photo by Morning_theft

Every few weeks, Dr. Vanessa Cullins, a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America, will be answering your questions here. To ask her your own question, click here.

Dear Dr. Vanessa,

I am a 34-year-old female virgin. There were times with one ex when I thought I was ready, but it would start to hurt, I’d get scared and then wouldn’t go through with it. I was wondering if I should see gynecologist and have my hymen broken ahead of time to save me from some discomfort. Everything I’ve read has said first intercourse sex is never “magical.” Could this help?

– First-Timer

Dear First-Timer,

It is possible that stretching the hymen open might help. The hymen is the thin, skin-like tissue that stretches over part of the vaginal opening. Some women are born with more hymenal tissue than others. Many are born with so little that they may seem they have none. Often, women stretch their hymens open during activities that have nothing to do with sex. These activities include working out, gymnastics, horseback riding, and other sports. Penetrative masturbation — with or without sex toys, such as vibrators or dildos — may also stretch the hymen open.

Women with a lot of hymenal tissue can stretch it open slowly over time. A gynecologist can tell you how to obtain vaginal dilators. They are a series of increasingly thick rods that can be used to stretch open the hymen. Or you or your partner can use fingers in the same way. Start with the smallest finger that causes no discomfort. Then increase to two to three fingers over time. This type of dilation usually takes weeks. It is best done as a form of foreplay when you are aroused. Don’t attempt penile-vaginal intercourse until you have been comfortably dilated to about the size of a penis a few times.

The hymen, however, is not the only cause of painful intercourse — also called dyspareunia. There are two very common causes. One is insufficient sexual arousal before intercourse. This leads to a lack of vaginal lubrication, which leaves the vagina too dry to comfortably enclose a finger, penis or dildo. This may be resolved with more foreplay and/or the use of artificial lubricants such as K-Y or Astroglide. Read the rest of this entry »

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Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City and she answers your medical questions here once a week. To ask her your own question, click here.

Dear Dr. Kate,

When trying to conceive, are there things you can do to try to tip the scales in the direction of one sex or the other, i.e. so if you wanted a baby girl you could increase your odds and vice versa?

– Gender Bender

Dear GB,

There are some theories about trying for a girl or a boy, famously laid out in Dr. Shettles’ book, How to Choose the Sex of Your Baby. These ideas haven’t been tested in large-scale studies (though that would be interesting!), so I’d file this advice in your doesn’t-hurt-to-try-it folder.

Male sperm are thought to be faster but weaker swimmers, so to try for a boy, you want to have sex as close to the time of ovulation as possible. Have sex the day before and the day of ovulation, if you can. And the best positions are ones that get the deepest penetration—him entering her from behind, or on her back with her legs pulled back—to deliver the sperm closest to the uterus. Best of all, female orgasm helps move those little guy swimmers towards the egg, so she should try to climax around the time that he does.

Female sperm, on the other hand, are slower but heartier, so to try for a girl, you want the male sperm to have swum off (or died off!), leaving only the female ones behind. The best times to have sex are two or three days before you ovulate. Your guy should pull out slightly when he comes; this makes the sperm have to travel the length of the vagina, increasing the chances that the stronger female sperm will make it. And the woman should try not to have an orgasm when trying for a girl (oh, the irony).

– Dr. Kate
Gynotalk

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City. She also lectures nationally on women’s health issues and conducts research on reproductive health. Check out more of her advice and ask her a question at Gynotalk.com.

photo by Evil Erin

Please welcome Dr. Joe to our site! Once a month, Dr. Joe DeOrio, a urologist in Chicago, will be answering your questions on male sexual health. To ask him your own question, click here.

Dear Dr. Joe,

To circumcise or not to circumcise — what’s your medical take on the matter?

– Parent-to-Be

Dear PTB,

To snip or not to snip? That is the question. And, oh, what a question it is. While this is not the most difficult topic to discuss with a parent, it is one heck of a controversial topic to debate on the internet. There is an overwhelming abundance of information on the web, and like all information on the net, it’s confusing and difficult to navigate. Just googling circumcision returns over 11 million results. Is there a right answer? Well, I guess that depends on your point of view.

Circumcision started as a religious practice, well-known today in Jewish and Muslim culture, but it also occurred ritually in ancient Egypt and in many other cultures all over the world. In the United States, doctors began performing circumcisions as a way to discourage young boys from masturbating (it’s true!). Though its roots remain religious and cultural, the medical community has found health benefits to circumcision, thus justifying its non-religious practice. These proven health benefits, however, are not overly dramatic when you actually look at absolute improvements. For example, a 10-fold decrease in urinary tract infections seems pretty impressive, but you’d have to circumcise 100 boys to prevent just 1 infection.

If you believe that circumcision is proper from a religious or cultural viewpoint, far be it from me, or any doctor, to tell you differently. It is a relatively simple procedure, and has a very low complication rate. Complications, when they do occur, are almost always minor, and soon to resolve. Can bad things happen? Sure. Bad things can happen during any medical procedure, no matter how minor. Avoiding risk, however, is not always a strong argument against action. Fact is, bad things happen everywhere in life, yet we take the risk of living. And for those that refer to the procedure as “mutilation,” I can understand your argument, but it is nonetheless an accepted practice within our culture, just like body piercing and tattoos.

So let’s get to the skin of the matter, the medical pros and cons, so to speak. On the pro side, circumcision does decrease the risk for urinary tract infections in the newborn male (10-fold in the first 3-6 months of age), as well as decrease the risk for HIV transmission in the sexually active adult (>50% in men studied in sub-Saharan Africa). Circumcision has also been shown to decrease the risk for penile cancer. This finding, however, is likely more closely related to improved penile hygiene after foreskin removal. Finally, it also eliminates potential future problems arising from the foreskin itself, such as phimosis, which is scarring of the foreskin preventing retraction. Read the rest of this entry »

photo by stevendepolo

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City and she answers your medical questions here once a week. To ask her your own question, click here.

Dear Dr. Kate,

I have just recently started dating someone who ejaculates each time she has an orgasm. I’ve always wanted to experience it, and I think it’s totally hot. However, she ejaculates such a high volume that I am now wondering if it is actually urine.  Sometimes she gets really wet around the outer edge of her vagina, she will drip and things get very slick.  Sometimes I see a larger discharge from that same area, which comes from the side of her vagina and is clear and has a unique viscosity.  My perception is this is part of her ejaculate. Seconds later, however, she really sprays and it looks like it’s coming from her urethra (I think). It kind of smells like urine too. My questions, then, are: How do I tell the difference between urine and ejaculate?  If it does turn out to be urine, how do I talk to my partner about this? I don’t want to make her self conscious but I’m not sure I’m down with her peeing on me each and every time.

– All Wet

Dear A.W.,

It can be really hard to distinguish vaginal fluid (totally normal in all women when they’re aroused) from ejaculate (less common, but still normal) from urine (which happens to the best of us from time to time). The thicker, clear, mucus-like secretions (around her vaginal opening) are most likely from her vagina, and are a sign that she’s really aroused (good for you, as her partner, for doing your share!). The more watery liquid that’s transparent or milky is most likely ejaculate. But remember, unlike vaginal fluids which are secreted from the vagina, ejaculate emanates from the urethra, just like urine — so you can expect trace amounts of pee in ejaculate, or more if her bladder is full.

Therefore, the best way to reduce the chance of passing urine with sex or orgasm (whether female ejaculation occurs or not) is to empty the bladder right before sex. If your girlfriend regularly pees before sex—the best way to prevent bladder infections, incidentally—then it’s unlikely that the spraying fluid is urine. But if she’s not hitting the bathroom before bed, you can try making the suggestion to reduce the chance of accidental leakage.

Tread lightly, however—you don’t want her to feel self-conscious about her body or her enjoyment.

– Dr. Kate
Gynotalk

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City. She also lectures nationally on women’s health issues and conducts research on reproductive health. Check out more of her advice and ask her a question at Gynotalk.com.

photo by me_and_the_sysop

Every few weeks, Dr. Vanessa Cullins, a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America, will be answering your questions here. To ask her your own question, click here.

Dear Dr. Vanessa,

I’m 37 and for all my menstrual life I’ve been regular as clockwork, 29 days each cycle. And then suddenly in the last few months, my cycle has been all over the place — sometimes as low as 22 days long, and other times back up to 29 days. The only thing I’ve heard of that can do this to your period is menopause — could these be the beginning signs?! Is it possible to start experiencing symptoms at my age? And if these are early signs, does that mean I can no longer get pregnant?

– Ms. Irregular

Dear M.I.,

As we grow older, our bodies begin making less of the hormones estrogen and progesterone, and this could be the reason that your cycle has been unpredictable lately. The gradual change leading up to menopause is called perimenopause. Perimenopause usually happens around ages 45 to 50, but can begin as early as the late 30s. It usually starts about two years earlier for women who smoke than for those who don’t. Perimenopause is a stop-start process that can take a few months or can last up to 12 years.

It may be that you have stopped ovulating regularly and are having what is called dysfunctional uterine bleeding (DUB). DUB is very common. It is caused by hormonal imbalances which may be stimulated by excessive exercise, dieting, stress, or getting older.

DUB is diagnosed by ruling out other conditions that may cause irregular periods. Other causes include pregnancy, sexually transmitted infection, polyps on the cervix, hypothyroidism, cervical cancer, and using certain forms of hormonal birth control, such as the pill or the shot. The cause of your irregular period may be short- or long-term, and completely harmless or more serious. Because there are so many causes for the bleeding you describe, you must be evaluated by your health care provider. Read the rest of this entry »

photo by PinkMoose

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City and she answers your medical questions here once a week. To ask her your own question, click here.

Dear Dr. Kate,

What do you think of the new mammogram policy?

– Keeping Abreast

Dear K.A.,

I love it.

Unfortunately, medicine and science are great at producing tests and studies that become part of the standard care we receive long before we know if they do any good or not. Mammograms definitely save lives by finding breast cancer before we can feel a lump, but they’re not perfect — and I don’t just mean that they can miss a very small cancer. Mammograms can lead to unnecessary testing and biopsies that all have their own risks. And confusingly, they may pick up what are called indolent cancers — the slow-growing kind that would never kill someone — that then get treated, with all of the side effects that follow. How awful, to treat a cancer that didn’t need to be treated, then the woman has to live with the effects of the chemotherapy and radiation, that may cause additional serious problems.

So we need to balance the benefits and risks of this test, like all others. We need to give mammograms to enough women to save lives, but not give them to so many women that more women are hurt rather than helped by the tests. And that’s what the new guidelines aim to do. If you have a high risk of breast cancer (abnormal biopsy, strong family history), the new rules won’t apply to you. And the guidelines are not a hard-and-fast rule; you and your doctor can work out a testing schedule that feels right to both of you. And for the majority of women, these guidelines may be just right.

– Dr. Kate
Gynotalk

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City. She also lectures nationally on women’s health issues and conducts research on reproductive health. Check out more of her advice and ask her a question at Gynotalk.com.

photo by Helga_Weber

Every few weeks, Dr. Vanessa Cullins, a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America, will be answering your questions here. To ask her your own question, click here.

Dear Dr. Vanessa,

Okay, so I have a very embarrassing question for you and wanted to check with you before I go see a health provider. This past weekend, I went away with a guy I have just gotten into a relationship with. He is my second sexual partner and has been checked for STDs recently, as have I.  This weekend, we had sex fairly often, and we also used a vibrator that, unbeknownst to him, was not meant to go inside me. Even though I pulled it out, I have been feeling a lot of discomfort since we got back.

I have a lot of whitish discharge and it has a terrible odor, not to mention the fact that I am very sore. Could this be a case of irritation due to the “foreign object” or possibly a case of BV? If it is just irritation, then I would prefer not to pay for a medical visit, but if it’s BV, my understanding is that I should get antibiotics. Any ideas would be appreciated.

– Saddle Sore

Dear S.S.,

You should be seen by a health care provider. Whenever a woman has an irritation of the vagina and an abnormal discharge — vaginitis or vulvovaginitis — she should see her health care provider and try to get a definitive diagnosis. Because the discharge you describe has a strong, unpleasant odor, three possible causes of vaginitis come to mind.

The first possible cause is what you suspected — bacterial vaginosis (BV). It is a condition caused by several bacteria, including gardnerella vaginalis. (BV used to be called “nonspecific vaginitis.”) Usually there is a heavy vaginal discharge. It is grayish and frothy and has an unpleasant, “fishy” odor. Most women have at least one incident of BV in their lives. Read the rest of this entry »

photo by woodleywonderworks

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City and she answers your medical questions here once a week. To ask her your own question, click here.

Dear Dr. Kate,

There’s been an ad for egg donors in the paper for the last few weeks. This isn’t something that usually would have caught my eye at all, but the kicker? They’re offering $5,000 compensation for one bout of egg donation. For a struggling college student, this seems like it could definitely be worth it, however I’m slightly worried about the process and risks that could accompany egg donation. How many eggs do they take? Could it affect my fertility later? What sort of risks are associated with getting the eggs out? Any guidance you could give me would be fantastic, and thank you!

– Ms. Eggscavation

Dear Ms. E.,

Donating eggs to an infertile couple is a wonderfully selfless act, but is a lot more difficult than donating sperm (as evidenced by the much higher payment rates). Women who wish to be donors undergo a rigorous screening process to make sure that they’re in great health, with no family history of genetic problems.

Women who qualify for donation typically go on birth control pills for a month or two to regulate their periods, then begin a series of daily self-injections to make your ovaries produce as many eggs as possible. These are generally shots into your belly, and they do hurt a little. The risks of the hormones are low, but include incredible bitchiness.

Once your ovaries appear to have made enough eggs (determined by ultrasound), the doctors remove the eggs via a skinny needle that’s placed into your ovaries through your vaginal wall (don’t worry, you’ll be sedated during the process). The risks of egg retrieval are generally low as well, and include bleeding and infection. You won’t damage your own egg supply—you have plenty of eggs to be able to have your own children later—and the best evidence says that you’re not affecting your own fertility in any way.

Beyond the physical risks, though, you need to consider the possible psychological ones—can you live knowing that there might be a little boy or girl (or three) out there who is genetically half you? If you’re really interested in pursuing donation, make an appointment with the medical staff, and find out all of the information about it.

– Dr. Kate
Gynotalk

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City. She also lectures nationally on women’s health issues and conducts research on reproductive health. Check out more of her advice and ask her a question at Gynotalk.com.

photo by procsilas

Every few weeks, Dr. Vanessa Cullins, a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America, will be answering your questions here. To ask her your own question, click here.

When I have sexual intercourse with my boyfriend, whenever he hits my G-spot it feels good but it hurts far more than it pleasures. Is it suppose to hurt so much? It happens every time and usually post love making I will have a kind of sharp pain in my lower abdomen, and I was just wondering if something is wrong with me to experience this pain from G-spot stimulation. And it has always hurt in past sexual encounters with past boyfriends that have hit my g-spot.

Some women do report that their G spots are very sensitive and cause discomfort or pain when they are stimulated directly.  A change in position during vaginal intercourse may solve the problem.  In some positions, the penis is less likely to directly press on the G spot.

For readers who may be wondering what the G spot is, it is located within the vagina, about one to two inches from the vaginal opening.  It is on the anterior vaginal wall of the vagina.  Think of the vagina as a tube.  The anterior vaginal wall of the vagina is the top portion of the vagina on the same side as a woman’s belly button.  (The bottom part or posterior part of the vagina is on the same side as her rectum.)  The G spot contains spongy tissue that may feel rougher than other areas of the vagina.  The area is usually bean-shaped and about the size of a quarter.  “Hitting the G spot” during penile vaginal intercourse or through masturbation or “fingering” your female partner can result in intensely satisfying orgasms.

Now back to the question: a very sensitive G spot is not the only possible cause.  It is also possible that the pain you feel after intercourse is unrelated to the pain you feel during intercourse.

There are many causes of pain before, during, or after sexual intercourse.  Sometimes the cause is emotional.  It could be fear, anxiety, or a previous traumatic experience during sexual intercourse.  Sometimes pain is caused when a woman is not aroused enough or is not lubricated enough.  And sometimes the cause is from an infection or other problem with the internal reproductive organs.  This could be a sexually transmitted infection or a non- sexually transmitted condition such as endometriosis, polycystic ovary syndrome, a tilted uterus, or fibroids.

The best way to find out what is causing pain is to consult your health care provider.  Have a conversation about the pain you feel during intercourse and the pain you feel after.  Your provider may want to give you a physical exam to see if there is a physical condition that could be causing one or the other or both.

No one should experience pain as a regular part of sexual activity.  As always, anyone who finds sex to be consistently painful should definitely check with a doctor or nurse.

Best wishes for your good sexual health,

Vanessa
Planned Parenthood

photo by mistress_f

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City and she answers your medical questions here once a week. To ask her your own question, click here.

Dear Dr. Kate,

My boyfriend and I have been together over a year and a half and we’ve been having very good sex for about that length of time as well. However, for the last two months or so, every time we have penetrative sex it is painful. I feel like the angle is off and my vaginal opening is ripping. After the third time, I checked, and sure enough, the anterior part of my vaginal opening is tearing, into the perineum. Since then, we have tried to find ways to either alleviate the pain or change positions during sex to keep it from happening, but to no avail.

My boyfriend’s penis is quite girthy around the base, and I think that may be the problem. The tearing is quite painful and becomes irritated when I urinate. What can I do to prevent this? What can I do to fix it? Or should I be concerned about an infection or growth causing the sporadic pain?

– Oh Oh Oh Arghhhh

Dear O.O.O.A.,

Good sex shouldn’t make you bleed or hurt. Because you can actually see a tear, I would see your gyno first thing, to make sure that there’s no underlying problem with the skin around the opening of your vagina. If you get the clean bill of health, it may be that your vagina isn’t ready for intercourse when you start — you need to be fully aroused (where your vagina engorges with blood and actually gets wider and longer) and lubricated for maximum comfort. Make sure you’re getting enough foreplay — at least 20 minutes of toe-curling activities — and try using a lubricant. You can also try positions where you control both the speed and the depth of his penetration, like you on top. Also, you might want to check out two other related posts on this site:

• Sex Hurts At First
• Sex with My Girlfriend Is a Tight Squeeze

– Dr. Kate
Gynotalk

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City. She also lectures nationally on women’s health issues and conducts research on reproductive health. Check out more of her advice and ask her a question at Gynotalk.com.