photo by Blyzz

This week, Dr. Joe DeOrio, a urologist in Chicago, tackles questions about male sexuality. To ask Dr. Joe your own question, click here.

Dear Dr. Joe,

Is there any way to increase sperm count to help my wife and I get pregnant?

– Breeding

Dear B, Read the rest of this entry »

photo by stepheye

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

Dear Dr. Kate,

My husband sometimes likes to make me “squirt” (the female equivalent of ejaculation). He does this by fingering me really deep and hard. It feels insanely good, but I’m curious… is this safe? Are there any risks involved in doing this, like infections or irritation? Sometimes, because he’s fingering me rather hard, I bleed a little bit, but it often stops within minutes. Is that normal?

– My Cup Runneth Over

Dear M.C.R.O.,

When it comes to safety in sex play, your body is often the best judge — if you’re not in pain with a particular activity, then it’s likely safe (apart from infection risk in general). What worries me, though, is that you’re bleeding — bleeding during penetration (unless you’re on your period) is not normal. He may be irritating your cervix, which may be inflamed from an infection, or aggravating a benign polyp. But I’m also concerned that he may be causing a shallow cut in your vagina itself.

I would go see your gyno for an internal exam and testing for vaginal and cervical infections — please tell your doctor what your concerns are, so she knows what to look for. If your exam is completely normal, I would be less worried. As long as his finger is clean and his nails are trimmed, fingering you shouldn’t increase your risk of infection. But the bleeding is a sign that all may not be well.

– 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.

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,

The last time I tried going on the Pill, it made me crazy (depressed, overly emotional, etc). Can you recommend a brand that has fewer mental effects? I also remember gaining weight — are there ones that are better at not making you retain water? And is there a pill that has neither of these side effects?

– Cross-legged

Dear C.L.,

In general, mood swings, depression, and weight gain are not associated as frequently with the newer low-dose formulations of the pill. These side effects were associated more frequently with earlier formulations that relied on much stronger doses of hormones.

Some women, however, have idiosyncratic responses to various formulations of the hormones — estrogen and progestin — which are used in the pill. Some women are not good candidates for the pill use because of their individual responses to either or both of these hormones. Depending on your symptoms, your health care provider may be able to prescribe a pill that does not affect you in these ways. But finding just the right one will be a process of trial and error.

Many women who have had these side effects while using the pill, find that switching to a pill with lower doses of both estrogen and progestin or a formulation that contains a different progestin or switching to alternative delivery systems —such as the contraceptive implant, patch, or ring — reduces the unwanted effects of the hormones. (We do not suggest the shot as an alternative for women concerned about weight gain because weight gain is more frequently associated with the shot.)

Another alternative for women who are sensitive to the hormones used in the pill is the intrauterine device (IUD). One IUD, ParaGard, contains no hormones and can be used for 12 years. The other, Mirena, does contain progestin, but no estrogen. It can be used for five years.  It is very unusual for women to experience unexpected weight gain, mood swings, and depression with their use of an IUD.

To find the method that is best suited for you, talk with your health care provider about your experience with the pill. Discuss the possibilities of using a different formulation, and explore the options for different delivery systems.

In the meantime, best wishes for your good sexual health,

Vanessa
Planned Parenthood

Vanessa Cullins, MD, MPH, MBA, is a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America.

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 every two weeks. To ask her your own question, click here.

Dear Dr. Kate,

After several unsuccessful attempts at having intercourse (due to pain), I talked to my doctor. My doctor told me to practice using tampons. I can’t even push a tampon all the way in!  It hurts or feels uncomfortable. What’s wrong with me? I have a healthy sexual relationship with my partner, but I really want to experience vaginal intercourse. What do I do?

– Shut Shop

Dear S.S.,

It sounds like you’re suffering from vulvodynia (pain in the vulva), or vaginismus (muscle spasms of the vagina), or even both. And having these conditions is not a reflection on your relationship. We don’t know what causes the vagina to interpret normal touching as pain, but the pain you’re feeling is definitely real. If the pain is from vulvodynia, a combination of topical medication and oral medication can help to relieve the pain. And dilator therapy has been used successfully in both conditions; by inserting a series of dilators into your vagina over several weeks (the smallest one is smaller than a tampon), you can help your vagina get used to the presence of something there without pain.

There are also physical therapists who specialize in sexual dysfunction. If your gynecologist is unable to help you figure out exactly what the problem is, you need to find someone with more experience — either get a recommendation of a great gyno from a friend, or consider joining the National Vulvodynia Association to get access to specialists in your area. But please don’t give up — many women with vulvar pain can find enough relief to have intercourse without pain, once they find the right help.

You can also check out the pain installment of my Female Sexual Dysfunction series for further reading.

– 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 via Flickr

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

Dear Dr. Kate,

I am a woman with oral herpes. Is this something I should tell new partners before kissing them? (Assuming I am not in the middle of an outbreak.) And if he asks about the possibility of contracting oral herpes from me between outbreaks, what can I tell him are the risks? What about the risk of me giving him oral herpes if I give him a blowjob between outbreaks?

– Don’t-Kiss-Me Kate

Dear D.K.M.K.,

The issue of disclosing an oral herpes infection is really tricky. On the one hand, you want to be honest with your partners — that there is a chance of transmitting the infection when you kiss, even if you’re not having an outbreak. But it’s also true that about 60-80% of adults in the US have the “oral herpes” (herpes simplex I) virus. So the odds are that your partner already has the virus, even if they’re not aware of it.

We don’t know exactly what the odds of transmission are — you’re right that if you don’t have a cold sore, the odds of giving them the infection are lower, but we don’t know how much lower. Same goes for transmitting the virus during oral sex — it’s less common (but very possible) to give your partner genital herpes, even if you’re between outbreaks. The good news there — if you can call it that! — is that genital herpes caused by the herpes type I virus is less intense, and less likely to recur, than the infection caused by the herpes type II virus. But it’s still a good reason to use a condom, even during oral sex.

– 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 via Flickr

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 haven’t had sex in over 8 months. When I finally do have intercourse again, will it hurt like when I lost my virginity?

– Cross-legged

Dear C.L.,

Most likely not. It’s common for a woman to feel pain the first time she has intercourse. Often, this is from the stretching of her hymen, which is tissue that blocks part of the opening of the vagina. All girls are born with a hymen. Some girls have a lot of hymenal tissue, and their first intercourse can be painful unless their partners are patient about slowly stretching the hymen open. Some girls and women have so little hymenal tissue it may appear that they have none. In any case, once the hymen is stretched open by vaginal intercourse or by various kinds of exercise, it does not grow back again, no matter how long a woman goes without sex. So you should not worry about sex being painful because of your hymen.

Having a hymen is not the only cause of painful intercourse, though. Your next intercourse could be painful if you are not sexually aroused enough to be sufficiently lubricated for comfortable penetration. Many women find using lubricant makes sex more comfortable and pleasurable.

It could also be painful if you are fearful or anxious about having intercourse. Fear and anxiety can cause vaginismus, the medical name for painful intercourse that has emotional causes. Talking with your partner about what you would like to do and what feels good to you may help you relax and enjoy yourself.

There are some other less common causes of painful intercourse, but if you were enjoying sex without pain before you stopped having it eight months ago, it is very likely that will still be the case for you if and when you decide to have sex again. If you decide to have sex and do find it to be consistently painful, I recommend you talk with your health care provider, who can help you figure out the cause and get the best treatment.

In the meantime, best wishes for your good sexual health,

Vanessa
Planned Parenthood

Vanessa Cullins, MD, MPH, MBA, is a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America.

photo by longhorndave

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

Dear Dr. Kate,

My girlfriend’s vaginal fluids sometimes smell and taste funny (not a good funny). I read online somewhere that there are drops you can place on a woman’ vagina to make it taste and smell good. Are these real and are they safe? I know my girlfriend would allow me to use these on her as long as they’re safe.

– Nose

Dear Nose,

I don’t know what drops you’re specifically referring to; my quick search for remedies turned up tea tree oil, neem bark extract and garlic. To the best of my knowledge there’s been no published studies of these products, taken either orally or topically, to gauge their effectiveness. But I do know that the application of any product to the vulva or vagina that wasn’t meant to be there increases the risk of irritation, discharge and yes, infection. So I would proceed with caution before using any of these remedies.

The smell and taste of a woman’s body normally varies throughout her cycle, but they can also be affected by common vaginal infections (like bacterial vaginosis). If your girlfriend notices an odor, her best bet is to see her gyno to be checked for vaginal and cervical infections. You can also check out the recent column by Em & Lo, How Can I Smell & Taste Better Down There?

– 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 via Flickr

This week, Dr. Joe DeOrio, a urologist in Chicago, tackles questions about male sexuality. To ask Dr. Joe your own question, click here.

Dear Dr. Joe,

I am BEYOND confused because none of the information related to HPV seems to focus very much on HPV in men. Once a man has it, is it possible that the virus can go away completely? I don’t mean the symptoms (as I am aware that they often go away on their own), but the VIRUS that causes these symptoms? Will a man who once had the virus ever not be contagious? And would a man benefit from the HPV vaccine?

– Confused

Dear Confused, Read the rest of this entry »

photo by Janine

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

Dear Dr. Kate,

I’m beginning to wonder if I’m unable to have an orgasm. I’ve been sexual with a partner for the first time in the past year with oral and intercourse. During intercourse, I can barely feel anything, and other types of stimulation don’t bring me to climax. What can I do? Is there something wrong with my body?

– Turned Off

Dear T.O.,

A true inability to orgasm is really rare — it’s more likely you haven’t hit on the right combination of sensations yet. It can take time to learn your body and what stimulates you. And it’s very common for intercourse alone to not arouse you, if the angles are wrong and your clitoris isn’t getting any stimulation.

Have you tried masturbation, or a vibrator? It may be easier to experiment alone, without the pressure of a partner, to see what kinds of pressure, speed and touch work to get you off. Once you’ve mastered the art of orgasm when you’re alone, you can then better guide your partner as to how to touch you to make you climax — and any partner worthy of you will want to be guided, because they’ll want you to enjoy sex as much as they do.

For further reference, here are some recent columns by Em & Lo on the topic of orgasms:

• My Boyfriend Can’t Give Me An Orgasm
• My Boyfriend Doesn’t Care About My Orgasm
• 15 Reasons Why Everyone Should Masturbate
• What’s a Good My First Vibrator?
• 10 Steps to Orgasming Without a Vibrator
• Toys Terrify My Boyfriend

– 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 via Flickr

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 don’t want any more kids, but I really don’t want my tubes tied and my husband doesn’t want the snip either. What are our other permanent or semi-permanent birth control options? I really don’t want to have to remember a daily pill anymore.

– Sorta-Commital

Dear S.C.,

There are a few options for long-lasting reversible birth control that work as well as or better than some forms of permanent birth control. One is a contraceptive implant called Implanon, which can be worn for three years. Another is an intrauterine contraceptive (Editors’ note: IUC, or the birth control formerly known as an IUD): Mirena contains hormone and can be worn for five years; Paragard contains copper and can be worn for 12 years. There’s also the Depo Provera shot. Here are some of their pros and cons:

1. Implanon: If you choose Implanon, your clinician will put a small implant under the skin of your upper arm.  It will constantly release small amounts of a progestin, the hormone called etonogestrel, which will prevent the ovaries from releasing an egg (ovulation) and also thicken cervical mucus to prevent sperm from joining an egg (fertilization).

Implanon is more than 99.9 percent effective — more effective than some forms of permanent birth control.  The advantages to Implanon are that it can be used by women who can’t take estrogen, there is no pill to take daily, it provides long-lasting birth control but is not permanent, and the ability to become pregnant returns quickly when use is stopped.

The possible disadvantages of the implant include irregular bleeding patterns; headache; change in sex drive; discoloring or scarring of the skin over the implants; soreness, bruising, or swelling for a few days; rarely, a woman may need medication for infection or pain, and rarely, a woman may have pain at insertion site for longer than a few days. Other possible side effects include nausea and sore breasts, but usually for only the first two or three months of use.

The cost for three years of protection with the implant ranges between $400 and $800.  It costs $75 to $125 to have the implants removed.

2. IUCs: If you choose an intrauterine contraceptive (IUC), your clinician will put a small plastic device in your uterus. The IUC contains either copper (ParaGard) or the hormone levonorgestrel (Mirena) that will keep sperm from joining the egg. IUCs are more than 99 percent effective against unintended pregnancy — better than some forms of permanent birth control.  The advantages of IUCs include not having to put anything in place before intercourse, not having to take a pill every day, and the ability to become pregnant returns quickly when the IUC is removed. The Mirena may help reduce menstrual cramps. The ParaGard can be used during breastfeeding.

The possible disadvantages of IUC use include spotting between periods. Use of the ParaGard may increase cramps and heavier and longer periods. Rarely, insertion of an IUC can lead to infection, which, if left untreated, could lead to infertility. And rarely, the wall of uterus is punctured during insertion. Pregnancies, which rarely occur with IUC use, are more likely to be ectopic (not in the uterus). The cost of five to 12 years of protection with IUCs is between $175 and $650.

3. Depo-Provera: Some people include contraceptive injections in the category of long-acting reversible contraceptives. The most common brand of injection is Depo-Provera. Each injection of the hormone progestin provides three months protection against unintended pregnancy. It is between 97 and 99 percent effective. Its advantages and disadvantages are similar to those of the implant. The cost is from $35 to $75 dollars an injection plus the cost of the doctor visits.

So there are many great alternatives for long-lasting reversible contraception for you to consider. For more information, you can visit Planned Parenthood.

In the meantime, best wishes for your good sexual health,

Vanessa
Planned Parenthood

Vanessa Cullins, MD, MPH, MBA, is a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America.