Tuesday, May 26, 2009

This Ain't Your Mother's Rhythm Method

image from cyclebeads.com

While under normal circumstances people who report using "natural family planning" are about as close to my heart as college students who report using "withdrawal," I've become a fan as of late of the Cycle Beads, which are a method of "natural" family planning developed by the Institute for Reproductive Health at Georgetown University. The Cycle Beads, based on the Standard Days Method, are a string of 32 differently-colored beads that represent the different stages of the menstrual cycle and when sex is likely and unlikely to result in pregnancy.

Previously, effectively using natural family planning required a lot of hassle like repeated daily temperature taking, examination of vaginal mucus, etc. For people who weren't able to keep up with the demands and accurately determine on which days they were actually at risk so they could avoid sex, natural family planning had a really high rate of accidental pregnancy.

Cycle Beads take a lot of the risk of idiocy out of the method by making it really, really easy for users to figure out when they are likely to get pregnant so they can avoid sex or use condoms on those days. The beads are cheap, too--you can buy them online for about $10-12 and they never expire or run out. There aren't any side effects, either--no loss of sex drive, no moodiness, no weight gain--but you must use condoms or not have sex on the days the beads say you're at risk or else you may have the biggest side effect of all: pregnancy.

When used consistently and correctly, Cycle Beads/Standard Days Method was found to be 95% effective at preventing pregnancy. You can read the scholarly articles here. Obviously, you must have a regular menstrual cycle for any method of natural family planning to work, but if you do then Cycle Beads are worth a shot. They can also be used by those who are trying to get pregnant.

If you want to learn more or figure out if Cycle Beads are right for you, their website has a handy screening tool you can try.

Friday, May 22, 2009

Time to Check-In with R. Kelly

picture via Entertainment Weekly

I realize that few (read: none) of my readers share my appreciation (read: obsession) for R. Kelly but it's been so long since I've heard anything about my old pal that I clicked his name into Google News to see what's going on in Kells' world.

He's selling his bar on Craigslist, for one, so things can't be that great. I don't know about you, but when I hear Kelly sing about stepping up out the club with 2 chicks that both got dizzy heads and legs, taking them home to pop some bub (read: champagne) and puff some dro, I don't picture it happening near this weird Looney Tunes bar.

Maybe he's just doing some renovations to his crib, but I hope this doesn't indicate bad financial times for Kells.

By the way, if you still haven't seen "Trapped in the Closet," you should watch it right now. There are new chapters set to drop this summer so it might be time for everyone to enjoy a retrospective. Before things get real freaky.

Thursday, May 21, 2009

More Evidence Antidepressants are Bad

Image from time.com

I'm well known for being an antidepressant hater because of their well-documented effects on sexual desire and orgasm. I should note that the debate continues about whether antidepressants are at fault in all cases or whether those taking them had low desire to begin with, since many times decreased desire for sex is a symptom of depression itself. Whatever.

I'm less well known as an alumnae of Mr. Jefferson's University (aka the University of Virginia) and occasionally read the lame alumni magazine they send me. So imagine my surprise when I read this article in the new issue, which had this to say:
"Biological anthropologist Helen Fisher of Rutgers University and U.Va. psychiatrist James Thomson (Med '74) theorize that the possibility of love itself is blunted by SSRIs (selective serotonin reuptake inhibitors), the most common type of antidepressants. They say they've seen evidence that antidepressants alter brain chemistry in a way that reduces the chance a person can fall in love or feel strong romantic attachment."

This is big, I think--while there are patients for whom antidepressants are absolutely necessary, as someone who has been the romantic partner of someone taking these drugs, this speaks to my experience to a certain extent. So we can add "inability to fall in love" to the list of reasons taking antidepressants might not actually be a good way to treat depression. But this is a challenge to Science to figure out how to treat medical conditions in a way that doesn't turn people into feelingsless robots. Prescribing physicians (especially psychiatrists) need to be forthcoming with patients about sexual side effects and understand that, for some patients, these effects are totally intolerable. But that's another post.

Tuesday, May 19, 2009

You've Gotta be F-ing Kidding Me:
Douching with LYSOL?!?

via Oddee

Occasionally a student of mine--usually a very smart, pre-med, super adorable, great female student will ask me the question that vexes me every time: "Is douching really bad?" Obviously, douching is bad. Don't ever do it. Ever. For any reason. Not even after your period. Not even with just water.

But where the fuck did douching even come from? Obviously, I like to blame doctors (in the aggregate, of course, not any individual doctor [wink]) for just about everything that's wrong with sex and sexual health, but today I discovered something that blew even my mind.

The above ad is for Lysol--you know, the stuff used to clean truck stop bathrooms and prisons? The ad is promising women who have "been locked out" from their husband by "intimate neglect" (i.e., not putting out) should just use Lysol to douche their vag to "banish the misgivings that often keep married lovers apart." I'm assuming that by "often" they mean "monthly" and the "misgiving" that sex during or after your period is "gross" and "doucheworthy."

The most curious part of the ad copy is that Lysol promises that after douching, "appealing daintiness is assured." I thought to myself, Hmm, that doesn't sound like the way I would use "dainty" which I think of meaning "cute and little"--perhaps there's another meaning? And sure enough, one of the meanings is "pleasing to the taste" or "something considered choice to eat."

I'm always amazed at how revisionist our perceptions of sex in the 1950s are; despite the Kinsey Reports that demonstrated both men and women, married and not, were pretty fucking sexually interesting back in the day, we think all those vacuum cleaners and martinis after work and Leave it to Beaver separate beds meant nobody was having good sex. But what we have here is an ad for Lysol promising women that if they douche with it (again, OUCH), their husbands will be all about eating them out.

While we're collectively much more anti-douche these days and the douches that are out there are usually made of things that aren't necessarily appealing to the taste (vinegar + vagina = gross) I've never seen an ad for Massengill promising a gal that she'll get her bits licked.

Monday, May 18, 2009

Q: Does Withdrawal Deserve Another Look?
A: Seriously?

Breaking news from my pals at the Guttmacher Institute: withdrawal is an effective birth control method! But why don't more people use it and, furthermore, why don't doctors talk about it as an option? Here's their headscrataching concluding paragraph:

Although withdrawal may not be as effective as some contraceptive methods, it is substantially more effective than nothing. It is also convenient, requires no prior planning and there is no cost involved. Consistent dual use of withdrawal in conjunction with hormonal, barrier or other methods could constitute an effective contraceptive strategy. Health care providers and health educators should discuss withdrawal as a legitimate, if slightly less effective, contraceptive method in the same way they do condoms and diaphragms. Dismissing withdrawal as a legitimate contraceptive method is counterproductive for the prevention of pregnancy and also discourages academic inquiry into this frequently used and reasonably effective method. (page 10)

Earth to Guttmacher researchers, people do use it--here at the U of T at A, withdrawal (aka "pull and pray") is our 3rd most popular contraceptive method. And doctors do know about it, because it's listed in the method effectiveness table in Contraceptive Technology which appears in every single box of condoms, pack of birth control pills, and diaphragm container. There's actually a whole chapter on it in the 19th edition of Contraceptive Technology that features this extremely important point that Guttmacher fails to note, from the section "Disadvantages and Cautions":

"One reason for contraceptive failure may be a lack of the self-control demanded by the method. With impending orgasm, men (and women) experience a mild to extreme clouding of consciousness [!*] during which coital movement becomes involuntary. The man may feel the urge to achieve deeper penetration at the time of impending orgasm and may not withdraw in sufficient time to avoid depositing semen in his partner's vagina or on her external genitalia...For some couples, interruption of the excitement or plateau phase of the sexual response cycle may diminish pleasure." (pg. 339)

Contraceptive Technology, at least, acknowledges that there are pleasure implications of the withdrawal method that make it undesirable. Furthermore, I call bullshit on using withdrawal in conjunction with another method -- to do so is just paranoid. In my professional work, I encounter guys who pull out despite the fact that they're wearing a condom and the girl is on the pill, just because they are Completely Fucking Terrified of the girl getting pregnant. Those guys are not enjoying the sex they do have, because they're wearing a life jacket and a helmet and jumping off the raft before it goes over the waterfall. What's fun about that?

*I refer to this as "under the fuckluence," defined as "under the influence of fucking." As in, "I meant to use a condom but once we got started I was under the fuckluence and couldn't stop."

Thursday, May 14, 2009

The Rules of STI Disclosure

Tertiary, Brain-Eating Syphilis.
And you thought HPV was scary?

Q: What are your "rules" in terms of sti disclose? Always before sexual activity no matter the type of STI?*

A: It depends on the circumstances. In the case of a one-time encounter, if safe practices are insisted upon and used (condoms, dental dams, etc.) then I think the infected partner can use their discretion about whether to disclose. If someone is willing to have casual sex, they should be willing to assume some risk therein. But the infected person has to be reasonably sure that they're never going to date the person or see them again, because if they find out later that you withheld that info, that can be a big violation of trust and hurt potential intimacy between the two. And if you're using barrier methods anyway, you're being as safe as you can be.

If a person is dating someone that they hope to continue dating, it's a good idea to disclose prior to any activity that presents risk. But more importantly, people who intend on fucking someday should ASK about STIs and when the person was last tested, sooner rather than later. I usually ask about it right up front. Of course, I'm sex educator so I can get away with asking questions like that and it not seeming out of character, but it's a question people have the right to ask. It's an awkward conversation, but usually I condition it with something like, "Hey, let's have a really awkward, uncomfortable conversation for a minute; I don't have any sexually transmitted infections, do you?"

Almost without exception, the person replies, "No, I was just tested X months ago and haven't had sex with anyone since/have used condoms every time" or "You know, it's been a while since I got tested, I should do that." The only time someone has balked I ultimately broke up with them over it, because they were clearly just not smart about the reality of risk they faced, something that, in my line of work, I can't abide.

If a person has gonorrhea, chlamdyia, or syphilis, they should be treated and finish treatment before having sex, and then they don't need to disclose--because those STIs are curable. It's not necessary, in my view, to talk about STI history if you have had something you know has been cured. But ongoing infections, like HIV and herpes, do need disclosure and behavior monitoring to reduce the risk.

With HIV, obviously, condoms are always necessary no matter what. With herpes, if the infected person is on treatment (Valtrex or other antiviral) and hasn't had an outbreak for a period of months, the risk of transmission is insanely low. Disclosure is necessary, but the person with herpes can assuage the fears of their partner by saying, "I take Valtrex, I always use condoms, I've been tested so I know I don't have any other STIs, and I haven't had an outbreak for X months." That's the best you can do, and if the partner freaks out, they're probably not worth dating.

As for HPV, I just don't care. I have students who come in all the time who are like, "OMG my girlfriend was just diagnosed with 'high risk HPV,' do I have to tell everyone I have sex with in the future?" And usually I tell them that if they want to earn their Scouts Honor badge by telling, they can, but since everyone has HPV, if they're using condoms, they're doing as much as they can to reduce the risk. And besides, the chances they will have sex with someone else who has HPV at some point are like 100%. And for the last f-ing time, the Pap Smear is the most effective cancer screening tool in medicine and it detects almost all cervical cancer and pre-cancerous changes. And if you have genital warts, you have genital warts. So for fuck's sake, stop freaking out about HPV. Merck is just trying to scare you into spending $500 on their vaccine.

So those are my 'rules.' Hope that helps!


*I'm not discussing the far less common, but no less annoying, STIs here like hepatitis (that is a vaccine you need to get), chancroid, molluscum, crabs, scabies, etc. You can learn more about them at the American Social Health Association links above.

Tuesday, May 12, 2009

My First Vibrator: What to Buy?

The Slimline.

Indulge me in relaying a first-time vibrator story: a certain someone, her freshman year at a small women's college, ventured to the Toy Box in Upland, California late at night and purchased a hard plastic Slimline vibrator. It was baby blue, took C batteries, and it died after less than a week.

The Slimline is an iconic sex toy; whenever a goofy movie character discovers a mom's vibe in a drawer, it's invariably a Slimline. But is it really the best choice for a first-time vibe?

Frankly, I don't think so. First of all, it's large--eight inches long and one and a half inches in diameter. For those of you who don't remember geometry, that's almost five inches in circumference--big.

Secondly, it's cheap--the motor is poorly made and either burns out or starts to rattle loudly (or both) very rapidly. If you're living in a dorm room, silence is key. Lastly, most women who purchase sex toys buy them for clitoral stimulation, not insertion, so the Slimline just isn't the right object. The hard plastic provides no friction, meaning it doesn't pull against the skin of the vulva, and the vibrations aren't localized in one place which is what you want on the clit.

So what should the vibrator first-timer buy? If you want focused sensation but need something cheap, try the Silver Bullet. At $15, it uses AA batteries (which are so much cheaper and easier to get than Cs) so when it breaks after a few months you won't be out a bunch of money and left with a stack of batteries you can't use for anything else.

If you want something insertable, I'd start out with something a little smaller than Slimline. The Velvet Jewel Vibe is plastic, which means it's not covered with any yucky phthalate-containing jelly substances, but it has the new-ish "velvet" finish, which means it will provide some friction where you need it. Plus it has rhinestones. And at four inches by .75 inches in circumference, this toy is a great place to start out with insertion play that won't leave you thinking, 'Wow, I should've bought lube.'

And just for fun, here's the trailer for my favorite movie where a goofball character discovers a mom's vibrator: Baseketball.

Thursday, May 07, 2009

Tell me about your first time...

Well, don't tell me. But tell Abby at Deflowered, a website devoted to blowing the lid off of the loss of virginity.

Since we're all being assaulted by the house of horrors that is Bristol Palin's hard-knock life of teenage motherhood, reading stories about sex that are not based on stupidity and panic is refreshing.
Here's their perspective:
In addition to their entertainment value, these stories offer subtle commentary
on the female experience of virginity in a culture where "saving" yourself for
marriage is no longer the norm but the stigma of "losing it" has not been
completely shed. While there is no professional analysis and no attempt to make
a formal political or cultural comment on the topic, the narratives address the
subject naturally as they recount the varied hopes and expectations the writers
had regarding their virginity as well as their feelings after it's loss. In
presenting these shocking, funny, and sometimes sad first hand accounts,
Deflowered seeks to personalize the female experience in a way that other books
on the topic have failed, and, in doing so, subvert the notion that something is
always "lost" when a girl makes the initial jump from virgin to vixen...
In case you're wondering, I haven't submitted...yet. But when I do, it'll be under a nom de plume so you'll have to try and figure out who's me. But I will say this: we did not know then what we know now about nonoxynol-9 condoms.

You can read the memoirs that are already up here.

Wednesday, May 06, 2009

Tuesday, May 05, 2009

Q: Can girls get blue balls? A: Yes

photo credit

Dear Go-To Girl,

Last night I was having sex and I didn't come. Obviously, I was not happy about this. But afterwards I got into the shower and started having these really bad cramps that came in waves. WTF?


Dear Jessie,

Even though we ladies don't have the flagpole indicator that guys do, during arousal the genital region (aka "your area") gets similarly engorged with blood, a stage called vasocongestion. The vagina gets puffy, red, and wet--the reuslt of bloodflow to the pelvis. Blood vessels in the genitals are designed to fill up with blood and then constrict, so that the lubrication and such stays around while you're having sex.

Vasocongestion is supposed to go away with orgasm--chemicals are released to make those blood vessels open back up and drain back into your system. If you don't have an orgasm, the vessels drain slowly, which can cause cramping--guys know this feeling as blue balls but it can happen to women, too.

If this happens again and it's especially painful for you, feel free to grab a vibrator or whatever you need to get yourself off. But it isn't an indicator of a serious problem with your body and the pain shouldn't last.*


*It can be an indicator of a woman seriously wanting to punch a dude in the face. Or so I've heard ;)