I’m Trans. Do I Need Birth Control?

Image from Bedsider

Image from Bedsider

All pregnancies require 4 things to get going: a uterus, an egg, a sperm, and for the egg and sperm to come together.  

Just like cis-gendered people, not all trans people use birth control to prevent pregnancy. There are important things to consider before waging your chances of getting pregnant. As Juno Obedin-Malvier, MD, explains, pregnancy depends on “what equipment you’ve got, what you’re doing with it, who you’re doing it with (and what they’ve got), and whether pregnancy is a goal or not”.

Here are important points about the possibilities of getting pregnant for trans people:

  • Testosterone isn’t both control. For many trans men, taking testosterone may halt the menstrual cycle. However, testosterone doesn’t complete end egg production from the ovaries and some trans men have gotten pregnant even without a period.
  • Birth control methods available for cis-women are equally effective for trans men.
  • Likewise, estrogen is not birth control. Trans women who take estrogen and have a penis and testicles can still get their partner(s) pregnant.
  • Condoms are a great option for trans women. Plus they are the only form of protection that helps prevent STIs and pregnancy.
  • There are many health care providers that specialize in the trans community. Check out the resources at the bottom of this article.

This article by Juno Obedin-Maliver was originally published at Bedsider.

BY BEDSIDER | Bedsider.org

Do trans people need to use birth control? Well, it all depends. It depends on what equipment you’ve got, what you’re doing with it, who you’re doing it with (and what they’ve got), and whether pregnancy is a goal or not.

For any readers who aren’t familiar with the terminology, here’s a primer. Briefly, being transgender (“trans” for short) is about living in a gender that is different than the sex you were born with. Being cisgender is about having that sex and gender line up. Whether one needs birth control depends on what sex you were born with and what sex your partner was born with.

Transgender folks and cisgender folks come in all shapes and sizes. But everyone—no matter whether they identify as a transgender man, transgender woman, man, woman, or another identity—is born with only one set of gametes (if any). Gametes are the cells from two different people that come together to make a baby. For humans, gametes come in two types: the sperm type and the egg type. And all pregnancies require at least four things to get going: a uterus, an egg, sperm, and for the egg and sperm to come together.

Trans men

(FTM, or folks who were assigned female sex at birth and identify on the male gender spectrum)
For those guys who were born with a uterus and ovaries (where eggs are made), if you still have those parts, you can get pregnant. So, if you’re doing someone who has a sperm delivery system (a penis and testicles) you have to think about the possibility that you could get pregnant.

Many, but not all, trans men use testosterone (T). For most, that stops the monthly visit from Aunt Flo. But that doesn’t necessarily mean you can’t get pregnant. Some trans men have gotten pregnant even when they weren’t having their periods and were still taking testosterone. How is that possible? Well, testosterone doesn’t completely stop egg production, so some guys will still release eggs even on T and even without a period. In other words, T isn’t good birth control.

So if getting pregnant isn’t in your plan, what are your options? All the methods that cisgender women may consider are also good options for trans guys. You should talk about them with your health care provider, who can help you tailor the method to your needs. If you want to get pregnant, you should also talk with your provider because there are things you can do to make sure you’re as healthy as possible before you do.

Trans women

(MTF, or folks who were assigned male at birth and identify on the female gender spectrum)
For those gals who were born with a sperm delivery system (penis and testicles)—if you still have those parts and your partner has a uterus and ovaries, you can get them pregnant. Many trans women think that if they are on estrogen they can’t get another person pregnant, but that’s not true. Though it may be harder to get an erection, make sperm, and ejaculate when you are on estrogen, it’s not impossible.

So if you and your partner have the equipment to get pregnant but don’t want to be, you’ve got to think about birth control. All the things that cisgender men think about for contraception are on the table. Condoms are especially cool because they protect against both sexually transmitted infections and pregnancy.

If you want to have kids and you’ve got sperm, you should talk with your health care provider—ideally before starting estrogen—about saving those spermies for a rainy, pregnancy-desiring kind of day.

Finding good care

If you want to talk to a health care provider about any of these issues and don’t already have one you trust, check out the providers on this list. If you’re in one of the following cities, you can go to a health center that specializes in care for the trans community:

Baltimore : Johns Hopkins Bayview Medical Center

Boston: The Fenway Institute

Chicago: Center for Gender, Sexuality and HIV Prevention at Ann & Robert H. Lurie Children’s Hospital, the Howard Brown Health Center

Cleveland: The PRIDE Clinic at MetroHealth Medical Center

Los Angeles: The Los Angeles LGBT Center

New York: Callen-Lorde Community Health Center

Philadelphia: The Mazzoni Center

San Francisco: Lyon-Martin Health Services, the Tom Waddell Health Center, the Asian and Pacific Islander Wellness Center

Washington, D.C.: Whitman-Walker Health

There are also Planned Parenthood clinics—like the ones listed here under “What health services”—that have providers who can help trans folks with general health questions, as well as birth control questions.

condom ad condoms too loose

bedsiderBEDSIDER is an online birth control support network for women operated by The National Campaign to Prevent Teen & Unplanned Pregnancy. Bedsider is totally independent (no pharmaceutical or government involvement). Honest and unbiased, Bedsider’s goal is to help women find the method of birth control that’s right for them and learn how to use it consistently and effectively, and that’s it.
Find Bedsider on twitter @Bedsider

Can I Get Pregnant If…? A Pregnancy Scare Companion

pregnancy scareDo you think you (or your partner) might be pregnant?

We get a lot of questions from readers wondering, “Can I get pregnant if…”. Bottom line: You can’t get pregnant from activities like petting or oral sex, only from activities in which semen comes in direct contact with the vagina. But what if there was pre-cum, or ejaculation near the genitals? What if you are late for your period even though you used a condom?

If you are not sure if you experienced real risks of pregnancy, this post is for you. Heather Corinna of Scarleteen provides information and resources based on your unique situation. Whether you are late for your period, or tested positive for a pregnancy test, or don’t know where to find emergency contraceptives, this article will help you figure out the next best steps.

Here’s a quickie on how pregnancy happens:

  • Pregnancy can happen when semen (ejaculation or cum) or precum gets inside the vagina.
  • Emergency contraceptives (the morning after pill) can prevent pregnancy up to five days after unprotected sex.
  • You can reduce the risk pregnancy by not having direct genital-to-genital contact, or using condoms and birth control every time you have sex.
  • Read the article below for more information about the type of sexual activities that increase  risk of pregnancy.

This post was originally published on Scarleteen.

BY HEATHER CORINNA | Scarleteen

In the thick of a pregnancy scare? Freaking out? Not sure what to do? We know how scary this can be, and we’re here to have your back in it.

Take a few deep breaths (really: do some good, slow breathing, you’ll feel better and be able to think more clearly once you do), and have a seat. Based on your unique situation, we’ll walk you through your next steps, give you some extra helps, fill you in on some common self-sabotagers, and do our best to help you chill out and pull it together so you can get through a scare without losing your mind and your well-being in the process.

Is your (or your partner’s) menstrual period not yet due?

In other words, a period isn’t late or missed, because it’s not even due for another few days or weeks. Click here for your next steps.

Are you (or your partner) due for a menstrual period around now, but it’s not late yet?  Click here for your next steps.

Are you (or your partner) currently experiencing a late or missed menstrual period?

In other words, a menstrual period has not yet arrived and was expected at least five or more days ago. Click here for your next steps.

Do you (or your partner) have irregular periods, so you can’t really answer the questions above?

If your (or your partner’s) menstrual periods are irregular, or you (or your partner) use a method of contraception that often causes skipped or missed periods, click here for your next steps.

Have you (or a partner) had a menstrual period since the risk you are concerned about?

A menstrual period is happening now or has occurred since the risk you’re concerned about, but you’re still worried about pregnancy. Click here for your next steps.

Have you (or a partner) had a pregnancy test with a positive (pregnant) result? Click here for your next steps.

Have you (or a partner) had a pregnancy test with a negative (not pregnant) result? Click here for your next steps.

Has it been less than 120 hours since your risk?

If you would like to reduce your risk, you or your partner can use a method of emergency contraception (EC) to reduce the risk by as much as 95% with oral medications designed as EC, and as much as 98% using a copper IUD. EC is most effective when used within 24 hours, so you want to get a move on if you can and want to use it. For information on emergency contraception, click here. To find the kinds of EC available in your area, or which kinds of oral contraceptives you can use as emergency contraception, and how to use them that way, click here.

Not sure if you or a partner have had a real risk of pregnancy or not?

In order for pregnancy to be a possibility, the kind of contact that has to happen is:

  • Direct (with no clothing, at all, covering anyone’s genitals) genital-to-genital contact between someone with a penis and someone with a vulva, such as genital intercourse or otherwise rubbing genitals together OR
  • Direct contact with ejaculate (semen) and the vulva, vaginal opening or anus.

BUT (and it’s a really big one): If either of those kinds of contact did occur, but one or more reliable methods of contraception was used properly, that risk is radically reduced, by a minimum of 70%*, and as much as 99.9%. And even if you used two methods, any two reliable methods at all — like the pill plus withdrawal, or a condom plus a Depo shot — only typically, rather than perfectly, you still will only have had about a 10% risk of pregnancy at a maximum.

Scenarios like these are NOT how pregnancy happens:

  • Masturbation or mutual masturbation (masturbating in the same space with someone else)
  • Being in the same space as someone with a penis and doing things like using their towels, sharing a toilet, touching their clothing, or sharing a bed to sleep or rest in
  • Sitting somewhere where someone did or may have ejaculated
  • Taking a shower, bath or swim with someone with a penis
  • Thinking about sex or fantasizing
  • Kissing, making out or fondling
  • Dry humping (rubbing genitals together when one or more people involved have some kind of clothing on that covers the genitals)
  • Oral sex or manual sex (fingering or handjobs)
  • Contact with pre-ejaculate, but NOT during intercourse or direct genital-to-genital contact
  • Touching yourself after you touched someone whose hand has touched their penis
  • Having someone with a penis ejaculate on some part of the body other than your genitals, like your buttocks, back or breasts
  • Direct genital-to-genital contact or direct contact with ejaculate when you and a partner have the same kinds of genitals (like each of you having a vulva or each of you having a penis).

Situations like these are ways pregnancy can theoretically occur, but where it is not at all likely:

  • Rubbing the vulva with hands that have recently touched semen
  • Intercourse or other direct genital-to-genital or genital fluid contact where two (or more) reliable methods of contraception were used properly
  • Unprotected anal sex without ejaculation

Are pregnancy scares a constant for you, or occurring even when you’re not having the kinds of contact that can result in pregnancy in reality?

1) Do you know the facts about how pregnancy happens, and what can and cannot present real risks of pregnancy? If not, you can educate yourself here or here. If you already know the facts, or find that now that you have them, you still feel scared or can’t believe them, then this probably isn’t about a lack of education about reproduction.

2) Do yourself a solid and take any kind of contact that is freaking you out like this off the table ASAP for now (that you can: for instance, if living in a house with family members who have a penis is freaking you out, you can’t very well ask them to leave so you can deal). If you are not in a relationship where you feel you are allowed to have any limits you need with sex of any kind, that’s a cue you’re not in a healthy relationship or dynamic, or just not yet able to assert yourself enough to manage sexual activity, so may need to get yourself away from that relationship, period.

3) Take some real time — not hours or a few days, but a week or two or even a few months or more, whatever you need — to figure out what you need to have these kinds of contact comfortably and without panic. Only engage in that kind of contact again when you CAN have what you need to be comfortable, whether that’s two methods of contraception, a different partner or kind of relationship, or counseling or therapy to help you with assertiveness, sexual fear or shame or an anxiety disorder.

4) If none of the above has any big impact on your fears over the next few weeks or months, then it’s time to seek out some help from a qualified mental health professional, like a counselor or therapist.

Want more information about pregnancy scares, pregnancy, contraception and making sexual choices you feel comfortable with?

Pregnancy Scared?
Human Reproduction: A Seafarer’s Guide
On the Rag: A Guide to Menstruation
Let’s Dial Down Some (Maybe) Ovulation Freakouts
Chicken Soup for the Pregnancy Symptom Freakout’s Soul
You’re Not Pregnant. So, Why Do You Think You Are?
Peeing on a Stick: All About Pregnancy Tests
Birth Control Bingo!
The Buddy System: Effectiveness Rates for Backing Up Your Birth Control With a Second Method
Have a Little Faith in BC
Who’s Afraid of Sperm Cells?
Ready or Not? The Scarleteen Sex Readiness Checklist
Risky Business: Learning to Consider Risk and Make Sound Sexual Choices
Whoa, There! How to Slow Down When You’re Moving Too Fast

Here’s some information from other credible sources:

Can I Get Pregnant If…? (Options for Sexual Health)
Could I be Pregnant? (Teen Health Source)
How Pregnancy Happens (Planned Parenthood)
Am I Pregnant? (Brook)

*Effectiveness rates for methods of contraception are figured for one full year of use. Figures presented here and elsewhere about effectiveness, with the exception of emergency contraception methods, present effectiveness rates over one full year of use, not per use or per day.

condom ad condoms too loose

heatherHEATHER CORINNA is an activist, artist, author and the director of Scarleteen, the inclusive online resource for teen and young adult sex education and information. She is also the author of S.E.X.: The All-You-Need-to-Know Progressive Sexuality Guide to Get You Through High School and College and was a contributor to the 2011 edition of Our Bodies, Ourselves. She’s received the The Champions of Sexual Literacy Award for Grassroots Activism (2007), The Society for the Scientific Study of Sexuality, Western Region’s, Public Service Award (2009), the Our Bodies, Ourselves’ Women’s Health Heroes Award (2009), The Joan Helmich Educator of the Year Award (2012), and The Woodhull Foundation’s Vicki Award(2013).

scarleteenSCARLETEEN is an independent, grassroots sexuality education and support organization and website. Founded in 1998, Scarleteen.com is visited by around three-quarters of a million diverse people each month worldwide, most between the ages of 15 and 25. It is the highest-ranked website for sex education and sexuality advice online and has held that rank through the majority of its tenure.
Find Scarleteen on twitter @Scarleteen

Birth Control When You’re Living With HIV/AIDS

Photo credit: Jacinta lluch Valero

Photo credit: Jacinta lluch Valero

Taking medication for HIV? Here’s what you should know to avoid an accidental pregnancy.

If you are one of the 1.1 million people in the U.S. living with HIV or AIDS, you might have heard that your choices of birth control are somewhat limited. The good news is that many methods—including some of the most effective ones—should still work well for you. What you can use for birth control when you’re living with HIV/AIDS depends on whether you are taking anti-retroviral medicine (ARVs) and what your overall health is like. In the following article, Merrie Warden, MD, MPH, at Bedsider, talks details about what you should know when it comes to HIV and contraceptive methods.

Here are some key facts from the article below:

  • The IUD is the most effective form of birth control and is not impacted by the type of medication you are using. However, the IUD does not prevent STI and HIV transmission.
  • Condoms are the only contraceptive today that helps prevent both HIV transmission and accidental pregnancy.
  • The shot, implant and IUD are safe and effective to use with any HIV medication you are using.

This article by Merrie Warden, MD, MPH, was originally published on Bedsider.

BY BEDSIDER | Bedsider.org

I have HIV but I’m not on meds right now. What are my birth control options?

If you’re not taking medications for HIV, the sky’s the limit. You can use any method of birth control, including combined hormonal methods like the pill, the patch, the ring, or more effective methods like the shot, the implant, or the IUD. Just keep in mind that none of these methods prevent the transmission of HIV or other sexually transmitted infections (STIs), so it’s important to use condoms too.

Why use condoms + another method of birth control?

If you’re living with HIV or AIDS, using condoms every time you have sex can help protect you and your partner. Doubling up with condoms and another type of birth control is even better since:

  • Some birth control “side effects” may be a benefit for you. Some birth control methods can make your period lighter, less painful or go away altogether. Others offer long-term prevention of certain types of cancer.
  • Peace of mind that you won’t have an accidental pregnancy feels good. If you’re relying on condoms for birth control, they can slip or break. And planning for pregnancy can give you the ability to have a healthy pregnancy when you want one: less than 1% of pregnant women with HIV give the virus to their babies when taking a special set of medications.

I’m taking HIV medication. What birth control can I use?

The shot, implant, and IUD are effective regardless of what HIV medication you’re on. Whether you can use other types of birth control depends on what type of medication you’re taking.

Nucleoside Reverse Transcriptase Inhibitors (NRTIs). If you’re taking a type of ARV called a “nucleoside reverse transcriptase inhibitor,” like zidovudine or tenofovir, it’s safe to use any type of birth control, including combined hormonal methods like the pill, the patch, or the ring. The scientific evidence shows that these meds and birth control don’t mess with one another. Here’s a list of NRTIs to see if you’re taking one.

Non-nucleoside Reverse Transcriptase Inhibitors (NNTRIs). There’s some limited evidence that “non-nucleoside reverse transcriptase inhibitors” like efavirenz or nevirapine may cause small changes in how the pill, patch, or ring is metabolized in your body, though they don’t appear to decrease the effectiveness of these methods. Here’s a list of NNTRIs to see if you’re taking one.

Protease inhibitors. If you’re taking a type of medication called a “protease inhibitor” like combinations of medications containing ritonavir, the medication may make the pill, patch, or ring less effective. Protease inhibitor meds may also mess with the progestin-only or mini pill.

There’s also some evidence that the pill, patch or ring changes how a protease inhibitor with ritonavir is broken down by the body. These changes may make the medication more likely to cause minor problems with your liver or other side effects. Always talk with your doctor about using any of these HIV medications with the pill, patch, or ring. Here’s a list of protease inhibitors.

HIV makes me more vulnerable to infections. Is it safe to use an IUD?

IUDs are the most effective reversible birth control we have, and they do not increase the risk of a pelvic infection. In fact, this is a great method to use to prevent an accidental pregnancy while getting your body healthy on medications.

  • If you have HIV and are healthy, you can use any kind of IUD.
  • If you have AIDS, we usually recommend that you wait until your infection is under control before starting to use an IUD.
  • If you already have an IUD in place and develop AIDS, it is safe for you to keep using it.

I’ve heard that using the shot may increase the risk of transmitting HIV. Is that true?

Health researchers all over the world are working hard to make sure we have the right answer to this important question. It’s possible that there is an association between using the shot and increased risk of getting HIV, but more evidence is needed. Current guidelines from the World Health Organization say that it’s safe for HIV positive people to use the shot, but that condoms should always be used to prevent HIV transmission. For more information just for women living with HIV, check out:

bedsiderBEDSIDER is an online birth control support network for women operated by The National Campaign to Prevent Teen & Unplanned Pregnancy. Bedsider is totally independent (no pharmaceutical or government involvement). Honest and unbiased, Bedsider’s goal is to help women find the method of birth control that’s right for them and learn how to use it consistently and effectively, and that’s it.
Find Bedsider on twitter @Bedsider

3 Questions About Taking The Birth Control Pill

Photographer Monik Markus

Photographer Monik Markus

Knowing how to use the birth control pill in the most effective way can seem confusing, especially considering all the different brands and varying information out there. The most common questions tend to center around the risks of pregnancy if the pill is not taken at the same time everyday, as well as what to do if you miss a pill.

In this article, Heather Corinna clears up all confusion, explaining the basic, must-knows about this form of contraception. She clarifies how to take the pill, when it’s most effective, and when it may not be.

Here are the key points discussed in detail below:

  • It is strongly advised to use the “dual method”, coupling hormonal contraception with condom use.
  • The Pill provides no protection against STIs.
  • If you aren’t using condoms and you are just starting the Pill, wait one full cycle of active pill taking before using it as your only form of birth control.
  • Ideal, perfect pill use is taking it at the same time of day within a few hours difference.
  • A “late” pill varies more in definition among sources, and to some degree from pill to pill. For all birth control pills, if you have taken a pill more than 12-24 hours late, you should consider using a backup method of birth control (i.e. condoms) for the rest of your cycle.
  • A “missed” pill is one that has not been taken within 24 hours of the last pill you took. Read below for what to do if you miss a day or more.
  • Do your research. How birth control pills are taken, when effectiveness is compromised, and what side effects and risks are most prevalent can ALL differ from pill to pill. So make sure to read the pill packet information in full and consult your health provider with any concerns.

This article was originally published on Scarleteen 

BY HEATHER CORINNA | Scarleteen

Anonymous asks:

I had sex with no condom 3 days before I started my period, AND 1 day after I started my period. I’m on birth control BUT I was at the end of my 1st pack I have ever took (taking the non-active pills) and I don’t exactly take them at the exact same time every day but pretty close. I was wondering what’s the possibility of me getting pregnant considering the circumstances, birth control doesn’t take effect until the first month is up, but I’m already taking my inactive pills so that technically means the month is up doesn’t it? Also, I was getting ready to start/was on my period, and I have a regular cycle so I don’t think there’s any way I could have been ovulating but I’m really worried, please help!

And Gail asks…

I’m 16 years old, and I’m on the pill. I’ve been on it for little over a month, and recently me and my partner have been doing it without a condom (we’re clean) since I’ve been on them for a month now. Question is, I’m not a perfect user. I take my pill within a 30 min. range, never exactly right on time, what’s my chance of pregnancy?

And Hockeylover asks…

I’ve been on the pill for about a year now and I’m sexually active with my boyfriend. This past month I had sex with my boyfriend and the condom didn’t break but may have leaked or something because my boyfriend seemed to think that something minor could have been wrong. A few days after that I forgot to take a pill until about 12 hours after the fact. Now, my pill pack is finished and it is time for me to have my withdrawal bleed which has always occurred at the same time. Today, however, I have experienced nothing but minimal spotting, which is unusual.

Also – just for future reference as I was always curious – I know that it is extremely difficult to become pregnant while on the pill as long as it is taken properly. However, if pills were forgotten or whatnot I realize that it is possible to get pregnant but I was wondering whether one would still experience the withdrawal bleed or whether this would not occur (just like a period doesn’t occur if someone is pregnant). Does any blood that comes during a withdrawal bleed while on the pill signify that no pregnancy has occurred? Am I at risk?

Heather Corinna replies:
Since there are so many different pill brands, so much information to sort through, and since with adolescents and/or young adults information on some aspects can vary slightly, and we get so many questions about the pill, it seems it’s high time to give the most basic rundown I can speaking to concerns about how to take the pill, when it’s effective, and when it may not be.

Let’s start with a super-simple summary of how combination birth control pills work.

First, take a look at our piece which explains how the fertility and menstrual cycle works, so you have some context. Got the gist?

So, the pill acts to alter that natural cycle so that you don’t become pregnant, via synthetic hormones (usually estrogen and progesterone) to contradict your real ones. The pill works to do that in three ways:

  • by keeping your follicles from maturing and your body from ovulating (releasing a mature),
  • by thickening cervical mucus so sperm have a terribly tough time getting anywhere near an egg if by chance one is still released, and
  • by preventing implantation of an embryo by keeping the endometrium thin in the event that both somehow still manage to happen.

At the start of your pill pack, the hormones in your pills effectively have a little chat with your pituitary gland and tell it to suppress FSH — your follicle-stimulating hormone — so that an egg doesn’t mature, nor will the cells around it grow to form a follicle that releases estrogen at the beginning of your cycle, which would stimulate your body to prepare thicker endometrial lining through the cycle to sustain a pregnancy.

Your pituitary gland (being highly impressionable, you know the type) steps it up and doesn’t produce that FSH, so that maturation doesn’t happen and the lining of your uterus doesn’t thicken the way it would to sustain a pregnancy. At the time your LH surge would normally happen — around halfway into your cycle — the way the pill controls progestin keeps that surge from happening, too, which suppresses ovulation. Thus, no egg is released to be fertilized by sperm. As a backup, it’s at the same time keeping cervical mucus thick: to get why that matters, imagine trying to push a piece of thread head first through school paste: that’d be quite a challenge, and is what it’s like for sperm to try and move through that mucus to get into the cervix.

When you go off your active pills, and into the placebo (inactive pill) period you get your withdrawal bleed, because taking those hormones away allows for the breakdown of a thin uterine lining you had there (and because the pill keeps it thinner, often people on the combination pill experience lighter, shorter periods).

And when you start your next pack, you start that cycle all over again.

But while we know that the pill, in perfect use, is highly effective, we also know that a) some people do become pregnant while on the pill and b) in typical pill use, lower rates of effectiveness have been shown in studies for adolescents than for adults. Here’s the scoop on what perfect use is, how to have the pill be as effective as possible for you, what a missed pill is and what you should do, when it’s time to worry about pregnancy and when it’s not.

First starting the pill and birth control backups

With all BCPs (birth control pills), to be as safe as possible, and in the interest of having as much protection as possible, it is strongly advised to back up the pill with condom use when using the pill as birth control.

Most effectiveness rates for the pill are lower for younger women, usually because plenty of younger women are having to hide the pill and/or be sneaky in taking them, so it’s more likely that younger women, rather than older women, will miss pills and/or take pills late, which can reduce effectiveness. Too, younger women who don’t tell their general doctors they are using the pill may not be warned in advance about drug interactions with the pill and general medications (usually that’s only the case with one class of antibiotics and some herbal supplements) or that some illness can reduce effectiveness.

STIs should also be a big concern, especially when you’re under 22, since adolescents and young adults are both at the highest risk for STIs of any group, and younger women also are at higher risks of long-term complications from STIs. The pill provides no protection against STIs… and also often seems to provide a bit of a sense of false security in terms of infections, since so many women are most worried about pregnancy. Condoms provide that protection, and in addition, the one-two punch of the pill AND condoms (so long as one is used perfectly, and better still if both are used properly) almost guarantees you will not become pregnant.

If you are NOT going to back up with condoms, and are just starting the pill, we strongly advise you to wait one full cycle of active pills before using ONLY the pill as birth control, even though for many people, the pill may likely be fully effective within seven days, and for some, even sooner. If you have gone without a backup method in those first seven days and had sex with only the pill, it is advised to call your healthcare provider and ask about emergency contraception. You may also want to consider doing so if you went without a backup in that first cycle.

Two ways to start taking the pill for the first time

A first day start means you start taking the pill on the first day of your menstrual period. With a first day start, the pill may be effective as early as that first day, but waiting one full cycle before going without a backup is strongly advised.

A Sunday Start is when you start the pill on the first Sunday AFTER your period begins (or, if it starts on a Sunday, on that Sunday). When you start with a Sunday start, the pill may be effective as early as within one week, but waiting one full cycle before going without a backup is strongly advised. The Sunday Start method was devised primarily for women who would prefer they have their withdrawal bleeds (your period wile using the pill) on a weekday, rather than on weekends, as it makes that more likely.

Unless your healthcare provider suggests one way of starting is better for you, how you start is your call, based on your preferences. These two ways are ONLY relevant when you first start taking the pill. For every cycle thereafter, you’ll start your new pack when you finish the pack before.

What’s taking it on time and what isn’t?

You want to do your level best to take your pill as close to the same time every day as is possible, ideally within a window of a few hours: if you do that, every day, then you’re a perfect pill user — that doesn’t mean you get a gold star (unless you want one, in which case, by all means, star yourself!), but it does mean that unless you have any other misuse you can rest assured you have the highest effectiveness in terms of pregnancy protection possible from your pill.

To simplify that, what’s important is not that you take the pill at the EXACT same time every day (as in, “Oh god! I usually take it at 10:32, and it’s 11:03!”), but at the same time of day: for instance, always in the morning, or always before you go to bed. That gets pill-taking into your regular routines so that you’re most likely to remember to take them. For instance, Gail says she’s not a perfect user, but, in fact, she is, and it sounds like our user with the first question is, too. For that matter, even Hockeylover isn’t that far off: with combination pills, while you probably don’t want to get in the habit of taking them with a 12-hour difference, just because it can be easier to space out pills that way, but she hasn’t put her effectiveness at risk.

A “missed” pill is one that was not taken within 24 hours of the last pill you took. A missed pill should always be taken as soon as you realize you have missed it, but there is likely no risk from one missed pill or a need for EC. A “late” pill varies more in definition among various sources, and to some degree from pill to pill, but with any type of pill, if you have taken a pill more than 12-24 hours late, you may want to consider using a backup method of birth control for the rest of your cycle to play it safe.

With ALL pills if you have missed a pill, the right thing to do is to take that pill as soon as you know you missed it. If it’s on that same day, take it when you realize. if you realize you missed a pill when you go to take the next day’s pill, take both pills at the same time. If you realize you messed up and missed a pill days later — while still taking the other pills on time — then take that pill then. The same goes if you’ve missed two or three pills rather than just one. When you miss a pill, we advise using a backup method of birth control for the rest of that cycle.

If you’ve missed more than three, with most pills, you’ll want to wait to take any more pills until the following Sunday, then just start a new pack entirely, but use a backup for that cycle as well as the time in between. If you have missed several pills and have had sex in that cycle without a backup method, we advise emergency contraception. When in doubt, always contact your healthcare provider or pharmacist and ask what to do.

How do you know if you become pregnant while on the pill?

The same way you would if you were not: you’ve really just got to take a test. The most common symptom of pregnancy is a missed or late period, or a period that comes around the time you’d expect it but is very unlike what your period (or withdrawal bleed, when you’re on the pill) is usually like. So, when on the pill, if you become pregnant, you most likely will NOT have your withdrawal bleed. But ultimately, you’re unlikely to become pregnant while on the pill unless you have not taken it properly, so if you know you have not and are concerned about pregnancy, just take a pregnancy test (and the pill, for the record, doesn’t get in the way of pregnancy test accuracy).

I always tell women that I personally feel like a box of a few pregnancy tests in the cabinet is about the cheapest therapy there is: for a pretty small investment, you can have a real sanity-saver handy right when you need it. Even if you think you’re just being paranoid, there are times when spending that ten or fifteen bucks to verify you’re being paranoid is seriously worth it.

Read up and play it safe

With ALL pills, read your pill packet information. Pills — how they’re taken, when effectiveness is compromised, what side effects and risks are most prevalent, and the best ways to take them — can ALL differ from pill to pill. So, be sure if you’re on the pill, to read those inserts and to talk to your healthcare provider prescribing the pill for you and ask ANY questions you have: there’s just no reason to fly blind with your birth control.

Please understand that more often than not, we DO err on the side of caution here at Scarleteen, both because in many aspects the population we serve is unique (and largely underrepresented in many studies on everything to do with sexuality and sexual health) and because while we are not legally liable for information here, we are certainly accountable for the information we give you and want to be sure we’re doing the best we can to help you stay as safe as you want to be if you’re going to be sexually active. We always review a myriad of credible sources with our information, and do our level best to look at that information as a whole and draw whatever conclusions from all of it which we feel the most confident will help you to be the most safe.

As usual, we will always encourage you to seek out a second opinion from your healthcare provider whenever you like or feel a need. Don’t forget that part of the service your healthcare providers provide is information: when you’re starting any medication — be that the pill or something else — ask as many questions as you have, don’t hold back! It’s your doctor or nurses’ job to be sure you know how to use your medication properly and understand all you can about it.

heatherHEATHER CORINNA is an activist, artist, author and the director of Scarleteen, the inclusive online resource for teen and young adult sex education and information. She is also the author of S.E.X.: The All-You-Need-to-Know Progressive Sexuality Guide to Get You Through High School and College and was a contributor to the 2011 edition of Our Bodies, Ourselves. She’s received the The Champions of Sexual Literacy Award for Grassroots Activism (2007), The Society for the Scientific Study of Sexuality, Western Region’s, Public Service Award (2009), the Our Bodies, Ourselves’ Women’s Health Heroes Award (2009), The Joan Helmich Educator of the Year Award (2012), and The Woodhull Foundation’s Vicki Award (2013).

Can Pre-Ejaculate Cause Pregnancy?

Photographer Zen Sutherland

Photographer Zen Sutherland

Can pre-ejaculate cause pregnancy? This is an important question for anyone who can become pregnant, or is having sex with someone who can get pregnant. Particularly for those who use the “pull-out” or fertility awareness method, understanding the risks involved is fundamental to making proper health choices for yourself.

The answer to this question, however, is not so certain and still under going research. In this article, Heather Corinna explains what exactly we do know for certain about pre-cum and how best to approach risks with the information that is out there.

Here are her key points:

  • There is far less sperm in pre-cum than there is in ejaculation.
  • Chances of sperm in pre-cum are lowered if one has recently urinated and has not ejaculated before intercourse.
  • Pre-cum can transmit infections.

This post was originally published on Scarleteen.

BY HEATHER CORINNA | Scarleteen

Jess asks:

Can a woman become pregnant off of pre-cum fluid alone?

Heather Corinna replies:

The short answer is that it is possible, yes, but is not very likely.

The longer answer is that there are a lot of variables, and we still need more study to be done on this to give a better answer.

Do we know that pre-ejaculate fluid can contain sperm? Yes, we do. We also know that there are far, far less sperm in pre-ejaculate — when there are any at all — than there are in a full ejaculation: a full ejaculation contains as many as 100 million sperm, whereas when sperm is in pre-ejaculate, it’s more like a few million, if that many. But it only takes one active sperm and a few hundred helper sperm to create a pregnancy, so sometimes there may be more than enough sperm in pre-ejaculate when sperm are present in it to make that happen. However, sperm also need the fluid they’re part of to create a pregnancy, so the limited volume of pre-ejaculate is also an issue, as is the far fewer sperm which may be (and often are not) part of it.

There’s no 100% way to know at the time if pre-ejaculate contains sperm, but it’s generally agreed upon that it is most likely or only likely to when a man has recently ejaculated and has not urinated afterwards (urine flushes the urethra out, removing traces of sperm). It’s generally considered to be least likely to contain sperm when a man either hasn’t ejaculated in a while and/or has recently urinated before he’s pre-ejaculating.

Since you’ll often hear a lot of argument when it comes to whether sperm are or are not present in pre-ejaculate, here’s what some other credible folks have to say on the matter:

Go Ask Alice at Columbia University says:

Sperm could be in pre-cum, but only after a recent ejaculation, after which some sperm may be left hanging around in the urethra. “Recent” means masturbating earlier and then having sex with a woman, or during the same sexual episode of the recent ejaculation. Urinating in between ejaculations flushes the urethra of stray sperm and makes the way clear for the sperm-less pre-ejaculate fluid. If sperm remains after a prior ejaculation, then it’s possible that they can enter the vagina and make their way to meet an egg.

The Feminist Women’s Health Center says about it:

During sex, the penis releases two kinds of fluids. The first is pre-ejaculate or pre-cum, a lubricant made in a gland in the penis. This fluid usually contains no sperm, but can transmit infections. The second, released with ejaculation, is semen, which is made in the testicles and carries thousands of sperm in addition to any sexually transmittable infections that may be present.

Many sources that discuss the ineffectiveness of withdrawal argue that pre-cum can contain sperm. This is because previous ejaculations can leave some sperm behind in the folds of the penis. While there is a need for further study, it is likely that urination before intercourse washes leftover sperm from the urethra, the tube from which both urine and semen exit the penis.

Here’s what Student Health Services at Oregon State University has to say:

Pre-cum is the pre-ejaculate fluid that can be released from the penis during sexual activity. It is usually released before the male reaches orgasm, which results in the ejaculation of semen. Pre-cum prepares the urethra for the semen and helps in lubrication during sexual intercourse. Also the pre-cum may contain sperm. Since the pre-ejaculate can contain sperm, a pregnancy can occur if the man’s pre-cum comes in contact with the woman’s vaginal canal.

However, there is inconclusive evidence as to where the sperm in the pre-ejaculate comes from. Many researchers suggest that the sperm in the pre-ejaculate comes from leftover sperm from a previous ejaculation of semen. These researchers suggest that urinating after the ejaculation of semen will remove any sperm from the urethra, so as to prevent the pre-ejaculate from containing sperm. However, research is still being conducted to support this widely accepted idea.

And here’s what Contraceptive Technology has to say:

Some concern exists that the pre-ejaculate fluid may carry sperm into the vagina. In itself, the pre-ejaculate, a lubricating secretion produced by the Littre or Cowper’s glands, contains no sperm. A study examining the pre-ejaculate for the presence of spermatozoa found none in the samples of 16 men. However, a previous ejaculation may have left some sperm hidden within the folds of the urethral lining. In examinations of the pre-ejaculate in a small study, the pre-ejaculate was free of spermatozoa in all of 11 HIV-seronegative men and 4 or 12 seropositive men. Although the 8 samples containing spermatozoa revealed only small clumps of a few hundred sperm, these could possibly pose a risk of fertilization. In all likelihood, the spermatozoa left from a previous ejaculation could be washed out with the force of a normal urination. However, this remains unstudied.

So again, the only right answer we can give right now is a maybe.

But we also do know that withdrawal isn’t one of the most effective birth control methods, in either perfect or typical use, and that enough people report using it perfectly — saying they withdrew well before ejaculation — and still becoming pregnant (including my parents as well as a close friend of mine, for a personal perspective), that we’d be remiss to rule out pre-ejaculate as a pregnancy risk. Bear in mind that during the Baby Boom in the United States — a period in history when we had more births than any other — that withdrawal was the most common method of birth control people were using. Of course, many of those pregnancies may well have been due to men who said they pulled out on time not realizing they had actually ejaculated, and we have no way of knowing what the real deal was. What we can know, for sure, are the success and failure rates of withdrawal as a method, however it is practiced, and know that most other methods of birth control are more effective.

Too, unprotected sex, period — ejaculate or no — poses risks of all sexually transmitted infections, which should be just as great a concern as pregnancy. And pre-ejaculate can transmit the HIV virus just as much as full ejaculate can.

So, having unprotected sex, period, just isn’t a good idea unless you are trying to become pregnant AND you and your partner have both been practicing safer sex for at least six months, monogamously, AND each have at least TWO full and clear STI screens under your belts. While it’d be nice if we had more data on pre-ejaculate at this point, at the same time, it’s not all that essential. We already have the essential information we need, which is that ANY unprotected intercourse presents risks of pregnancy and STIs, and that people who want to prevent pregnancy achieve that best with the most reliable methods of contraception, used properly and consistently, or by abstaining from the kinds of sex which present pregnancy risks.

If you want to engage in intercourse safely, you need a condom at a minimum, and if, for whatever reason, that or some other reliable method is not an option, then the only good choice is to choose not to have sex until sound contraception can be used.

Here are some extra links to grow on:

heatherHEATHER CORINNA is an activist, artist, author and the director of Scarleteen, the inclusive online resource for teen and young adult sex education and information. She is also the author of S.E.X.: The All-You-Need-to-Know Progressive Sexuality Guide to Get You Through High School and College and was a contributor to the 2011 edition of Our Bodies, Ourselves. She’s received the The Champions of Sexual Literacy Award for Grassroots Activism (2007), The Society for the Scientific Study of Sexuality, Western Region’s, Public Service Award (2009), the Our Bodies, Ourselves’ Women’s Health Heroes Award (2009), The Joan Helmich Educator of the Year Award (2012), and The Woodhull Foundation’s Vicki Award(2013).

 

scarleteenSCARLETEEN is an independent, grassroots sexuality education and support organization and website. Founded in 1998, Scarleteen.com is visited by around three-quarters of a million diverse people each month worldwide, most between the ages of 15 and 25. It is the highest-ranked website for sex education and sexuality advice online and has held that rank through the majority of its tenure.
Find Scarleteen on twitter @Scarleteen

The Greatest Misunderstanding About IUDs- Corrected

The IUD (with the less appealing name, Intrauterine Device) is one of the most effective and reversible long-term birth control options. Currently, there are three IUD product options: the Mirena, ParaGard and Skyla. Yet despite how wonderful this device is, many women (and some doctors!) still believe that you must be over a certain age in order for an IUD to work.

Bedsider sets the record straight with quick, accurate IUD must-knows.

Watch and be rest assured. For more IUD myth busting, visit Bedsider’s 5 Myths About IUDs

This video is published with Besider’s permission.

BY BEDSIDER | Bedsider.org

bedsiderBEDSIDER is an online birth control support network for women operated by The National Campaign to Prevent Teen & Unplanned Pregnancy. Bedsider is totally independent (no pharmaceutical or government involvement). Honest and unbiased, Bedsider’s goal is to help women find the method of birth control that’s right for them and learn how to use it consistently and effectively, and that’s it.
Find Bedsider on twitter @Bedsider

Emergency Contraceptives: Setting The Record Straight

Photograph: Gilbert Rodriguez

Photograph: Gilbert Rodriguez

BY JOELLEN NOTTE | theRedheadBedhead.com

In the wonderful world of sex, things don’t always go as planned— Condoms break, pills are forgotten, folks get drunk and reckless. When these things happen, Emergency Contraception (EC) can mean the difference between a brief panic and an unplanned pregnancy. However, before you can protect yourself with EC, it’s important to know your options and how they work. This is trickier than it should be though, as rumors, myths and misapprehensions regarding EC are rampant.

So let’s clear up some of the confusion, shall we?

What’s in a Name?

Emergency Contraception frequently goes under another name that confuses the issue greatly – The Morning After Pill. That name on its own confuses people on three separate issues:

  • “The” implies that there is only one kind of EC. Nope!
  • “Morning after” makes it sound like you must take it immediately or you are screwed. Not so!
  • “Pill” leads us to believe that EC only comes in pill form Incorrect! (That’s right folks, pills are not your only choice.)

There go three big fallacies before we even get past the introductions!

So, what are your options? How do they work? Where can you get them?

Well, they range from over-the-counter one-dose pills to IUDs (for real, IUDs can be used as EC!). To get the skinny on what’s out there, how you can get it and how much it might cost you, check out the Emergency Contraception page from our friends at Bedsider. It includes an emergency contraception locator and guidelines on following the Yuzpe Regimen – a way to use your regular BC pills as EC.

Mistaken Identity

Also, EC suffers from a huge case of mistaken identity! There are a lot of folks out there who think that Emergency Contraception and medication abortion are the same thing or that EC is an “Abortion Pill”. This is just plain wrong.

Emergency contraception prevents pregnancy, it does not end it.

Here’s how I like to think about it: Imagine you are a car and sex is driving (go with me here). In this world, EC would play the role of your brakes – there to prevent an accident. Medication abortion fits in the same category as things like air bags- there in case said  accident occurs. For more information on medication abortion and what it actually is, head over to Planned Parenthood’s Abortion Pill page.

The New Ella and The Great IUD

So, those are the big misconceptions but they are far from the only ones. Thankfully, once again, Bedsider to the rescue with 5 myths about the emergency contraceptive pill, busted. A quick disclaimer about this one, it does include one out-dated piece of information, which is that all of the pill options become less effective the longer you wait to take them. There is one pill, Ella, (which is the newest and available by prescription only) that doesn’t decrease in effectiveness.

Finally, be aware that the IUD is the only method that, once inserted, protects you against future pregnancy. Also, it is the most effective in terms of the pregnancy you are currently trying to prevent. Check it out:  IUDs Work Best for Emergency Contraceptive.

JoEllen-NotteJOELLEN NOTTE is helping to share the gospel of better living through better sex ed (amen!) – serving as both the Education Coordinator & Lead Sex Educator for the Portland Academy of Sex Education and a co-Emissary of Sex Geekdom Portland. Working as an adult retail consultant, she is working to help promote better sex through better adult retail. JoEllen first began fighting sexual mediocrity on her site theRedheadBedhead.com. Follow JoEllen on twitter: @bedheadtweeting

The CSPH: Will The Nuva Ring Affect How I Have Sex?

oh megan nuva ringThe Nuva Ring is used now by around 1.5 million women worldwide and has been hailed as a wonder contraceptive by many. The birth control makes reversible hormonal contraception simple as the user can insert it for a period of 3 weeks to help prevent pregnancy.

However, the Nuva Ring is not a widely known contraceptive and those interested in learning more or are new to using the product may have some questions.

In this video, sex educator Megan Andelloux addresses some of those questions and tells the viewer:

  • The Nuva Ring fits into the back of the vagina and is held in place by the vaginal muscles.
  • The penis likely won’t feel the Nuva Ring although a finger may.
  • Removing the Nuva Ring for 4 hours still leaves you protected from pregnancy if you don’t want to risk it interfering with sex or you don’t want your partner to know you are wearing it.
  • Silicone lube and toys can be used with the Nuva Ring and will not affect it’s quality.

This video was originally published on the CSPH website.

BY The CSPH | theCSPH.org

Like all forms of contraception it’s important you know the full risks and advantages of using the Nuva Ring and talk with a medical professional about it’s suitability for you.

megan_andellouxMEGAN ANDELLOUX  is a Clinical Sexologist and certified Sexuality Educator, listed on Wikipedia as one of the top sexuality educators in America, her innovative education programs, writing, social media presence, and ambitious speaking schedule has made her one of America’s most recognized and sought-after experts in the growing field of sexual pleasure, health, and politics.
Follow Megan on twitter @HiOhMegan

 

csphThe CENTER for SEXUAL PLEASURE and HEALTH (The CSPH) is designed to provide adults with a safe, physical space to learn about sexual pleasure, health, and advocacy issues. Led by highly respected founder and director, Megan Andelloux, The CSPH is a sexuality training and education organization that works to reduce sexual shame, fight misinformation, & advance the sexuality field.