esteem, please contact me to book an appointment.

Be kind to one another!

Julia, Sexologist

Julia, Sexologist Blog

We are here to help you grow. To improve, maintain and restore your sexual health. To help keep this blog going, any contribution will be helpful.

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