Sexual and Reproductive Health

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Curious about female breast anatomy

Dear Reader,

Breasts can be rather intriguing — so it’s no wonder you’re curious. To get right to your questions, Reader, the components of the female breasts largely dictate the size and shape of the anatomy in question. They are mostly made of fibrous tissue and fat, with the amount of fat accounting for much of the differences in breast size. As far as shape is concerned, this is due in part because they contain the components necessary to make human milk. Though breasts are largely associated with the female of the human species, males have them too — and despite biological sex, there’s a lot of variance with each and every one.

Because the function of the female breast has an impact on appearance, it’s helpful to know a little bit more about lactation or the production of human milk. Milk production takes place within small round glands in the breast (called lobules) and usually occurs during the late stages of pregnancy (starting around the fifth or sixth month) and just after birth in order to breastfeed. Ducts connect the glands to the nipple, where milk exits the body. Breasts of females who are not pregnant and who have not recently been breastfeeding after giving birth do still contain the glands to produce milk, but do not have milk inside of them. It may interest you to know that the ability to produce milk is not the only change in female breasts resulting from pregnancy. Hormonal changes during pregnancy also cause the dark areas around the nipples (areolas) to grow and the overall breast size to increase.

In both males and females, the fatty tissue that composes the breast lies on top of the chest’s pectoralis muscles (or “pecs”) and is protected by a layer of connective tissue called fascia. Even though male breasts may not appear as “breasts” are often thought of, the structure is there. However, males typically have less tissue and also fewer glands and ducts than females. Almost 60 percent of men over the age of 44 have breast tissue that can be detected by touch. Lactation in human males has only been documented in rare cases.

As with other body parts, breasts vary from person to person. In addition to differences in shape and size, breasts can occasionally bear certain characteristics like extra breast tissue (polymastia) or extra nipples (polythelia). Sometimes, an individual may have only one breast or no breasts at all (amastia). Though every breast is unique, check out this Mayo Clinic slide show for a visual aid of the female breast anatomy. Hopefully this will help shed some light on what’s actually inside those mysterious female breasts!

Alice

Impact of hypothyroidism on pregnancy and the baby?

Dear want to be a mother,

Thyroxine is the main hormone produced in the thyroid gland. If there’s too much or too little of this hormone in the body, it can result in hypothyroidism (due to especially low levels of thyroxine) or hyperthyroidism (due to especially high levels of the hormone). For more information on hypothyroidism, check out Hypothyroidism symptoms? Turning to your specific question, want to be a mother, low levels of thyroxine (and, in turn, hypothyroidism) may affect conception and pregnancy and it’s good to be aware of the potential health risks for both mother and baby. The good news is that treating hypothyroidism under the guidance of a health care provider can minimize these risks.

The ability to conceive varies across individuals due to all sorts of factors — one of them being hypothyroidism. In some, but not all people, having low levels of thyroxine may interfere with the ability to ovulate (when an egg is released from an ovary) — which is a necessary step in order to conceive. If the low levels of thyroxine occur due to an autoimmune disease or a pituitary disorder, there may be other risks to fertility as well. For those with hypothyroidism who are able to conceive and become pregnant, there are a number of conditions that they are at a higher risk for, including:

  • Anemia
  • High blood pressure
  • Pre-eclampsia
  • Premature birth
  • Postpartum thyroiditis (a contributing factor to postpartum depression)
  • Placental disruption (in which placenta becomes detached from inner wall of uterus)
  • Miscarriage

Fortunately, treating hypothyroidism — usually by taking the synthetic thyroid hormone levothyroxine — under the supervision of a health care provider may increase the likelihood of conception and a safer pregnancy. Depending upon the specific type of hypothyroidism, treatment during pregnancy may differ. People with overt (or full-blown) hypothyroidism taking levothyroxine are advised to continue taking it during pregnancy. Sometimes a change in dosage is necessary as determined by the health care provider. With the correct dosage, there should be no harm to the fetus, though regular monitoring by the health care provider is essential. Those with untreated subclinical hypothyroidism (which is characterized by a mildly underactive thyroid gland) require monitoring during pregnancy and some health care providers may recommend that they also take levothyroxine while pregnant. This is to make sure their condition does not progress to overt hypothyroidism. Untreated hypothyroidism during pregnancy can increase the risk of serious health consequences to both mother and baby, including:

  • Impaired neurodevelopment of the fetus
  • Mental impairment of baby
  • Acute respiratory distress syndrome of the newborn
  • Postpartum hemorrhage

Receiving appropriate treatment for hypothyroidism as early as possible, under the close supervision of your health care provider, is the best way to prevent health complications of the mother and the child. For more information on becoming and being pregnant, check out the Go Ask Alice! pregnancy archives. Best of luck to you as you begin this exciting new journey!

Alice

For more information or to make an appointment, check out these recommended resources:

Medical Services (Morningside)

Student Health Service (CUMC)


Boric acid safe for chronic yeast infections?

Dear Reader,

Considering how common yeast infections are, you’d think the yeast that could be done is to come up with an easy, reliable way of getting rid of them. After receiving confirmation that your symptoms do in fact point to a vaginal yeast infection (and not some other issue with similar symptoms), there are several options for treatment. Using boric acid suppositories is one option that is widely considered to be safe, although it’s also good to be aware of some exceptions and potential side effects.

Boric acid is a chemical that can act as both an antifungal and antiviral agent. Available over-the-counter (rather than by prescription), boric acid can be placed in gelatin caps that are then inserted into the vagina. Usually, these boric acid-filled gelatin caps are inserted vaginally each night before going to bed for a week. Studies have found boric acid to be a safe, affordable, and helpful treatment for many people with chronic or recurrent yeast infections that have not been successfully treated by other means. It may be especially effective for diabetic people with chronic or recurrent yeast infections. While some other antifungal yeast infection treatments only treat the Candida albicans yeast, boric acid treats both Candida albicans and Candida glabrata yeasts.

Though this treatment option may be suitable for many people, there are a few exceptions. Boric acid suppositories are considered safe for treating chronic yeast infections as long as they are not taken orally or used by children or pregnant people. That said, mild to moderate side effects are possible. Even when used correctly, boric acid can cause skin irritation or a burning sensation in the vagina. Before starting treatment, a visit to your health care provider can confirm that what you are experiencing is truly a chronic yeast infection and provide guidance on the best method of treatment for you. For more information about yeast infections and treatment options, check out the related Q&As below.

Alice

For more information or to make an appointment, check out these recommended resources:

Medical Services (Morningside)

Student Health Service (CUMC)


Essure: non-surgical sterilization

Dear Your #1 Fan,

Thanks for pointing to a gap in the contraception archives. As you allude to in your question, if by surgery, you mean a procedure that requires an incision, then you are correct: Essure is a birth control method that works to prevent pregnancies much like tubal ligation. Both are types sterilization, which means that they both inhibit the ability for sperm to meet an egg (and in turn, fertilization). They do this by physically and permanently blocking the fallopian tubes, but they do this in different ways (more on that in a bit). And much like other birth control methods, Essure does have its share of pros and cons, which are worth exploring prior to deciding on a birth control method.

While tubal ligation is a procedure that physically ligates (ties off, staples, or clamps) the fallopian tubes, Essure is not so much a procedure, but a product. Small coils made of metal and fiber are inserted into the fallopian tubes and over time, scar tissue builds up around the coils and blocks the tubes – thus achieving the same end result. The main difference between tubal ligation and Essure is that tubal ligation requires an incision through the wall of the pelvis. With Essure, no incision is required. A health care provider inserts the coils into the fallopian tubes by passing it through the uterus. To do this, a thin tube with a camera on the end called a hysteroscope is inserted through the vagina and cervix (which is first filled with water to ensure the fallopian tubes are open). The hysteroscope then uses a catheter to insert the coils into the fallopian tubes. Most women who’ve undergone the Essure placement procedure are sent home that same day. Although there may be some pain or discomfort, resuming normal activities are typically given the green light that day or the next.

It’s good to note that Essure is not immediately effective as birth control, as it takes time for the scar tissue to form (up to three months). To prevent pregnancy during this time, using another method of birth control for the first three months, such as the pill, the patch, or condoms is advised. After three months, an ultrasound or X-ray will help confirm whether the coils are in the right place and that the fallopian tubes are blocked. Once that’s been established by a health care provider, other methods of birth control can be stopped. Essure does not protect against sexually transmitted infections (STIs) so the use of condoms or barrier methods are recommended if a person is concerned about her/his risk.

There are additional benefits and risks involved in using Essure, like all methods of birth control. Reviewing them can really inform the decision-making process regarding this specific method.

The other benefits of Essure include:

  • Permanence and effectiveness: women who have had the Essure procedure have a less than one percent chance of becoming pregnant
  • Generally quick and painless insertion: no need for general anesthesia during insertion, the coils can be placed in less than an hour, and placement doesn’t result in scarring or wound healing due to intravaginal insertion
  • Not interruptive to sex: that is to say once scar tissue has developed (not including methods used to reduce STI risk)
  • Menstrual periods are not affected

Risks may include:

  • Considered permanent and not reversible: women who think they may want to become pregnant in the future may want to seek out another method.
  • Some side effects: immediate side effects of the placement procedure can include abdominal or pelvic pain, bleeding or spotting, cramping, dizziness, nausea, or vomiting (though usually short-lived)
  • Infection, persistent pelvic pain, perforation or tearing of the uterus or fallopian tubes
  • Only one of the fallopian tubes being blocked
  • May interfere with a previously inserted intrauterine device (IUD)
  • Eligibility for future surgeries that involve electrosurgical procedures (the metal coils could conduct electricity and damage tissues)

If extreme or persistent pelvic pain is experienced as a result of using Essure, or if a coil comes out of the vagina, it’s crucial to seek medical care immediately. Additionally, this method of birth control isn’t recommended for all women. This includes those who have a sensitivity or allergy to nickel, an existing uterine or fallopian tube blockage, a recent pelvic infection, been pregnant or given birth, or have had her fallopian tubes previously ligated may not be the best candidates for this method.

Learning more about this product is a great first step in deciding whether to use Essure. As far as next steps are concerned for those interested in the method, making an appointment to chat further with a health care provider is recommended!  

Alice

For more information or to make an appointment, check out these recommended resources:

Medical Services (Morningside)

Student Health Service (CUMC)


Positive pregnancy test after after surgical abortion?

Dear Reader,

The short answer to your question is that if you had the Depo-Provera contraceptive shot within five days of your abortion, becoming pregnant even if your partner did not use a condom seems unlikely. According to Planned Parenthood, the shot provides immediate protection if it’s administered within five days of an abortion or miscarriage or within three weeks of giving birth. If the shot was not given in the appropriate time frame or not given at all, it’s certainly possible to get pregnant again after an abortion. For more details about possible pregnancy due to unprotected sex after an abortion, read Can you get pregnant within two weeks of having an abortion? In light of this, an unasked question here might be: Is there a possibility that you might have had a false-positive pregnancy test result following an abortion? The answer is yes and that’s why it’s a good idea to get your health care provider involved to confirm.

Since you received the contraceptive shot in the appropriate time frame following the abortion, why would a pregnancy test still come out positive? Pregnancy tests look for a high level of the hormone human chorionic gonadotropin (HCG). All people (regardless of gender) have some amount of HCG in their bodies — but the levels are usually too low to be picked up by a pregnancy test. Pregnant women release much more HCG, with levels changing as the pregnancy progresses. HCG levels in the body gradually decline in the 60 days following an abortion, so many people who take a pregnancy test within that time frame are likely to test positive — even if they are not in fact pregnant anymore or pregnant again because the levels of HCG are still high enough to be detected from the previous pregnancy. Pregnancy tests that use urine simply check for the existence of HCG above a certain threshold, so this can be especially misleading after an abortion. A blood test can identify both if HCG exists above that threshold and exactly what the level of HCG is, which provides a more full picture of what is happening inside the body.

Going to a clinic to take a pregnancy test — rather than relying on an over-the-counter (OTC) pregnancy test — is recommended and has several advantages:

  • A series of blood tests can show if the HCG levels are decreasing (as would be expected after an abortion, miscarriage, or giving birth) or increasing (suggesting a new pregnancy).
  • A pelvic exam can confirm the findings of a blood pregnancy test (both to show the abortion was successful and that a new pregnancy has not started) and also check for any physical complications after an abortion.
  • Talking with a health care provider during your visit to the clinic is a good way to follow up after the abortion experience and ask any additional questions about pregnancy or pregnancy prevention in the future.

Following up with your health care provider after an abortion is always recommended in order to address any physical and emotional needs you might have. If you have any concerns you may be pregnant again or questions about how to stay protected in the future, making an appointment with her/him is an especially good idea. As an additional note, high levels of HCG can point to different medical conditions besides pregnancy. Men can have their HCG levels checked, too! Only a health care provider can determine what the results may mean.

Hopefully, learning more about how levels of HCG remain elevated post-abortion sheds some light onto what may be happening. Going to see a health care provider is the only way to be absolutely certain you know what’s going on — and to be able to put your mind at ease.

Alice

For more information or to make an appointment, check out these recommended resources:

Medical Services (Morningside)

Student Health Service (CUMC)


Irritable male syndrome?

Dear Synced and confused,

It’s terrific that a) you are keyed into your boyfriend’s mood changes and b) that you are concerned enough to try and figure out what is causing them. That said, it’s unlikely that he is experiencing what has been referred to as " irritable male syndrome". The term, coined in 2001, was used to describe irritability, nervousness, and depression in males who experience a drop in testosterone. However, this was observed at the end of the mating seasons in male animals (not humans) that breed annually. The "syndrome"  has been touted as a male condition similar to female pre-menstrual syndrome, but there is a lack of evidence to suggest that the condition exists in humans. To the issue of your menstrual period’s influence on your boyfriend, research has shown that menstruation does not affect male testosterone levels in any significant way. Though these biological factors may not give reason for your partner’s emotions, it’s possible that there’s a more psychological explanation at play.

While your menstrual period (biologically speaking) may not be directly influencing your boyfriend’s mood at ‘that time of the month’, your inclination to connect the two isn’t exactly that far off. Interestingly, there is documented evidence of psychological and even physical symptoms ‘syncing up’ among both female and male partners during pregnancy and the post-partum period. It has been well documented that men can be affected by their pregnant partners in a condition called Couvade syndrome. Also called “sympathetic pregnancy,” this condition occurs when men experience physical or psychological phenomena like nausea, depression, or even a toothache seemingly in tandem with their pregnant partners. Along those same lines, maternal post-partum depression is also closely linked and a significant predictor of paternal post-partum depression. These are just a few instances where female fertility has been linked to symptoms that can seemingly be shared between two people.

In your case, it may be a bit more reasonable to suspect that your boyfriend’s moods could be a result of a reaction to another person, rather than hormonal cycles. There is some psychological literature that explains a phenomenon referred to as emotional contagion. This is more or less the process of one person’s mood rubbing off on another. In a given interaction (say between you and your boyfriend), emotional contagion starts to take hold when one person begins to mirror the facial expressions, vocal qualities, posture, and movement of the person with whom they’re interacting — without even noticing. As those actions occur, the person doing the mimicking seemingly adopts the other’s emotions. While this phenomenon is thought to encourage successful social interactions and empathy, it can also make a person more vulnerable to the influence of another’s negativity or bad mood. You mention that your boyfriend seems to experience these monthly emotions even before you mention your period. Do you notice your moods changing around the time you have your period? Is it possible that your moods and emotions during that time are different than what you perceive them to be (i.e., that you feel that they are typical or positive, when in fact, they are not)? Is it possible as your boyfriend experiences a change in your mood, he unconsciously mimics it before you two even talk about it? These might be issues the two of you want to discuss.

Whether his moods are a result of emotional contagion or some other factor, there are some ways to address noticeable emotional change patterns. Together, you could try to maximize positive emotions during these times by taking a fun trip to a museum, taking a walk in the park, or going for a run (to get those endorphins going!), or tag-teaming dinner preparations. Research has demonstrated that those who practice regular reflections of gratitude also have significant and positive health benefits (emotional and physical), so you both might take a few minutes per week to reflect on things you are grateful for or excited about. If you want some help or an outside perspective in working with your boyfriend’s monthly emotional episodes, you might also consider checking in with a counselor or your health care provider, either together or on your own.

All in all, a critical part about emotion management is recognizing that the emotions are there in the first place! So far, sounds like you’re on the right track to being a responsive partner.

Alice

For more information or to make an appointment, check out these recommended resources:

Counseling and Psychological Services (Morningside)

Mental Health Service (CUMC)


HIV prevention with PEP, PrEP, and ART medications

Dear Reader,

It’s great that you recognize that there are ways to be sexually active with your partner while also minimizing your risk of contracting human immunodeficiency virus (HIV). You mentioned four important ways that HIV risk can be minimized, both before and after potentially infectious contact. Since you and your husband are in what is referred to as a HIV-discordant or sero-discordant relationship (where one of the two of you, not both, are HIV positive), understanding the many medications that may help reduce the risk of HIV transmission can go a long way to fostering a healthy, safer, and fulfilling sex life.

Post-exposure prophylaxis (PEP), refers to the drugs that can be taken immediately after someone who is HIV negative is exposed to potentially HIV positive body fluid like blood or semen. Who might need to take PEP? A health care worker who got accidentally stuck with a needle that was used to take blood from someone who might be HIV positive, or someone who got blood or body fluid into their eyes, mouth, or skin that was blistered, chapped or cracked, might be evaluated for PEP use. Other people who might need PEP are those who had a single episode of unprotected sex with someone who could be (or is) HIV positive. Under these types of circumstances, PEP is typically administered within 72 hours of exposure. It’s also recommended that other protective measures (sterilizing needles, using condoms and other barrier methods) are used as well just in case you did contract HIV. PEP is not 100 percent effective, but if it’s used properly, it could reduce your risk of developing HIV. For greater detail about PEP, including where you can get it check out the AIDS.gov website.

Unlike PEP, which is intended for short-term, emergency use directly after risky contact, the three other tools you mentioned: anti-retrovirals for your husband, using condoms, and pre-exposure prophylaxis (PrEP) are all intended for ongoing use to minimize the transmission of HIV between HIV-discordant sexual partners.

First, let’s chat a little about PrEP. PrEP is a prevention method endorsed by the Centers for Disease Control and Prevention (CDC) for people (like you) who are HIV negative but who could be at risk of getting HIV. PrEP combines two drugs, 300 mg of tenofovir disoproxil fumarate (TDF) and 200 mg of emtricitabine, into one pill that is taken once a day. For people who take the drug every day, and engage in other HIV prevention activities (e.g. consistent condom use, HIV couples counseling), research has found that (depending on the population) PrEP is between 62 to 92 percent effective at preventing HIV transmission. In one recent study with subjects who identified as men and transgender women who have sex with men, an effectiveness rate of 0.0 infections per 100 person-years was found among those who took four or more doses of PrEP weekly during the study period. In pregnant women, PrEP might also be a good way to reduce the risk of HIV transmission to the fetus.

Next on the list: the antiretroviral medications that your husband takes. Yep, antiretroviral therapy (ART) consist of a combination of medications that are recommended as ongoing therapy for those who are HIV positive, in order to keep the viral load of HIV in check. ART can be used in combination with PrEP — so for example, your husband could be on ART and you could take PrEP daily. However, the use of ART and PrEP does not completely eliminate the risk of transmission or infection, therefore, an important final step to minimizing risk of transmitting HIV is by using a barrier such as a condom or dental dam when having sex.

Finally, you mention you want to “complete the process like normal.” What is considered “normal” when it comes to sex may be different for different couples. While there is no 100 percent effective way of preventing transmission of HIV while having sex, it's possible to have a satisfying sex life while also taking steps to minimize the risk.

To your health!

Alice

For more information or to discuss these medications, check out these recommended resources:

Gay Health Advocacy Project (Morningside)

Medical Services (Morningside)

Student Health Services (CUMC)


Impetigo + oral sex = gential herpes?

Dear kitten,

The quick answer is nope! If you have been diagnosed with impetigo, oral sex with your boyfriend could transmit the impetigo to him but it won’t cause genital herpes. While impetigo is a contagious skin infection, it's caused by bacteria (either staphylococcus or streptococcus strain) while herpes simplex (both type 1 and type 2) are caused by viral infections. It’s true that both of these skin infections are contagious and can be passed on by sexual contact, but impetigo infections can’t cause herpes outbreaks and vice versa.

Let’s chat a bit more about impetigo: It is a very contagious skin infection, one that is often seen in babies and children. The infection will usually appear as red sores on the face, often clustering around the nose and mouth, and when they burst the sores develop yellow or honey-colored crusts after a few days. Unless the condition clears up on its own (typically in a couple of weeks), a doctor will prescribe an antibiotic to accelerate healing and limit how contagious the condition is. Bullous impetigo is a different, less common form of the disease, which will appear as larger blisters on the trunk or groin area. Ecthyma is another more severe form, which will cause painful fluid or pus-filled sores that can become ulcers deep in the skin (this type happens more commonly in older adults with diabetes or a compromised immune system).

Impetigo is transmitted by touching the sores of an infected person or by coming into contact with items that they have touched like clothing, linen, towels, or in the case of children (or big kids at heart), toys. Impetigo can start because bacteria have gotten into a small cut or insect bite, or even a scratch on the skin. Impetigo is entirely curable with antibiotics. Impetigo is not usually dangerous however sometimes there are complications. Ecthyma has been known to cause scars and one type of bacteria can cause kidney damage.

Herpes, on the other hand, is transmitted by the viruses HSV-1, HSV-2, or the herpes varicellus-zoster virus. (See What is herpes? for information on the difference between the viral strains and the possible resulting conditions. For even more info, visit the Go Ask Alice! Herpes archive.) Herpes is transmitted through skin-to-skin contact, and unlike impetigo it’s pretty unlikely that just sharing a towel or t-shirt with someone that is infected will lead to contracting the virus. While there’s no cure for herpes, medication can help manage outbreaks.

Until the bacteria causing the impetigo infection has been eradicated, the condition is highly contagious, so it might be best for you and your boyfriend to take a break from sexual contact until then.

Here’s to a speedy healing so you can go back to playing like the kitten you are!

Alice

Taking birth control pills when I need it — Effective?

Dear Reader,

Reuniting with a long distance partner after months apart can be such a magical time! Feeling confident in your birth control choice through advanced planning takes the pressure off trying to make a game time decision. Reader, the short answer to your question is that taking birth control pills only during months you anticipate spending time with your beau is not an effective method for preventing pregnancy. For more information about how birth control pills work to prevent pregnancy, read How do birth control pills work? There are many reasons why a person may skip birth control pills including infrequent intercourse, cost, change in health insurance status, and side effects. However, these interruptions severely reduce the pill’s ability to prevent unintended pregnancy. Luckily, there are other contraceptive options that may better suit your needs without compromising comfort and sensation.

Deciding which birth control method is best for you is a highly individual decision because of how differently people prioritize factors like price, convenience, comfort, and more. Below is a list of different options that you may want to consider (Keep in mind that none of these options protect against STIs):

There are several methods that require a prescription (you've got to see a health care provider for these):

  • Intrauterine device (IUD): An IUD is a small, t-shaped device that's inserted into the uterus. It's effective for 3 to 12 years and requires minimal user maintenance — it only needs to be checked once a month. This method is about 99 percent effective at preventing pregnancy.
  • Contraceptive implant: This device is implanted in the upper arm by a health care provider. It remains in place, prevents pregnancy for up to three years, and is up to 99 percent effective.
  • Contraceptive patch: This method is used each week for the first three weeks of the month (one patch per week), and the fourth week of the month does not require a patch at all. When this method is used correctly and consistently, it’s 99 percent effective in preventing pregnancy.
  • Contraceptive injection: This injectable birth control method is only needed once every three months. Because this method is administered by a health care professional (limiting the risk of user error), it can be upwards of 99 percent effective in preventing pregnancy.
  • Vaginal ring: The contraceptive ring is inserted into the vagina and remains there for three weeks out of the month and then must be removed for the fourth week. When used correctly and consistently, it’s 99 percent effective in preventing pregnancy.
  • Diaphragms or cervical caps with spermicide: The diaphragm and cervical cap are similar, but have a few important distinctions. It’s recommended that spermicide be used with each. As far as effectiveness goes, the diaphragm is 94 percent effective and the cervical cap is about 86 percent effective at preventing pregnancy when used correctly and consistently every time you have sex.

Interested in a little do-it-yourself? Check out these over-the-counter (OTC) options:

  • Contraceptive sponge: The sponge is inserted before sex and protects against pregnancy for up to twenty-four hours. If used correctly and consistently each time, the sponge is 91 percent effective in preventing pregnancy.
  • Vaginal spermicide: Vaginal spermicide comes in various forms (cream, gel, suppositories, films, and foams), and may also act as a lubricant. This method runs between 72 to 82 percent effective at preventing pregnancy.
  • Fertility awareness: The idea behind fertility awareness is that by observing changes in body temperature and vaginal discharge, you can track fertile days. To reduce the risk of pregnancy, sex is to be avoided on days when these factors indicate fertility. This method requires the use of a basal thermometer and a commitment to daily measurements and observations. If used correctly and consistently, this method can be upwards of about 76 percent effective.

Although pulling out or withdrawal is another method that is both convenient and free, it’s not as effective as most other methods — largely because it doesn’t prevent contact with pre-ejaculatory fluid (which may contain stray sperm) and relies on the male partner’s accuracy and self-control in order to pull out in time. All of the above methods have trade-offs, so reading up on each of them may be helpful in deciding which — if any — is for you.

Check out Planned Parenthood’s My Method , an interactive tool to help you evaluate your birth control options. Talking with a health care provider is the absolute best way to have all of your specific questions answered and to make sure that a given method is the right one for you. May you have many future steamy and safe visits with your boyfriend!

Alice

For more information or to make an appointment, check out these recommended resources:

Medical Services (Morningside)

Student Health Service (CUMC)


Relationship with HIV positive man — Can I have kids?

Dear Reader,

Kudos to you and your boyfriend for taking some valuable steps in building a trusting and healthy relationship! Talking about HIV status can be a sensitive and daunting task — especially with someone you care about deeply. While HIV status may influence how or when you decide to have kids, it does not mean you can never have children. There are many ways for couples and individuals to choose to become parents — adoption, artificial insemination, conception via sexual intercourse, surrogacy, and so on. When one or both partners are HIV+, talking with a health care provider who is well versed in HIV care and family planning might help you talk through options to find what’s right for you and your partner. Below are some possible options for you both to consider, depending on your circumstances.

  • If you’re an HIV-negative biological female, you may consider:
    • Pre-exposure prophylaxis (PrEP) — Use of this prior to conception can greatly reduce your risk of contracting HIV (if you are currently HIV negative and having oral, anal, or vaginal sex with your boyfriend). PrEP is the procedure of taking anti-retroviral medications, if you’re HIV-negative, in order to prevent you from acquiring the disease. There is ongoing research being conducted about using PrEP to prevention transmission while attempting to conceive. In one study, among heterosexual couples with an HIV negative female partner, the use of PrEP during attempted conception was evaluated. No females in the study became HIV positive and pregnancy rates were high. Research is ongoing to evaluate whether the use of PrEP is safe to also use during pregnancy and lactation to prevent transmission to the baby.
    • Spermwashing — If you’d like your HIV positive boyfriend to be the biological father, one option for conception is spermwashing. This involves removing the seminal fluid surrounding a sperm, and then implanting that sperm in one of your eggs. HIV is carried by seminal fluid, but not by the sperm itself. Recent research shows spermwashing to be safe, if done by qualified medical personnel. Spermwashing is approved by the World Health Organization, however, the U.S. Centers for Disease Control and Prevention (CDC) recommend against it as an option due to at least one documented case in which a female partner became infected with HIV via spermwashing.
    • Semen analysis — Your partner may be advised to get a semen analysis before you try to conceive. If he has semen abnormalities, you may have a lower likelihood of getting pregnant. If you know that it’s unlikely that you can be pregnant using his sperm, you may choose to avoid unnecessary exposure to HIV.
    • Conception with an HIV-negative sperm donor or sexual partner via sexual intercourse or artificial insemination — Sperm banks test all donor sperm for HIV.
  • If you’re an HIV-positive biological female, you may consider:
    • Beginning or continuing antiretroviral drugs (ARVs) — You may already be taking ARVs. If you are, your health care provider can tell you if the ARVs you’re using right now would be safe during pregnancy. Your provider may also make adjustments if you are trying to conceive. If you’re not on ARV drugs, and you do become pregnant, you can start taking them at the beginning of the second trimester of pregnancy. If you are unable to do that, these drugs can also be administered during labor and delivery.
    • Caesarian delivery — Many HIV and family planning experts recommended that you deliver via Caesarian section (C-section) to reduce likelihood of HIV transmission during childbirth.
    • Choosing an alternative to breastfeeding — Breast milk is one way that HIV can be transmitted, so breastfeeding is not advised if there is a risk of transmission. Formula feeding can be an alternative to breastfeeding.
    • A combination of all three — Combining ARV, C-section, and formula-feeding can reduce the risk of transmitting HIV to the baby to below two percent.
  • If you are a biological male (cis- or male-to-female transgender), or have a condition which would prevent you from carrying a child to term, you could choose a surrogate mother. With spermwashing, even if the biological father is HIV positive, HIV negative surrogate mothers have carried HIV negative children to term at little risk of infection to the mother or child.
  • No matter what your circumstances, you may also consider adoption. Some things to keep in mind when considering adoption as a couple with a HIV positive parent:
    • The Americans with Disabilities Act makes it illegal for adoption agencies to discriminate against potential parents because they are HIV positive. Consider asking your health care provider for help locating an adoption agency.
    • Adoption agencies outside of the United States may have no such laws. If you try to adopt from abroad, you may end up being rejected because of an HIV positive diagnosis.
    • If you’re a same-sex couple, you may face a similar problem — Same-sex parent adoption is illegal in many countries, as well as some states in the U.S..
    • One way to hopefully avoid these examples of discrimination is to seek out adoption agencies that specialize in HIV positive and LGBTQ parenting. You may be able to find resources at your local LGBTQ community center. You can also find information from the Human Rights Campaign.  

 Here are some additional considerations for HIV+ individuals and family planning:

  • Genital tract infections — Whether or not you’re HIV+, HIV health care providers recommend screening and treatment for genital tract infections before you attempt to conceive. Genital tract infections can increase the reproduction of HIV in genital areas. Sometimes, HIV isn’t detectable in a person’s bloodstream, but is detectable in their genital tract.
  • Viral suppression — Before attempting to conceive, your boyfriend may be advised to take steps to suppress (or lower) his viral load as much as possible. Note: even if your boyfriend is at maximum suppression, there is still a chance that he could transmit the HIV virus to you if you’re having vaginal, oral, or anal sex.

Couples HIV testing and counseling is recommended and will likely help guide and support your family planning decision making. This service involves discussing your test results with a supportive professional. In turn, they can recommend treatment, support, and prevention of transmission of the disease, if you are HIV negative.

Lastly, it’s wonderful that you are choosing to use protection together. You may already be aware that condoms and other barrier use can greatly reduce the likelihood of HIV transmission. However, no form of protection is completely failsafe. Consider making an appointment with your health care provider if you would like to talk about your specific health concerns.

Alice

For more information or to make an appointment, check out these recommended resources:

Medical Services (Morningside)

Gay Health Advocacy Project (Morningside)

Student Health Services (CUMC)


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