photo by Helga_Weber

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,

A couple of weeks ago I douched after my period ended. A couple of days later, I had intercourse. A few days after that, my vagina started itching around the outside, and when I went to urinate I noticed my discharge was kind of like cottage cheesey, milky color and no smell to it. It worried me because it’s never been like that before but I had never douched either. A couple days later I had intercourse again and it was a little painful at the end and burned when I urinated. Now it’s back to normal. Should I worry and get checked or is it an after-effect from douching?

– Don’t Call Me a Douche

Dear D.C.M.A.D.,

The symptoms of itching and cottage-cheese discharge are classic for a yeast infection, as are pain during intercourse and during urination. A yeast infection isn’t dangerous, just incredibly uncomfortable, and it may resolve on its own. So if you’re feeling well now, there’s no need to rush to the gyno.

But your experience is a perfect example of why NOT to douche. Your body cleans itself after your period — there’s no need to douche. Even douching with plain water can wash away healthy bacteria (increasing your risk of vaginal infections), or push bacteria up into your uterus (increasing your risk of PID). Showering and standard, external washing is sufficient to keep you clean.

– 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 brandi666

This week, Dr. Joe DeOrio, a urologist in Chicago, tackles the male version of EMandLO.com’s most popular post to date, the anonymous confession “I Want to Do My Boyfriend with a Strap-On.” To ask Dr. Joe your own question, click here.

Dear Dr. Joe,

My girlfriend is really into not just receiving, but giving anal play, if you know what I mean. I consider myself fairly open-minded, but I can’t get past the idea that that seems gay or girly. And what I am really worried about is liking it too much. Should I just give it up to her (hey, try it, I might like it!), or just accept that this is just my own sexual preference?

– Tight Ass

Dear T.A.,

Sounds like you are a little bit confused, perhaps even a bit nervous.  And from the tone of your question, it seems you aren’t particularly interested in receiving anal sex.  Want a simple answer?  Don’t do it.  Want a bit more complex answer?  Read on.

First, ask yourself a couple questions, and give some honest answers:

1. Why does your girlfriend want to perform anal sex on you?
2. Why are you (or why are you not) interested?

For example, if your girlfriend wants to try anal sex because she thinks it may be adventurous or sexy or make you two feel closer, then this may be healthy.  If it truly excites her, this is healthy too.  Don’t you want to make her really excited?  On the other hand, if you suspect that she wants to try anal sex in order to belittle or degrade you in a malicious manner, then this is obviously not a good idea (unless you are a BDSM slave, and that’s your thing).

In terms of how you feel about the act, try to look at it objectively.  Are you really not interested in trying anal play?  As you said, you may really enjoy it.  And if you do, what’s the downside to that?  I understand the cultural or religious taboos that anal stimulation may evoke, but do these taboos have significant meaning for you?  Or are you just worried about being embarrassed if someone discovered your new bedroom activity?

It ultimately comes down to your comfort level.  If you won’t respect yourself in the morning, best leave anal play at the front door.  But if you are a bit curious, and you have a partner you can trust to keep your sexual life private, then swing open the back door!

Does trying anal sex mean that you are gay?  Of course not.  If a man that defined himself as gay had sex with a woman in his youth, would he automatically be considered straight?  Undoubtedly, labeling sexual acts as gay, straight, kinky, boring, immoral, etc. is an inherently faulty (and silly!) endeavor.  In a loving relationship, the old adage you mention (“try it and you might like it”) is probably decent advice.  Explore your sexuality, and learn what truly brings you pleasure.

Having said that, some words of advice:

• If you are absolutely not interested, or you are very uncomfortable, don’t do it.  Your self-respect and dignity should never be compromised.
• If anal play doesn’t bother you from a religious or cultural standpoint, and if you won’t feel like less of a man for exploring it, then give it a shot.  If anal sex was important enough to your girlfriend to bring it up, it is important enough for you to consider it.  If you don’t like it, you can always stop.  Besides, you’ll make your girlfriend really happy for doing something for her.  How many times have you begged her to do something for you in bed?
• Only explore sexual acts in a loving and trusting relationship.  You don’t want to find out next week that she told all your friends about it.
• Remember that pushing a little bit outside of your comfort zone allows for new experiences and personal growth.  This is true both inside the bedroom and outside of it.

Finally, if you decide to give anal sex a try, remember the following:

• Practice safe sex.  Always.
• Use lots of man-made lubrication; the anus is not self-lubricating.
• Go slowly — it’s not a race, and if you rush, it will hurt (or worse, do some damage).  This applies to both the speed and size of what you insert (be it a pinkie or a strap-on).
• Whatever was used on you should not be used on your girlfriend without being sterilized first. Germs can cause infection.
• Communicate with your partner.
• Relax and enjoy yourself.

– Dr. Joe

Dr. Joe earned his undergraduate degree in Molecular Biology from Princeton University. After attending the Loyola University Stritch School of Medicine, he completed his residency training in urological surgery at the Los Angeles County Medical Center. He lives and works in Chicago, IL. Keep an eye out for his upcoming blog at docjoe.net.

photo of Old Faithful by Chuck Martin

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 wondering if it is possible for a woman to urinate during orgasm? I realize that what I am experiencing may be female ejaculation, but everything I’ve read about it seems to stipulate that it usually happens during G-spot stimulation. The only times I’ve ever experienced this was during clitoral stimulation. Is it possible that it is female ejaculation even without G-spot stimulation, or could I really be urinating when I orgasm?

– Old Faithful

Dear O.F.,

Women’s anatomy can be strange sometimes. You’ve got the pleasure button of the clitoris located right above the functional button of the urethra, and it’s difficult to stimulate the former without some sort of sensation going to the latter. So it’s definitely possible that you’re urinating when you come — especially if you have noticed that you leak urine at other times (like when you cough or laugh).

Female ejaculation is still very controversial among doctors. Some believe that it represents fluid coming from the glands around the urethra, but many others think that any kind of fluid release is either urine or lubrication.

Emptying your bladder before sex can reduce the chance of urine leakage when you climax. And if you do notice pee leakage at other times, Kegel exercises can help strengthen your pelvic muscles (which has the added bonus of more pleasure during intercourse).

– 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 Janine

For the past few weeks we’ve been talking about sex that hurts — and not in a heartache kind of way. Two weeks ago we published an excerpt from When Sex Hurts: A Woman’s Guide to Banishing Sexual Pain. Then last week we published a basic overview of the causes of painful sex. So many women still don’t admit to having this problem — they may write in to an anonymous advice column like ours, but they won’t necessarily admit it to their gynecologist. Today we present a Q&A with Dr. Caroline Pukall and Dr. Andrew Goldstein, coauthors of When Sex Hurts, addressing some of the most common questions they hear about painful sex.

What is the most common cause of sexual pain?

There are many causes of sexual pain, the most common being vestibulodynia, the most common type of vulvodynia, which is chronic vulvar pain which has no known cause. Vestibulodynia is characterized by a severe burning pain at the entrance of the vagina during activities that involve vaginal penetration; the most common complaint of women with this condition is dyspareunia — pain during sexual intercourse. Women with vestibulodynia may also have pain during nonsexual activities, such as gynecological examinations.

What are some surprising contributors to sexual pain?

Oral contraceptives pill are probably the most common cause of sexual pain. Most physicians are not aware of this.

Why do you think as many as 40% of women who suffer from sexual pain won’t seek medical care?

Many women feel too embarrassed to bring up the topic with their healthcare provider as it involves sexual activity and pain in the genital area. Talking about such personal issues may be too uncomfortable for them despite the pain and negative consequences of the condition.

How can a woman identify the source of her sexual pain and how can she best communicate her pain to her doctor?

The best approach is to document as many aspects of the pain experience as possible, for example, when the pain started, and what other factors were happening at the time, such as, beginning a new medication; where the pain is located; how the pain feels, e.g., sharp, throbbing, burning; how long the pain lasts and during which activities it starts or worsens (even sexual ones!); how the pain is affecting one’s life; and what things make the pain better versus worse. A complete history like this can help the healthcare provider make an accurate diagnosis. Also, speaking about the pain in as factual a manner as possible while calmly discussing its effects will allow the healthcare provider to get an accurate picture of the pain and its consequences.

What are some prescribed treatments for sexual pain that, in fact, don’t work?

Many women are given prescription after prescription of antibiotics or anti-yeast medications when in fact, only rarely are infections the cause of chronic sexual pain. In addition, women are frequently given topical steroids, but steroids alone rarely work as a treatment for sexual pain.

Read the rest of this post on SUNfiltered

MORE ON PAINFUL SEX FROM EM & LO:

• Dr. Kate on Female Sexual Dysfunction: Pain Problems
• When Some Sex Positions Hurt
• Sex Starts Out Fine, Then Becomes Painful
• When Your G-Spot Hurts
• Why Am I Sore After Sex?
• How to Make First-Time Sex Less Painful
• Is Painful Sex Ever an Issue for Guys?
• Swollen Vulva & Painful Urination Post-Sex
• Painful Sex After a C-Section

photo via Flickr

Once a month, Dr. Joe DeOrio, a urologist in Chicago, answers your questions on male sexual health. To ask him your own question, click here.

Dear Dr. Joe,

My question is about my boyfriend’s “flavor.”  In the last few months I have noticed that the taste of his semen has gotten much more sour and salty tasting, to the point that I can barely even perform oral sex because of the taste of his pre-ejaculate.  When I do swallow, I become nauseated and develop a stomach ache for hours afterward, regardless of whether I have a full or empty stomach.  He hasn’t changed his diet or had any major health issues.  I don’t want to take this pleasure away from us both, but I can barely bring myself to go down on him anymore.  Is this problem fixable?  Do you think it is me becoming more sensitive to his taste or is it possibly something about his physiology that has changed?  I’d really appreciate any feedback; it would certainly put a smile back on both of our faces!

– Sour Puss

Dear S.P..,

When I was 8, my grandfather gave me a sip of his scotch – it tasted like crap.  Now, almost 30 years later, I think a good scotch is one of the finer pleasures in life.  Tastes change.  I don’t know why.

Though everything was fine for a while, it now appears that you have a case of the ol’ funky spunk.  This topic has been discussed in numerous forums all over the internet and even on popular television shows such as Sex and the City (their cure was wheatgrass shots!).

Most people who dislike the taste of ejaculate complain of a bitter or salty taste, much like you.  Thus most “remedies” seek to make semen sweeter.  But, in the end, you will have to find what you like.  Why your boyfriend’s semen formerly tasted good but no longer does I cannot explain.  Nonetheless, I sympathize with your problem, and I understand that it is affecting your sex life adversely.

As you can imagine, learning to alter the taste of sperm was not at the top of the medical school curriculum.  Understandably, it wasn’t even part of the curriculum.  From a scientific standpoint, semen is composed of water, various proteins, vitamins, sugars, salts, and cholesterol.  The little swimmers only compromise about 1% of the total volume.  How to alter the ratio a bit for a better taste?  Unfortunately, there is not a lot of scientific research of the subject.  I could just imagine the proposal for that one!  There is, however, no shortage of opinions.

Assuming no infection, it is generally agreed that sperm taste is affected by diet and overall health.  Seems logical enough, as diet can affect the taste of many body secretions – just stand next to anyone who’s had some raw garlic!  So what can you do?  The best answer: Experiment!  And that can’t be all bad.  Try adding or subtracting foods one at a time, and see how the change affects the taste.  To give you a head start, here are some general recommendations for him:

• Avoid coffee and alcohol
• Avoid smoking and recreational drugs
• Decrease red meat, dairy, and fried foods
• Drink plenty of water (perhaps a liter or 2 a day)
• Eat plenty of vegetables (though avoid high-sulfur foods such as onions, garlic, broccoli, asparagus, and cabbage)
• Eat plenty of fruits, especially pineapples, papayas, and bananas
• Pineapple juice (use a juicer!) is touted as the magical elixir.  Proponents suggest 24 ounces per day, but be careful – that’s about 400 extra calories per day
• Some people recommend parsley, wheatgrass, and celery
• Others recommend cinnamon, cardamom, peppermint, and lemon
• Get enough sleep
• Exercise

In general, live a healthy lifestyle while experimenting with the foods.  If none of these suggestions help, make sure your boyfriend sees a doctor to ensure that he is neither ill nor has an infection.  If he checks out, but his semen still doesn’t, try sucking on a candy or breathmint before fellatio (during if you can avoid choking) – the flavor and sweetness should hopefully mask some of the offending taste.  Hope that helps!

– Dr. Joe

Dr. Joe earned his undergraduate degree in Molecular Biology from Princeton University. After attending the Loyola University Stritch School of Medicine, he completed his residency training in urological surgery at the Los Angeles County Medical Center. He lives and works in Chicago, IL. Keep an eye out for his upcoming blog at docjoe.net.

photo by Gabriel Delgado

Last week we talked about when sex hurts, and why so many women still don’t admit to having this problem. It’s something that we, as sex writers, hear about constantly — it’s a sad but true fact that many women are more open with sex advice columnists than their own gynecologists — so we thought that focusing on this topic for a few weeks would, at the very least, prove that there’s a certain comfort to knowing you’re not alone. And knowing you’re not alone may give you the courage to speak up — to your partner and to your doctor. This week, the authors of the new book When Sex Hurts: A Woman’s Guide to Banishing Sexual Pain, give a basic overview of the causes of painful sex. For more information about any of the below, you can check out their book or talk to your doctor. Actually, whether you buy the book or not, please, for the love of sex, do talk to your gynecologist if sex hurts. It’s their freakin’ job to fix it, okay? No matter what you may have been taught.

CAUSES OF PAINFUL SEX

Even the following brief overview of these conditions will reveal a very important fact about sexual pain: Conditions frequently overlap, and women will often have several underlying causes. That’s one reason why you’re still suffering. A reminder: The term dyspareunia refers to sexual pain—no matter what the cause. Terms like vulvodynia, vestibulodynia, and vaginitis refer to specific conditions that cause dyspareunia.

Provoked vestibulodynia (PVD). This syndrome used to be called vulvar vestibulodynia syndrome (and, less commonly, vestibular adenitis). But PVD is not a single condition; rather, it constellates at least a dozen different conditions, resulting in pain originating from the entrance to the vagina, the vulvar vestibule. The most common cause of sexual pain in premenopausal women, it is also one of the most difficult for most doctors to diagnose and treat correctly. The most common causes of PVD are hormonal changes, tight pelvic floor muscles, and an increased number of nerve endings in the vestibule. In Chapter 6 we show how you and your doctor can figure out the cause of your PVD.

Hypertonic pelvic floor muscle dysfunction. This condition, also known as vaginismus, occurs when the muscles that surround the vagina, bladder, and anus spasm, causing pain at the vulvar ves­tibule and leading to pain upon penetration. Tight (hypertonic) pel­vic floor muscles can also cause constipation, fissures in your rectum, frequent urination, and problems urinating. In addition, if the muscles are in severe spasm, you may experience generalized vulvar burning, the major symptom of generalized vulvodynia (see below).

Vulvar and vaginal atrophy. One of the most common causes of sexual pain is hormonal changes (decreased estrogen and testosterone) that result in thinning (atrophy) of the vaginal and vulvar tissue. This, in turn, leads to dryness, irritation, tearing, and pain at the vestibule (provoked vestibulodynia). There are many causes of these hormonal changes, including hormonal contraceptives, infertility medications, endometriosis treatments, removal of the ovaries, medication for breast cancer, and menopause. In our experience, hormonal birth control methods (pills, patches, and rings) are the leading cause of atrophy in premenopausal women, thus a leading cause of their sexual pain.

Vulvar and vaginal skin disorders. The skin of the vulva and the mucosa of the vagina are susceptible to inflammatory skin diseases that can cause ulcers, erosions, and scarring. The most common of these disorders are lichen sclerosus and erosive lichen planus.

Interstitial cystitis (IC). IC, also know as painful bladder syndrome, is a condition in which the bladder lining becomes severely inflamed. This causes frequent urination (up to sixty times a day!), severe pelvic pain, and dyspareunia. Of women with IC, 75 percent say that sex makes their pain and need to urinate worse.

Read the rest of this excerpt on SUNfiltered. And check back in next week for a Q&A with the authors.

MORE ON PAINFUL SEX FROM EM & LO:

• Dr. Kate on Female Sexual Dysfunction: Pain Problems
• When Some Sex Positions Hurt
• Sex Starts Out Fine, Then Becomes Painful
• When Your G-Spot Hurts
• Why Am I Sore After Sex?
• How to Make First-Time Sex Less Painful
• Is Painful Sex Ever an Issue for Guys?
• Swollen Vulva & Painful Urination Post-Sex
• Painful Sex After a C-Section

photo by Jenny Lee Silver

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 mom’s hormones started changing when she was 38, and she actually got pregnant unexpectedly during this time. Is there a good way to practice birth control during pre-menopause? I understand that pills that have worked with your body for years warding off pregnancy can become ineffective at this time.

– Hot Flash

Dear H.F.,

The irony of perimenopause — the years of shifting hormones and irregular cycles that lead up to the total loss of your periods — is that you probably can’t get pregnant if you try… but that one occasional egg will lead to pregnancy if you don’t want it to.

Luckily, the same birth control methods that work for you in your 20s are still effective in your late 30s and early 40s. Hormonal methods, in fact, can lessen the bleeding irregularity and intense cramping that often come with perimenopause.

A warning, though: once you’re over 35, you may have contraindications to estrogen-containing methods (most pills, the patch, the ring) based on your medical history. If you’ve been a happy pill user, but smoke or have migraine headaches, your gyno will switch you to a progesterone-only method for safety reasons. And an IUD is always a good choice for most women, especially in perimenopause.

– 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 mistress_f

We’ve been writing about sex for more than ten years, and when we started out, the topic that our female readers wanted to hear about most was orgasms — how to have them (either solo or with a partner), how to have them more often, how to have different kinds, how to have them simultaneously with a partner, how to stop faking them, and so on. Well, the Big O is still a favorite topic, but these days it practically ties with another topic: painful sex. (And we’re not talking about the attending heartbreak, though consistent physical pain during intercourse can itself be heartbreaking, of course.) We don’t necessarily think that sex is suddenly more painful for women, but rather that it’s becoming more acceptable to talk about the fact that, for women especially, sometimes sex can hurt like a motherfucker…not to put too fine a point on it. But too many women still fail to speak up. So we were thrilled to hear about a new book that focuses on this topic: When Sex Hurts: A Woman’s Guide to Banishing Sexual Pain, by Andrew Goldstein, MD, Caroline Pukall, PhD, and Irwin Goldstein, MD. We definitely don’t have nearly enough letters after our names to adequately address the issues involved here! The authors were kind enough to allow us to publish an excerpt from the first chapter of their book, which you can read below. Check back in next week for their summary of the various causes of painful sex, and the week after that for a Q&A with the authors, in which they address some of the most common question they hear about painful sex.

PAINFUL SEX

“Sex has such an intense impact on how you see yourself and how you relate to other people. It penetrates every relationship….In fact, it is the central issue in any relationship whether the couple is aware of it or not. The nine years of sexual pain I lived through were an emotional hell.”—ANNIE, THIRTY

It’s been ten years, but Annie, now thirty, remembers the doctor’s words as if it were yesterday. She’d gone to her mother’s gynecologist for what she thought was a highly unusual and, truth be told, embarrassing problem: She couldn’t have sex. It simply hurt too much. After examining her, the doctor said, “You have a perfectly normal anatomy, but, sweetheart, if you’re as tense with your boyfriend as you are with me, it’s no wonder it doesn’t work.”

While those words, and the complete lack of empathy they exhibited, did nothing to help with her problem, they made Annie decide to become a doctor so other women could find someone with more compassion. Many other women like Annie, like you—more than 20 million American women alone—will experience painful sex in their lifetime. You’ve been bouncing from doctor to doctor and spending thousands of dollars seeking help to no avail. Even if you have found a doctor to correctly diagnose your condition, chances are you haven’t found much relief from the recommended treatments. Instead, you’ve spent years in agony, with pain so severe it feels as if acid is being poured on your skin or a knife inserted into your vagina.

Annie knows the drill well. From the first time she tried to have intercourse, she had lived in a world of pain, doubt, and frustration. The first time her boyfriend tried to enter her, she told us, she screamed in pain. “It felt like he was stabbing me, like I was being torn apart. It was horrifically painful.”

The two thought maybe Annie just needed to relax. And she tried. But nothing—not alcohol, not Valium, not even her pleas that he just “rape me”—worked. “I wanted to be normal so bad that I kept asking him to do pretty much anything he wanted,” she recalled. “‘Just close your eyes and go in there; it doesn’t matter if I’m in pain,’ I told him. But he was too good a guy to hurt me, and he couldn’t do it.”

It took another nine years—years filled with dozens of doctor visits, ruined relationships, and the certainty that she was crazy—before Annie found me (Andrew), and I diagnosed her with provoked vestibulodynia (PVD), a condition in which the slightest touch to the vulvar area results in excruciating pain. As many as 6 million American women suffer from this syndrome, which may have a dozen or more causes. Nearly 60 percent report visiting three or more health-care providers to obtain a diagnosis, and an astounding 40 percent remain undiagnosed.

In fact, as many as 40 percent of women with sexual pain don’t even seek medical care! They think that some level of pain or discomfort during sex is normal. Others are simply too embarrassed to talk to their doctor or don’t know how to bring the topic up. If this sounds familiar, take heart—our book gives you the tools to get you the help you need and deserve.

The problem is that painful sex doesn’t just occur in the bedroom. It infiltrates every aspect of your life. Many women feel it destroys their very sense of who they are. “I was very shut off physically for three years and am still recovering from that,” says Sheila. “I have a hard time being sexual because I don’t want to lead my fiancé on into thinking we are going to try to have sex when I am just not ready yet. For me, the pain really affected me more emotionally than it did physically.”

The National Vulvodynia Association reports that women like you find the pain of dyspareunia affects far more than your ability to have sex. It affects your ability to function in the everyday world, forcing you to leave careers and to limit physical activities. Some women we’ve met can’t even handle the pain of sitting long enough to drive a car, so they become virtual prisoners in their homes.

“I haven’t had sex since I was forty-two,” says Patty, now forty-nine. “I cannot wear underwear or pants or anything around my vulva. I wear long skirts with no underwear all year. I bought a special bike seat with a hole in the middle so when I ride nothing rubs against my vulva.” Patty used to express her sexuality through salsa dancing. Now that the pain has spread to her entire pelvic floor and hips, it hurts too much to merengue, so the dancing, her last vestige of sensuality after years of sexual pain, is out.

As you can see—and as you may well know—such pain soon becomes the focus of a woman’s life. No wonder a study published in 2007 found that 42 percent of women with dyspareunia felt they had no control over their lives and 60 percent felt they had no control over their bodies.

Read the rest of this excerpt at SUNfiltered

MORE ON PAINFUL SEX FROM EM & LO:

• Dr. Kate on Female Sexual Dysfunction: Pain Problems
• When Some Sex Positions Hurt
• Sex Starts Out Fine, Then Becomes Painful
• When Your G-Spot Hurts
• Why Am I Sore After Sex?
• How to Make First-Time Sex Less Painful
• Is Painful Sex Ever an Issue for Guys?
• Swollen Vulva & Painful Urination Post-Sex
• Painful Sex After a C-Section

photo by greenchartreuse

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 my period since August of 2008. I’m 21 and am not sexually active (I’ve never had sex) but I do “play” with myself every once in a while. Anyway, I was wondering what types of factors could be causing me to not have my periods?

– Grammatically Incorrect

Dear G.I.,

Many factors can cause amenorrhea — the medical term for the absence of menstruation. It’s helpful to know that you’re not sexually active so we can rule out pregnancy, the most common cause of missed periods. (You shouldn’t worry about masturbating — it has no role in whether or not a woman gets her period.)

Nearly every woman misses a few menstrual periods in her lifetime due to stress and illness. They can temporarily disrupt hormone levels, so one or two missed periods is usually nothing to worry about. When a woman becomes less stressed or recovers from an illness, her period usually returns to normal. Prolonged stress or illness can also lead to prolonged amenorrhea. The physical stress on the body from anorexia nervosa, strenuous exercise, or severe weight loss, for example, can keep a part of the brain called the hypothalamus from working properly. That can throw off your body’s levels of estrogen and progesterone, two hormones that are needed for normal menstrual cycles.

Polycystic ovary syndrome (PCOS) is another condition that can cause amenorrhea. Women who have polycystic ovary syndrome do not have normally fluctuating hormone levels, so they may not get their period regularly. Other possible causes of amenorrhea are low hormone production by the thyroid gland; structural abnormalities in the uterus or other reproductive organs; problems with the endometrium (the lining of the uterus), pituitary gland and other tumors; head trauma; shock following blood loss; menopause or premature menopause; and certain medications.

No matter what the cause is, prolonged amenorrhea should be evaluated and treated. Some of the causes of amenorrhea could also cause other health problems. Women who miss three or more periods should see a health care provider to determine the cause and prescribe treatment. You can be assured that there are very good treatments for amenorrhea. So, the best thing to do now is to make an appointment with your health care provider to figure out why you’ve not been having your period.

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.

jewelry from piercingdot.com

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,

How safe (or unsafe) are genital piercings?

– Holey Moley

Dear HM,

Basically as safe (or unsafe) as piercings elsewhere on your body. There are two risks with piercings: the sterility of the piercing process when you get it, and the ongoing risk of infection or damage to the tissue. Make sure you’re getting pierced in a reputable place (your best friend’s basement is not the place to experiment). Follow all of the directions about care of the piercing site. Your labia and clitoral hood have more exposure to bacteria than your earlobes, so you need to keep up your vulvar hygiene—no daily pantiliners, no douching, consistent condom use. And beware of creative sexual positions that put your piercing at risk of being yanked out (or of your jewelry becoming intertwined with that of your partner—that’s the not the kind of closeness you want). I’d recommend generous amounts of lube during penetration, and make sure you cease all activity if something begins to hurt.

– 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.