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Dear Dr. Vanessa: I’ve Missed My Period for Months, Years Even!

March 9, 2011

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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

dr_vanessa_cullins

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



Dear Dr. Kate: Are Genital Piercings Safe

March 2, 2011

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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_100Dr. 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.



Dear Dr. Vanessa: Doc Told Me I Have a Tiny Cervix

February 23, 2011

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photo by eclaire

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 24, and have not yet had any children. At my last gynecological exam, the clinician remarked that I have “the tiiiiiniest cervix!” I didn’t ask anything about it at the time, but now I’m wondering, is this something I should be concerned about? Will I have a difficult time giving birth?

– Tiny Dancer

Dear T.D.,

Please don’t let this clinician’s remark bother you. The remark may be more a reflection of the inexperience of the clinician than the size of your cervix. Regardless, having a small cervix does not mean that you will have a difficult time giving birth. You do not need any special evaluation or procedure because of this “lame” comment. Cervical size varies, but one thing is for sure, your cervix is small because you have not had any vaginal deliveries.

The cervix is the narrow, lower part — neck — of the uterus, with a narrow opening connecting the uterus to the vagina. A woman’s menstrual flow leaves the uterus through the opening of the cervix, which is called the os. Optimally, a pregnant woman’s cervix is long, thick, and firm so that it can provide support to keep the pregnancy within the uterus as well as to stretch open wide enough to facilitate childbirth. During pregnancy, the os is also plugged with cervical mucus to protect the pregnancy. Read the rest of this entry »



Dear Dr. Joe: Premature Ejaculation Is Ruining My Relationship

February 16, 2011

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photo by rightee

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 girlfriend and I have been together for nearly two years and have been having sex for nearly a year and a half of that. When we do foreplay, I’m fine and enjoy it. However, as soon as I enter her, I ejaculate really quickly, like after 5-10 seconds. We have tried different positions and used performance condoms, but these made no difference. It is starting to ruin our relationship, and we both get down after trying to do it.

– Early Bird

Dear E. B.,

First off, let me say that I am sorry that you are suffering from this condition. Ejaculating before you want to can cause distress, dissatisfaction, and a strained relationship. But don’t feel alone. Premature ejaculation, as this condition is commonly called in the medical community, is very common. In fact, between 25-40% of men will experience it at some point in their lives. It’s also treatable, so don’t fret that you will have to live with it forever.

The American Urological Association defines premature ejaculation as such: ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress, and occurring in greater than 50% of sexual encounters. Causes for early ejaculation are varied.

For one, there are biological causes, such as abnormal hormone levels, dysfunctional reflex activity of the ejaculatory system, hypersensitivity of the pelvic floor musculature and erectile dysfunction. Many individuals with biological causes, however, suffer lifelong premature ejaculation. On the contrary, your symptoms seem consistent with acquired premature ejaculation, characterized by development of symptoms after a period of normal, satisfying sexual activity.

Acquired premature ejaculation is often indicative of psychological causes. Job stress, personal stress, anxiety about sexual performance, depression, mistrust of your sexual partner, and poor communication within your relationship are just a few of the possible causes of premature ejaculation. To make matters worse, even in the context of a healthy relationship, premature ejaculation in itself can cause feelings of dissatisfaction and emotional distress, which can then exacerbate the problem. In truth, the potential causes are numerous, so the best treatment is a proper evaluation by a doctor and possibly a counselor, with the goal of treating the underlying cause(s). Read the rest of this entry »



Dear Dr. Vanessa: Can Zoloft Affect My Sex Drive?

February 9, 2011

7 Comments

photo by Nathan Csonka

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,

Can Zoloft affect my sex drive? I never feel intimate anymore, and it’s really hurting my relationship — my partner gets so upset because he doesn’t think I find him attractive anymore. I just don’t feel like having sex, ever.

– Sophie’s Choice

Dear S.C.,

Zoloft is one brand name of certain kinds of prescription medication that are technically called selective serotonin reuptake inhibitors (SSRIs). Other common brand names for SSRIs include Celexa, Lexipro, Paxil, and Prozac. SSRIs are used to treat depression, anxiety, panic disorder, and other conditions, including premenstrual dysphoric disorder. Like all medications, SSRIs may have side effects for some people. The possible side effects of SSRIs include decreased sex drive and/or more difficult orgasm — for women and men. Each SSRI may have different effects on different people.

Talk with your health care provider if you find that the SSRI — or any other medication — you are taking is affecting your sex life. Your provider may be able to substitute a different SSRI or a different kind of medication. Or your provider may suggest testing for other potential causes of decreased sex drive and function, which include certain hormone deficiencies and thyroid conditions.

Don’t let embarrassment prevent you from enjoying your sexuality as much as you can. Always be open about your sexual concerns with your health care provider, who will try to help you solve sexual problems that may be related to your medications. Read the rest of this entry »



Dear Dr. Joe: Can Pre-Ejaculate Get a Woman Pregnant?

February 2, 2011

4 Comments

photo by rightee

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,

Can pre-ejaculate get a woman pregnant?

– Leaky

Dear Leaky,

Pre-ejaculate, or “pre-cum,” as it is commonly known, is the predominantly clear fluid that leaks from a man’s penis during sexual stimulation prior to orgasm. And, yes, it can get a woman pregnant.

Pre-ejaculate arises primarily from the periurethral glands (glands of Littre) and the bulbourethral glands (Cowper’s glands). This fluid prepares the urethra for ejaculation, and, to some extent, may provide some lubrication during sexual intercourse. Despite the fact that these glands do not produce or secrete sperm, the pre-ejaculate fluid may still contain sperm.

How does that happen? Though it is not perfectly clear, the general consensus is that some sperm remain in the penile urethra after a previous ejaculation. The pre-ejaculate fluid “picks up” some of these sperm as it traverses the urethra and escapes from the penile meatus (opening). This theory is supported by the fact that pre-ejaculate from men who have recently urinated (thereby flushing the urethra) or who have not ejaculated for a period of time often does not contain sperm.

Unfortunately, there is no way to know if your or your partner’s pre-ejaculate contains sperm, barring a full microscopic examination, which isn’t very romantic. Normal ejaculate contains tens of millions of sperm (normal is greater than 20 million per milliliter). Pre-ejaculate is significantly less, but may still contain a few million sperm. Since it only takes one sperm (and a few helper sperm) to get pregnant, there are clearly enough little guys to fertilize an egg. Read the rest of this entry »



Dr. Kate’s Female Sexual Dysfunction Series: PAIN PROBLEMS (Pt 5 of 5)

January 26, 2011

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All this month Dr. Kate, an OB/GYN at one of the largest teaching hospitals in New York City, is dedicating her column on EMandLO.com to the topic female sexual dysfunction, since that’s what she seems to get the most inquiries about. Click here for all the installments of her five part series being published every Thursday afternoon in January.

Sex should never be dreaded, and should never cause you pain. Unfortunately, for some women, pain during sex takes all the pleasure out of what should be a wonderful, intimate experience. And pain is never normal. It’s your body’s way of telling you to stop what you’re doing. The official term for pain during intercourse is dyspareunia, and there are multiple reasons why it might be happening. Fortunately, there are answers for most of them.

  • Tightening in anticipation. The vagina is a powerful muscle. If you’re not fully relaxed before intercourse, you can feel a lot of pain with penetration. And if you’ve experienced pain before, it’s natural to “tighten up” when a penis is approaching you. So you’ve got to make sure you’re relaxed and warmed up. It takes the average woman 20 to 30 minutes of good, sexual attention to become both aroused and lubricated enough for intercourse. And I don’t mean him feeling up your boobs — that’s foreplay for him (unless that happens to work for you as well!) Make sure that you get lots of playtime first: his fingers, or going down on you, or a vibrator, whatever works for you! Having an orgasm prior to intercourse can help with engorgement of the area and natural lubrication, two things that make intercourse much more pleasant for a woman. And make sure he enters you very slowly, to give your vagina a chance to adjust. Better yet, get on top so you can control the pace of penetration.
  • Not enough lubrication. Simply not being lubricated enough is the number-one reason for pain during sex. Both wetness and engorgement signal your readiness for sex, so starting before they take place can hurt. There are many reasons for dryness, most of which have nothing to do with how much you want sex. If you’ve been taking an anti-allergy medication, for instance, that could be the culprit; antihistamines are one of several medications that can lead to dryness (others include antidepressants and the Pill). If this lack of lubrication is a continual problem, talk to your doctor about it. But for immediate help, use a man-made, water-based lubricant. Apply it to his penis and your labia liberally before insertion. And again, make sure you’re getting enough good stimulation beforehand.
  • A retroverted uterus. About 20 percent of women have a retroverted uterus (where it tips back toward the tailbone, instead of forward toward the bladder), which makes your cervix vulnerable to getting bumped during intercourse. But the mishap can happen to any woman during sex, especially if her partner is overenthusiastic in the jackhammering department. So insist on positions and a depth of penetration this is comfortable to you.
  • Chronic pain conditions. There are three main ones:
    1. Endometriosis, where tissue that looks and acts like the lining of the uterus grows outside of it — on the ovaries, fallopian tubes or even the abdominal wall. Aside from uncomfortable sex, it can also cause constant pelvic pain and excruciating periods. The Pill, or other hormonal birth control, is the best treatment.
    2. Interstitial Cystitis (IC), an inflammation of the bladder that causes a stinging sensation when you pee, and a frequent, urgent need to go. It’s often misdiagnosed as chronic UTI because of the similar symptoms. If you’re visiting the restroom hourly and are hurting during or after sex, see your doctor for an evaluation and ask about IC.
    3. Vulvodynia, a fancy-pants way of saying “pain in the vulva.” Other signs that you may have vulvodynia: does it hurt if he puts a finger inside you? if you use a tampon? if you wear tight jeans or pants? Often, women with vulvodynia have pain on ANY contact to their vulva, not just intercourse. If you think this describes you, there are treatments available — most often a combination of oral medication and a topical anesthetic cream — so talk to your gyno.

Whatever is happening, once you can figure out why you’re hurting, you can figure out ways to make sex more enjoyable — something that makes you shiver in anticipation, not dread.

– Dr. Kate
Gynotalk

dr_kate_100Dr. 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.



Dr. Kate’s Female Sexual Dysfunction Series: ORGASM PROBLEMS (Pt 4 of 5)

January 20, 2011

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All this month Dr. Kate, an OB/GYN at one of the largest teaching hospitals in New York City, is dedicating her column on EMandLO.com to the topic female sexual dysfunction, since that’s what she seems to get the most inquiries about. Click here for all the installments of her five part series being published every Thursday afternoon in January.

Many women have the expectation that they’ll have an orgasm with intercourse, every single time. After all, that’s the expectation men have, right? But biology isn’t always fair, and our anatomy is not always on our side. For most women, clitoral stimulation is the most reliable (or only) path to orgasm, which doesn’t always happen with vaginal intercourse. I counsel my patients that all orgasms are good orgasms, and there’s no “right” way to get one. So if it’s pre-intercourse play or afterplay—i.e. stimulation by touch or by tongue—that gets you to climax instead of intercourse itself, fantastic. And if you want to achieve the elusive beast of orgasming at the same time as your partner, a well-placed vibrator may be a reliable way. Many couples, over time, figure out a repertoire of play that will lead to satisfaction for both of them.

So what’s normal about orgasms?

  • Taking longer than he does to climax.
  • Climaxing quickly one night…and not at all the next.
  • Having a more difficult time achieving orgasm in particular positions or situations.
  • Having an orgasm with minimal (or no) clitoral stimulation (you lucky girl).
  • Taking a longer time to climax if you’re having trouble staying in the moment.

When you never seem to achieve orgasm, though, it’s hard to enjoy any sex play. And the number of women who struggle with the ability to climax is staggering; according to the Association of Reproductive Health Professionals, 24 to 37 percent of women have problems reaching orgasm. These problems range from a long delay to climax after stimulation, to never achieving orgasm at all. There’s such a wide variability in the type of stimulation that triggers orgasm that it can be difficult to figure out why it’s not happening in a particular situation.

The treatment for problems achieving orgasm is basically the same as the treatment for arousal disorder: sex therapy. When you work with a qualified therapist (who may be a social worker, a psychologist, or a medical doctor), there are multiple techniques that can be tried — imagery and fantasy, sensate focus, mindfulness. Ask your gyno if she’s knowledgeable about these techniques, or if she can refer you to someone who is. While orgasms are not the be-all, end-all of your sexual functioning, you certainly deserve them.

– Dr. Kate
Gynotalk

dr_kate_100Dr. 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.



Dr. Kate’s Female Sexual Dysfunction Series: AROUSAL PROBLEMS (Part 3 of 5)

January 12, 2011

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All this month Dr. Kate, an OB/GYN at one of the largest teaching hospitals in New York City, is dedicating her column on EMandLO.com to the topic female sexual dysfunction, since that’s what she seems to get the most inquiries about. Click here for all the installments of her five part series being published every Thursday afternoon in January.

So you want to have sex, and you’ve found a willing, worthy partner. But what happens if your body isn’t paying attention to the signals your mind and heart are sending? Arousal is another stage in our sexual response; it may follow desire, or may be the lead-off hitter in response to your partner’s touch. Patients complain to me all the time that it takes “too long” for them to become aroused when fooling around with their partner. But what exactly is “too long?” There is no magic number for how long it should take to become aroused, or about how much you should be aroused. We don’t measure the amount of wetness you get, or how much blood flows to your vagina (though it would make for interesting studies!).

Arousal will vary from woman to woman, from partner to partner, from night to night. So you may find that (sometimes, often, always) it takes you longer than you’d like to feel turned on in bed. And I think that “too long” is too often defined as “longer than it takes him.” It’s okay to not feel aroused on every occasion that you think you “should”—whenever your partner is horny, when you’re watching porn, when you finally have time alone with your partner (especially if you’re a parent). It’s also okay to play around and see if desire and arousal follow—and if not, to feel free to shut it down and go to sleep if that’s what will make you feel best that night.

When does a low level of arousal signify a problem? If you consistently can’t maintain arousal during sexual activity, or if you frequently or always don’t become aroused despite a desire to have sex.  Sexual arousal disorder is the second most common sexual problem among women, affecting an estimated 20 percent of women, though it most frequently occurs in postmenopausal women. Also called hypoactive sexual desire disorder, this condition may be due to depression, drug use, or medical problems, as well as stress, fatigue and certain medications (most commonly antidepressants and anti-hypertensives). And like other sexual disorders, negative emotions in your relationship—jealousy, fear, mistrust, you name it—can also lead to lack of arousal.

But the good news is that sex therapy can really help a woman combat arousal problems. When you work with a qualified therapist (who may be a social worker, a psychologist, or a medical doctor), there are multiple techniques that can be tried — imagery and fantasy, sensate focus, mindfulness. Ask your gyno if she’s knowledgeable about these techniques, or if she can refer you to someone who is.

– Dr. Kate
Gynotalk

dr_kate_100Dr. 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.



Dr. Kate, I Fall Asleep After Orgasms…and I’m a Woman!

January 12, 2011

0 Comments

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 every few weeks on EMandLO.com. To ask her your own question, click here.

Dear Dr. Kate,

I sleep so much better after an orgasm! Sometimes when I’m having trouble sleeping I whip out my vibe and I just pass right out after I finish. Why is this and is it alright that I use orgasms as a sleep-aid?

– Sleep Easy

Dear S.E.,

It’s a stereotype that only men want to pass out after orgasming – climax makes many people a little sleepy. Those muscle contractions aren’t just in your vagina – many women feel their orgasm through their pelvis and legs as well, and feel like they’ve had a work-out after they climax. In addition to the physical exertion that comes from an orgasm, there’s the mind-blowing that clears out much of the brain debris from the day.  I think personally you’ve found a great way to relax enough to fall asleep at night. Much better to get yourself off than to get yourself habituated to sleeping pills.

– Dr. Kate
Gynotalk
dr_kate_100

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. She generously shares her medical wisdom with EM & LO readers every few weeks. Check out more of her advice and ask her a question at Gynotalk.com.