Our Bodies, Ourselves (56 page)
Read Our Bodies, Ourselves Online
Authors: Boston Women's Health Book Collective
Emergency contraception is available at family-planning clinics, health-care providers' offices, and pharmacies. You can ask your provider to write you a prescription in advance so you have it on hand if you need it. The IUD must be inserted by a trained provider.
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What is my risk of pregnancy from unprotected intercourse?
The likelihood of becoming pregnant after a single act of unprotected intercourse depends on where you are in your menstrual cycle and on your body's unique fertility levels.
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What if I engage in unprotected intercourse but ejaculation does not occur? Is sperm present in pre-ejaculatory fluid?
The chance of pregnancy is probably extremely low. Three small studies found no motile sperm in pre-ejaculatory fluid.
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(However, HIV
can
be detected in pre-ejaculatory fluid.) If you are worried about the possibility of pregnancy, or if you are not sure whether ejaculation did occur, consider using emergency contraception.
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When should my next period come after I take emergency contraceptive pills?
After taking ECPs, some women have a period early, and some women have irregular bleeding
that is not really a period. The duration of the irregular bleeding is not predictable. You should have another normal period within the next month. If not, you should get a pregnancy test to make sure you're not pregnant.
Abortion rights opponents oppose EC and claim it is abortion, which ends a pregnancy, rather than contraception, which prevents one. However, EC works either by preventing ovulation or by preventing implantation of a fertilized egg in the uterus. The international medical community agrees that pregnancy begins with implantation, so EC acts before pregnancy even occurs.
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What if I have sex after taking emergency contraceptive pills?
Emergency contraceptive pills do not act as ongoing birth control. They will not protect against pregnancy from unprotected intercourse that occurs after the pills are taken.
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Is there a limit to the number of times emergency contraceptive pills can be used?
There are no safety concerns with using ECPs repeatedly. However, ECPs are not as effective as many other methods of contraception. EC is also expensive to use repeatedly. You (and your wallet) might benefit from finding an ongoing method of contraception.
For free information about preventing pregnancy after unprotected intercourse and to obtain names and telephone numbers of health care professionals in your area who can provide emergency contraception, call the Emergency Contraception Hotline at 1-800-584-9911 or visit not-2-late.com.
Safer Sex
S
ex that we say yes to and actively participate in can be pure pleasure, allowing us to express desire, playfulness, intimacy, vulnerability, and power. Unfortunately sex can also expose us to the risk of pregnancy and to sexually transmitted infections (STIs). In most cases, STIs can be treated. However, some STIs, if left untreated, can cause serious long-term health consequences, including chronic pain, infertility, cancer, and even death.
How do we enjoy pleasure and also protect our health? How can we explore our sexuality and avoid infection and unwanted pregnancy? Many of us know the basic answers, but in the heat of the moment, most of us have, at some point, failed to use the protection that would be in our best interests. Fortunately, we can help ourselves by better preparing for those moments.
This chapter talks about sex-positive ways to protect yourself and your partner(s) from STIs. Please see
Chapter 9
, “Birth Control,” for ways to prevent unwanted pregnancy. For details on the different types of STIs, along with STI diagnosis and treatment, see
Chapter 11
, “Sexually Transmitted Infections.”
Safer sex refers to steps you can take before and during sexual activity that are known to reduce the risk of STIs. The term “safer sex” is used instead of “safe sex” because sex with a partner is never guaranteed to be 100 percent safe.
Many of us have heard of HIV, the virus that causes AIDS, and other STIs such as gonorrhea, chlamydia, HSV (herpes simplex virus), and HPV (genital human papillomavirus, a leading cause of cervical cancer and genital warts). What we may not know is how common they are. While it's hard to know exact numbers, it is estimated that there are approximately 19 million new STI infections in the United States each year, with about half of the new cases occurring in young people age fifteen to twenty-four.
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Approximately one in four young women between the ages of fourteen and nineteen in the United States is estimated to be infected with one or more of the most common STIs: HPV, chlamydia, herpes, or trichomoniasis.
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More than two dozen bacterial, viral, or parasitic infections are known to be transmitted largely or exclusively through sexual contact. Many people do not know that they are infected because they have never been tested and because most STIs have no noticeable symptoms. Bacterial and parasitic infections are commonly treated with antibiotics or other prescription drugs. There is no cure for viral infections; treatment aims to prevent or reduce symptoms. Having an untreated STI can make you more vulnerable to a second STI (including HIV), and it may cause the symptoms of a second infection to be more serious or painful.
SAFER-SEX BASICS
Safer sex refers to sexual practices that can reduce or eliminate exposure to STIs, usually by preventing the exchange of blood, semen, or vaginal fluids. Using condoms consistently and correctly is an essential component of safer sex.
Some STIs, such as herpes and HPV, and genital ulcer diseases such as syphilis and chancroid (a bacterial infection characterized by painful sores) can be transmitted from contact with skin that is not covered by a condom. The risk is reduced only when the infected area or site of potential exposure is protected.
HE
T
ALK
Whether you are considering sex with someone new or negotiating sexual choices in a long-term partnership, there are key questions to consider: When and how do you talk with your partner(s) about sexually transmitted infections? Which activities have a lowerâor higherârisk of STI transmission? How do you decide which protection is best for youâand then follow through on your decisions?
Thinking about these questions and talking through the answers with your sexual partner(s) are the first steps toward enjoying your sexuality while staying safe. It can be good to know that those conversations can be comfortableâand empowering. One twenty-two-year-old says:
TEN MYTHS ABOUT STIS
1. You can tell by looking if someone has an STI.
There is no way to know for sure who may have HIV or another STI. Many people don't know themselves that they are infected. Many STIs are silent diseases, meaning that they produce few, if any, symptoms.
2. Being sexually exclusive with one partner will keep me safe.
A monogamous relationship reduces the risk of infection, so long as neither partner came to the relationship with an existing infection. However, many people enter new relationships not knowing if they are infected with an STI, and people don't always tell the truth about their past or present sexual practices. If you are having sex with only one person but that person has other partners, you can be exposed.
3. If he pulls out before he comes, I can't get infected.
Pre-cumâdrops of fluid that the penis discharges during arousalâcan contain HIV, other STIs, or even sperm. It's best to use a condom as soon as the penis is erect.
4. My birth control will protect me from STIs.
Condoms are the only birth control method that offers dual protection against pregnancy and STIs. The pill, hormonal injections and implants, diaphragms, and the IUD do not protect against STIs.
5. Lesbians don't get STIs.
All women who engage in certain sexual activities are at risk for STIs, though the risk is less for women who have sex only with other women. Some STIs can be transmitted between women by genital-to-genital or oral-to-genital contact that involves the exchange of vaginal fluids or by sharing sex toys, and some can be transmitted by skin-to-skin contact.
6. I have an STI and we've already had sex, so there's no point using protection.
Practicing safer sex is still essential. Your partner may not yet be infected, and even if you share an STI, you could have different types or strains of the same infection that could make the infection worse for both of you. Or your partner could unknowingly have a different STI, which could speed up the progression of your current infection. You and your partner can pass an infection back and forth if you're not both treated.
7. I am too young (or too old) to get an STI.
Girls and women of any age who are having sex can contract an STI. Adolescent girls have the highest risk because their cervix cells don't produce as much protective cervical fluid as, and are more susceptible to infection than, the adult cervix. Tears in the vaginal wall, which are more common in postmenopausal women owing to decreased production of natural lubricants, can increase susceptibility to bacteria and infections.
8. STIs happen to other people, not me. Besides, you can't get an STI the first time you have sex.
Anyone engaging in certain sexual activities with someone who has an STI can contract an STI, whether it's the first time or the hundredth.
9. My partner and I fool around naked and have oral sex, but we haven't gone all the way, so we're not at risk.
Not having anal or vaginal intercourse decreases your risk of getting an STI, but some infections can be spread by oral sex and by skin-to-skin contact. You can contract HPV, for example, if your partner is infected and you rub your genitals together. Herpes is transmitted by genital or oral contact with a developing or existing sore; the virus can also be spread without symptoms.
10. We shower before sex so we won't spread infections.
Lather up if you want to, and then cover up. Washing the genitals, anal area, and hands before and after sex, and between anal and vaginal or oral contact, is good hygiene and may cut down on urinary tract infections, but washing does not prevent STI transmission. (Douching, by the way, is never a good idea; it may even push infections higher up in the vagina and affect other reproductive organs, and it alters the vaginal flora, making you susceptible to other infections.) After you wash, don't forget to reach for that condom or dental dam.
In the past, I've mostly had sex with people I've flirted with, hooked up with, or had sex with more than one timeâthat is to say, I haven't had many one-night stands without any flirting or courtship leading up to sex. In these contexts, I've found it easy to have check-ins about STI status before getting too hot and heavy. I've had friends stop sweaty make-out sessions to check in, and had hookups that seemed to be headed toward sex stay as just making out because of explicitly communicated worries about STIs. These have always been comfortable conversations (in my experience) that are about respecting each other and wanting to have fun, and not about shame or stigma
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