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Body Q&A

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    A friend forwarded me an e-mail about how tampons are dangerous and can cause cancer. Is there any truth to that?

    No. Tampons do not cause cancer. There have been a number of e-mails going around in the past few years alleging that manufacturers add carcinogens like asbestos to tampons to promote bleeding or that tampons contain fiberglass. Neither is true. In fact, tampons have been found safe by the U.S. Food and Drug Administration. Also, manufacturers no longer use bleaching processes that were found to leave traces of the toxic chemical dioxin. So rest assured, tampons are completely safe to use.

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    I hear people talking about something called an intersex. What is that?

    Some people are born with external sex organs that are not easily distinguishable as female or male. Ambiguous genitalia are sometimes apparent at birth. But sometimes they don't become evident until puberty.

    Also, some people have sex chromosomes that are different from the usual xx female or xy male. People whose biological sex is ambiguous in these ways may be called intersex.

    Sometimes the ambiguity is never noticed, so some people have intersex conditions for their whole lives and never know.

    People with intersex conditions may be considered sexually ambiguous in different ways:

    • They may have sex organs that appear to be somewhat female or male or both. They cannot, however, have complete female genitals and complete male genitals.
    • They may have a large clitoris more than two-fifths of an inch.
    • They may have a small penis less than an inch.

    About one in 2,000 people born in the U.S. is intersex. Sometimes a female or male gender is assigned through surgery. Up to five infant gender-assignment surgeries occur every day in the U.S. Some people believe surgery should be postponed until intersex people are old enough to decide for themselves whether they would like their genitals to be operated on. Most people agree that babies with intersex conditions should be assigned a gender at birth. Some people believe that assigning a gender means performing surgery on their genitals, while others believe that a baby can be assigned a gender without surgery.

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    I'm 18.  I've been menstruating for about three years.  Then for a couple of months, I didn't have a period.  Now I seem to be menstruating every other week.  What could be going on?

    I assume that you are not on any form of hormonal contraception. If that is so, and you are not pregnant, it may be that you have stopped ovulating and are having what is called dysfunctional uterine bleeding (DUB). DUB is very common. It is caused by hormonal imbalances which may be stimulated by excessive exercise, dieting, or stress.

    Other causes of irregular bleeding that is not DUB include pregnancy, sexually transmitted infection, polyps on the cervix, and using certain forms of hormonal birth control  such as the pill or the shot, or cervical cancer. Because there are so many causes for the bleeding you describe, you must be evaluated by your health care provider.

    The first thing to do is to take a pregnancy test to find out if you are pregnant. Whether or not you are pregnant, you should also visit your health care provider. If the bleeding is related to unintended pregnancy, you will want advice about prenatal care or your other pregnancy option, abortion. If you are not pregnant, your health care provider can help you determine the cause of the bleeding. Although irregular bleeding is common, you need to be sure to rule out any of the more serious possibilities.

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    Why does my body look like this?

    I don't know
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    I have a friend who is 23 years old. She is not sexually active, and she doesn't think she needs to have a Pap test. How can I convince her that getting one is in her best interest?

    Your friend may be interested to know about the most recent guidelines published by the American College of Obstetricians and Gynecologists. It recommends that women should have Pap tests when they become older than 21 or three years after their first sexual contact.

    "Sexual contact" means any kind of intimate manual, oral, vaginal, or anal sex play with a partner. The kinds of virus associated with cervical cancer can be passed through any intimate skin-to-skin contact. Pap tests are used to detect whether or not cells in the cervix are developing abnormally because they have been affected by certain kinds of human papilloma virus (HPV) that are transmitted through intimate contact. Early detection leads to early treatment and saves thousands of lives every year in the United States.

    It is estimated that 75 percent of people who have ever been sexually intimate with someone else are or have been infected with HPV. Many of them are infected with the types of HPV that can lead to cervical cancer. That is why a gynecological visit with Pap test is so important.

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    Can shaving infected hair get rid of critters like scabies and pubic lice?

    No. Shaving, dousing with kerosene, hot baths, and other so-called remedies just won't work. Scabies are mites that belong to the same family as spiders. Pubic lice are tiny insects that look a lot like crabs. Both are transmitted through sexual and intimate contact. They can also be picked up from infested bedding and clothing. Scabies get under the skin. Pubic lice attach their eggs to pubic hair.

    Symptoms usually include intense itching. Scabies also appears as small bumps or rashes that look like dirty, small curling lines, especially on the penis, between the fingers, on buttocks, breasts, wrists, thighs, and around the navel.

    To get rid of scabies, follow the directions on the package insert of a prescription medication such as Kwell or Scabene. Repeated neck-to-toe applications may be necessary. Everyone who may have been exposed to scabies should be treated at the same time. All bedding, towels, and clothing that may have been exposed should be thoroughly washed or dry cleaned, and the home should be thoroughly vacuumed.

    To get rid of pubic lice, follow the directions on the package insert of an over-the-counter medication such as A-200, RID, and InnoGel Plus. (Pregnant and breastfeeding women and infants must use products especially designed for them.) As with scabies, repeated neck-to-toe applications may be necessary. (Many health care providers do recommend trimming back the pubic hair before shampooing to cut down on the number of nits. This can help treatment work faster because fewer nits need to be treated after some have been shaved off.) And everyone who may have been exposed to public lice should be treated at the same time. All bedding, towels, and clothing that may have been exposed should be thoroughly washed or dry cleaned, and the home should be thoroughly vacuumed.

    Scabies and pubic lice are highly contagious. Condoms usually don't cover all the areas that are infested so scabies can be transmitted even if condoms are used. The only protection for sexually active people is to limit the number of sex partners. Limiting the number of sex partners can help reduce the possibility of exposure to these infestations.

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    My boyfriend smokes marijuana, and I have been keeping my body healthy all my life. If he ejaculates inside me, does the marijuana chemical get deposited inside me? Will it affect me?

    No. Some chemicals, like the ones in alcohol, cigarettes, cocaine, heroin, and marijuana, can affect sperm badly. They may reduce the sperm count, or the quality of the semen, which may make it difficult for a man using them to cause a pregnancy. (It would be a very bad idea, however, to rely on taking these drugs for birth control.) But this will not affect the general health of the women a man has sex with.

    On the other hand, certain chemicals and nutrients that a man ingests may alter the taste of his ejaculate. For example the sugars and vitamins in fruit and naturally processed alcohol may make semen taste sweet. Coffee and chemically processed alcohol may make it taste bitter. But neither of these effects will affect a woman's health.

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    My boyfriend is getting pre-ejaculate fluid when he's at work and doesn't understand what is happening. It is happening without erection. He says the fluid is sometimes yellow. Sometimes it's clear. Is it normal? If not, what's he supposed to do?

    It is unusual for an adult, sexually active man to secrete pre-ejaculate without sexual stimulation. But there are different kinds of discharges from the penis that might happen during the day without sexual stimulation. The possibilities include

    • leaking of urine from the bladder because the bladder muscles are weak
    • leaking of urine that is caused by a urinary tract infection
    • discolored discharges that are caused by sexually transmitted infections, such as gonorrhea or chlamydia

    Men who have any of these symptoms should visit a health care provider to find out what is causing the secretion. They can visit their own provider, make an appointment with a urologist a physician who specializes in the health of the urinary tract and male sex organs, or contact the nearest Planned Parenthood health center by calling 1-800-230-PLAN.

    People who are diagnosed with sexually transmitted infections should be sure to contact all the partners they may have exposed to infection. The partners of people who have gonorrhea or chlamydia must be treated at the same time in order to protect them and to avoid reinfection. Untreated gonorrhea and chlamydia can have serious health consequences. They can lead to infertility and chronic arthritis in both women and men.

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    I'm going to have my first pelvic exam. Can a doctor tell if you've had sexual intercourse?

    Not generally. Pelvic examination doesn't reveal if you've had vaginal intercourse or if you masturbate, unless there are specific signs:

    • symptoms of a sexually transmitted infection such as herpes or genital warts
    • the presence in the vagina of semen from a recent act of intercourse
    • torn tissue from violent or rough sex

    If hymeneal tissue that a health care provider has previously observed appears changed, she may think that sexual intercourse has occurred, but she cannot be sure unless she is told.

    Usually, the only way the health care provider will know if a woman's had sex is if the woman tells her. That's why it's important to tell your provider if you are having sex. Don't let embarrassment become a health risk. Let your health care provider know what is going on with your sex life so that she can make a more informed evaluation of your health status.

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    Can women really ejaculate?

    During orgasm, only one out of 10 women ejaculate. Their ejaculate is a fluid that is very similar to the fluid produced by the prostate gland in men. The "prostatic" fluid in women may be secreted by the Skene's glands located in the vulva near the opening of the urethra. These glands, though much smaller than the male prostate, are similar enough in function that some scientists are considering renaming them "prostate" glands. Other glands may also be involved in female ejaculation.

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    Lately after my boyfriend and I are done having sex, I swell up down there, and it is really sore, and it burns when I urinate. What is making this happen?

    There are many possibilities. Swelling of the vulva may be caused by an allergy to a contraceptive, spermicide, or lubricant; a yeast infection or other kind of vaginitis; a lack of lubrication; or a sexually transmitted infection. A change in soaps or laundry detergent could also be the cause. Any of these can lead to irritation of the vagina and vulva and create tiny abrasions that would sting if they came in contact with urine.

    Having sex can introduce bacteria into the vagina and urethra, causing urinary tract infections (UTIs). That could create a burning sensation during urination. Some women who use spermicide regularly, with the diaphragm for instance, are prone to having UTIs.

    Very sensitive nerve endings in the vulva can lead to a condition called vulvodynia. It causes chronic and potentially severe pain for many women. The pain is often made worse by any kind of physical contact sex, tampons, or tight clothing. Vulvodynia can sometimes be treated with various prescription medicines.

    What to do? Wait a few days to allow the vulva to heal, and then try switching the type of condom, lubrication, spermicide, soap, or detergent you are using and see if the reaction still occurs. If that doesn't help, visit your health care provider and discuss your sexual history. The two of you can decide if a physical exam and/or testing for UTIs or sexually transmitted infections might be helpful.

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    Does the G-spot really exist?

    Although many women and authorities have identified the G-spot, many women cannot locate it. When located, it is found an inch or two beyond the vaginal opening in the wall of the vagina closest to the bellybutton.

    Women find that the G-spot is very sensitive to sensual stimulation, swells slightly during sex play, and plays a role in vaginal orgasm. Some recent studies also show that stimulation of the G-spot by the pressure of childbirth may help reduce pain.

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    I will be giving birth to a boy next month. Should I get him circumcised?

    We can't advise you what to do. This is a very personal decision for parents to make. Circumcision today is most often performed for religious or cultural reasons or to make the boy's penis resemble his father's. For many years in the U.S., it was considered important for good sexual hygiene. Today, routine circumcision is considered elective surgery without medical benefits. Although recent studies in Africa have suggested that circumcision may offer protection against HIV, other studies need to be done to confirm those results.

    Like all surgery, circumcision is not without risks. Although rare, complications include excessive bleeding, infection, scarring, and damage to the penis. Many parents and authorities are also concerned that the procedure is quite painful for the child. In any case, the rate of circumcision in the U.S. has dropped from 95 percent in the 1960s to 65 percent today.

    Penises with foreskins require a little extra care. After a boy is three to five years old his foreskin will most likely become retractable, and he must be taught to pull back and wash under the foreskin. Until he can do this for himself, you can gently pull back the foreskin for him and wash under it during bathing. Never try to pull back the foreskin of an infant or boys for whom the foreskin remains to too tight to be pulled back. For some boys it takes much longer for the foreskin to become retractable. And for a few, circumcision may become necessary.

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    I had severe cramps that had me on the floor crying. Using a heating pad did not help, and when I went to the bathroom I discovered I had some large-size and smaller, gray/gray-blue tissue and blood clots in my underwear. Could it have been a miscarriage? It's way too late to get a pregnancy test.

    It could have been one of a few things. It could have been an early pregnancy loss (miscarriage), a very heavy period, a symptom of ectopic pregnancy, endometriosis, or the expulsion of fibroid tissue. Sometimes, usually for older women, it is the expulsion of endometrial material during the hormonal shifts associated with perimenopause the time of changes leading into menopause. To be more certain, you should have a gynecological visit to have your health care provider make an evaluation. This can be especially important if tissue remains in the uterus that may cause infection. To help the provider make an evaluation, save the tissue that is expelled and take it with you for your visit.

    It is nearly impossible to determine what caused your experience without additional information and an examination. But it is important to have a pregnancy test done, even now, to make sure you are not pregnant. Pregnancy tests can also help detect ectopic pregnancies, which can be confirmed by ultrasound examination of the uterus. You should determine whether or not you have an ectopic pregnancy as quickly as possible.

    Ectopic pregnancy is very dangerous, and it can be fatal if not treated. It is important for all women to know the signs:

    • cramps and spotting
    • vaginal bleeding
    • severe lower abdominal pain on one side of the body
    • nausea
    • vomiting
    • fainting spells
    • dizziness

    Women who have these symptoms should contact their health care providers or go to an emergency room immediately.

    Pregnancy testing can also detect pre-existing pregnancies for some time after they have ended. The pregnancy hormone, HCG (human chorionic gonadatropin), can remain in the body for up to 60 days after an abortion or miscarriage. Similarly, HCG levels can be measurable for weeks after childbirth. If you are not and have not been pregnant, other possible reasons for the severe cramps and passage of tissue can be evaluated.

    Early pregnancy loss, also known as spontaneous abortion, during the first 20 weeks of gestation, happens in 15-40 percent of all pregnancies. It often happens before women are aware that they are pregnant. In fact, most often women are unaware of early pregnancy loss because the amount of tissue lost is very similar to the flow of a heavy menstrual period.

    As pregnancies go on, miscarriage becomes less and less likely. Later in pregnancy, of course, pregnancy loss is more likely to be observed and more likely to be upsetting because the woman is more likely to know she is pregnant and to plan on childbirth. Counseling for these pregnancy losses and evaluation for the outcome of future pregnancies can often be very helpful and reassuring.

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    Can I still take hormone therapy, or is it too dangerous?

    Thanks to medical research, we know a lot more about hormone therapy than we did a few years ago especially the risks. We know that the risks are slight for most women but they increase the longer the therapy goes on.

    We know that combined therapy with estrogen and progestin slightly increases the risk of breast cancer, blood clots, heart disease, and gall bladder disease. Therapy that only uses estrogen slightly increases the risks of blood clots, uterine cancer, and gall bladder disease. It is possible that estrogen therapy worsens heart disease for women who already have it. It is also possible that using hormone therapy for longer than 10 years increases the risk of breast cancer.

    That said, we know that hormone therapy can relieve vaginal dryness, hot flashes, and other symptoms of perimenopause and menopause. It can improve a woman's feeling of well-being. And it reduces the risk of osteoporosis bone thinning and colon cancer. These are important and worthwhile benefits.

    The key to safe and successful use of hormone therapy is to work with an experienced health care provider. She will be able to prescribe the smallest doses or hormone for the shortest amount of time necessary for effectiveness.

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    What's the deal with yeast? I keep getting yeast infections. What can I do to make them stop?

    First, make sure it's yeast, since sometimes symptoms that may seem like yeast can be caused by another kind of infection. And if that's what's going on, yeast treatments won't help! To find out, make an appointment with your health care provider and get a professional diagnosis.

    Yeast infections may be due to chronic skin conditions, the use of certain antibiotics, continuing bacterial imbalances in the vagina, excessive intake of milk or sugary products, blood sugar problems related to diabetes, a yeasty sex partner whose chemistry throws off your bacterial balance, or multiple and/or new sex partners. Then, of course, it might be something else!

    Your health care provider might suggest an anti-fungal treatment. Some, such as boric acid, are available over the counter. Others require a prescription. All can have side effects, such as irritation. That is why health care providers often alternate therapies for ongoing problems. Check with your provider for the best treatment for you. Whatever you do, don't douche. That may cause even further irritation.

    For further reading, take a look at The V Book A Doctor's Guide to Complete Vulvovaginal Health, by Dr. Elizabeth G. Stewart (Bantam Books, 2002). For clinical advice and guidance, make an appointment with the Planned Parenthood health center nearest you.

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    I heard that a woman could ovulate more than once a month. Is that really true?

    No, it isn't true. Ovulation the release of an egg into the fallopian tubes occurs only once in a woman's cycle.

    Eggs do grow larger at different times in the cycle. But ovulation takes place only once in a woman's cycle. Although ovulation may occur at any time in the cycle, it most often occurs 14 days before the onset of menstruation.

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    Do men need to get sexual health checkups too?

    Yes! Men's sexual health needs may not be as obvious as women's, but they're just as important. A sexually active man should see his health care provider or urologist for periodic checkups. During your sexual health checkup, your provider will

    • examine the penis, testicles, and scrotum
    • check for hernias
    • show you how to perform a testicular self-exam to detect for lumps or bumps that may be cancerous
    • perform a simple rectal exam to check the condition of your prostate gland

    Most providers won't automatically test for sexually transmitted infections you have to ask. To test for infection, the health care provider may draw blood, take a urine sample, or use a swab to collect discharge from the urethra or anus. By asking questions about your sexual history, your provider can help decide which tests are appropriate. Many Planned Parenthood centers offer health services specifically for guys. To make an appointment for an exam at the Planned Parenthood center nearest you, call 1-800-230-PLAN.

    Talk with your provider about how often you should have sexual health checkups. The need may vary depending on what kind of sexual health risks you may be taking and what risk factors you may have for testicular cancer.

This column is for informational purposes only and is not intended to constitute medical advice, diagnosis, or treatment. If you have a medical problem, please call toll-free 1-800-230-PLAN for an appointment with the Planned Parenthood health center nearest you.

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