leslieanne

I still have to fight the gag reflex from time to time - I wonder if this would help eliminate that? Think I'll give it a try.

Haven't had to deal with this myself (current SO has no porn collection other then the one DVD I gave him and exhubby denied having any - who knows if that was true) .......... however not long ago help a very dear, long time friend deal with this. She has been married 20 yrs - about 10yrs into their marriage she found a large # of playboy magazines - her hubby said he rarely if ever looked at them and proceeded to toss them all at her request. Unfortunately they did not discuss it any more at that time. Fast forward to about 1 yr ago - again she found a large collection of printed porn while they were rearranging and cleaning out a walk in closet. She was very upset and hurt - mainly because they have a very meager sex life due to lack of interest on his part - it seemed to her that the printed porn was a substitute for sex with her. Her sex drive has always been stronger then his - she has dealt with it by using toys whenever she was interested and he wasn't. He has never been willing to use toys (or oral sex or mutal masterbation) as a part of their sex life as he feels straight forward intercourse should be enough to satisfy her. When she talked to me about it I encouraged her to at least try to talk with him to see what he wanted/needed in their sex life and also to help her to understand that porn is rarely an instead of.......well in her (or should I say their case) it was an instead of - he state he enjoyed looking at the porn more then actually having sex - "it's just easier, less energy on my part and I don't need to worry about whether or not you're satisfied". he went on to tell her that his had been his preference his whole life - it was the same in his first marriage. So at least now it's no longer a hidden subject - she still is hurt, yet realizes it is not a reflection on her - that it's his issue. unfortunately neither of them are willing to do anything more about it. My contribution ....... a willingness to listen and to give her a vibrator on her birthday every year so she can continue to enjoy herself.

Glad to hear all is ok

additional question for Mikayla - I found the BDSM article for beginners, but have been unable to locate the advanced play BDSM article - not listed in the bondage section. Is there some place else I should be looking?

understand and appreciate the "yuch" and "pain in the butt" aspect of the irregular bleeding. If your exam in normal it's very possible that the recommendation will be to change the type of BC you're using, or stop x 1-2 months (use condoms and foam in the mean time) and then restart. Please do not be afraid to ask questions or get clarification if anything that is said doesn't make sense or isn't clear/understandable to you. Remember there is no "stupid questions" unless it's those we don't ask!

your welcome and my pleasure to be able to share and educate

With respect to any bleeding/spotting that occurs - most often the bleeding/spotting is coming from the uterus, not the vagina, however it is possible that bleeding can be from the tissue/skin of the vagina or the cervix. So...... With any form of hormonal birth control (BCP, Nuvaring, DepoProvera, etc) your periods are regulated which typically means that they will occur at regular intervals. When initially starting any hormonal birth control there is a time frame in which the hormones are working to over ride your own cycle - during that time period (usually 2-3 months) irregular bleeding/spotting can occur. Depending on how your body metabolizes and responds to the birth control you can sometimes end up with absolutely no period at all (loved by some, bothersome to others). Since a variety of things (such as stress) can affect how your body metabolizes the hormones it is possible to get minor hormonal fluctuations that end up with some irregular spotting. This is more apt to occur the longer you are on any particular type of hormonal birth control. So while it is more common initially it can occur at any time. With respect to vaginal trauma. Any type of vaginal "play" can cause cuts, scratches or abrasions (similar to cutting or scrathing the skin on your knees if you fall). While this doesn't happen very often due to the "stretchyness" of the vaginal tissue, it can happen. Finger nails can have a sharp edge, toys can have a rough spot, insufficient lubrication makes it easier to abraid the surface of the vaginal tissue - all of these things can cause some bleeding/spotting. Sometimes the scratch, cut or abrasion is very obvious, other times it can be microscopic - but still enough to cause some bleeding. The vaginal mucosa is not as sensitive as the opening of the vagina or the labia so it is possible that there can be a small amount of trauma and you would not have any pain. So check your toys for rough spots, sharp edges, etc. If finger play is used, make sure your partners finger nails are trimed and smoothed. As for the cervix - if there is an infection the cervix is often inflammed which can cause the surface of the cervix to bleed when it is "touched" - either by the penis or a toy. The bleeding can range from minimal to moderate. Some times the bleeding is obvious immediately - some times its a number of hours (6-24) before the blood is noticed when wiping or on your panties. Once again probably a longer answer then you were looking for........however the more we as women know and understand about our bodies and reproductive issues, the better off we are in the long run.

Hi - a couple of things With respect to PPH not telling you anything - most likely the person you spoke to to schedule the appointment was a clerk or a medical assistant. They can not (legally) assess and "diagnosis" and it was most appropriate for them to indiacte that you would need to discuss it with the physician or nurse practioner you will see for your appointment. There are a variety of reasons why you could be having the spotting/light bleeding you are experiencing. None of which can be diagnosis by a telephone call alone. An exam is needed to rule things in or out. So what can be causing the spotting/bleeding? 1. Most likely related to the birth control you are using as it is very common when on any form of hormonal birth control to have occasional episodes of irregular spotting and the longer you are on the birth control the greater the possibility that some irregular spotting will occur. 2. Infection - as stated by Suzy P an infection (bacterial vaginosis, chlamydia, trichamonis) can cause spotting in some women 3. Trauma (even a small scratch) to the vagina 4. Polyp on the cervix - very unlikely, not related to cancer So the long and short of it is that you need to be seen, have an exam done along with the appropriate tests. And although it is important for you to be seen and examined it is HIGHLY UNLIKELY that the spotting is related to anything "bad".

One of the joys of menopause (and yes I do mean joys) is not having to worry about birth control any more!!

Regarding antibiotics - changes in your menstrual cycle are a possible side effect of some antibiotics, not all. As with most medications the type of side effects vary from person to person. With regard to Tyger's response - although neither of you were on BCP - she is correct in stating that the effectiveness of BCP can be decreased by some antibiotics, so using a back up method (condoms) while on BCP is appropriate. Interestingly even on BCP the antibiotics can affect the cycle/flow. Shortstuff - (s)he did all the right stuff - those tests will give a "picture" of your hormone status. As long as they are WNL (with in normal limits) it's an indication that the cause of the irregularity is related to all the stress you've been under. I would make the same recommendations - BCP for 3-6 months or wait it out. Which you decide to go with depends on how much of a pain in the ass the irregularity is for you. Now back to Tyger's question about pregnancy tests and BCP. The BCP that are used now are typically "low dose" - they work by keeping your estrogen level at a constant, non fluctuating level. This interrupts the "conversation" between the hormones from the pituitary gland (LH and FSH) and the ovary thereby preventing ovulation. The estrogen level is not elevated - it's in the middle of the normal range. Since the hormone levels in your body are not elevated you can use the same pregnancy test whether or not you are on the BCP. The OTC (over the counter) pregnancy tests are just as sensitive as the urine pregnancy test you get done in the lab (truth be known they are exactly the same). In addition the urine pregnancy test is just as sensitive as the blood pregnancy test. I realize that some of this is off topic from Shortstuff's initial questions, however I thought it reasonable to answer Tyger's question. Must tell you ladies I LOVE IT when women want info and take ownership and control over what is happening to their bodies - many are very passive and don't. The more we know, the more we share what we know, the better off we all are!!

ball

Well you've got 2 out of 4 and possibly 3 out of 4 reasons for your cycles to be off. For women who are as regular as clock work there is always a lot of anxiety when their cycle get out of sync. The thing to keep in mind is that at your age the irregularity is seldom due to something "bad". There are of course a variety of other reasons which is why I'm glad you're going to see your OB. Things such as fibroids which have grown in size and persistant ovarian cysts (these can cause alterations in your hormone cycles) are 2 of the physical reasons cycles can become irregular. Keep us posted.

There are a multitude of things that can affect your cycle. 1. Antibiotics - they can affect your cycle for 1-3months 2. Stress - sounds as if there is stuff going on related to your mom 3. Age - very common for women to experience cycles changes in their 30's and again in their 40's 4. Changes in your weight Since you were on antibiotics in November, it possible that that was the initial cause of the cycle change. If you were then under stress that could be the reason for the ongoing irregularity. The heavy menses in March is total normal given that it was 47 days since your last one (more endometrium to be released). The best thing to do is go in an see your OB to see if there is a specific problem. Sometimes you can identify a reason, sometimes not. I will often recommend BCP for 3 months to help settle everything down and get the cycle back on track if there is no specific problem identified. Sometimes just waiting it out also works.

You're welcome

Ladylove is right on when in comes to possible reasons. When my patients bring this issue up I ask them the following questions 1. Do you work - if yes doing what, how many hours a day/week 2. What is your "wife" work load? housekeeping, laundry, etc, Does your SO lend a hand? 3. What is your "mom" work load? kids activities, chauffer duty, etc. Does your SO lend a hand? 4. Are you using birth control? If yes what type? (BCP can cause a decrease in your libido) 5. Have you started taking any new medications (prescription or over-the-counter)? 6. How are you sleeping? Are you getting less then 8 hrs/night? Are you up and down through out the night? 7. Have you had a full physical lately? (if not it would be a reasonable thing to get done) 8. Any other family/friend stressors? By family I mean husband, kids, parents, siblings 9. Any significant weight change in the preceeding 6 months? (increases or decreases) 10. How do you feel about yourself at this point in your life? How do you feel about where your life is at? Any and all of the above can effect you emotionally, metally and physically and ultimately affect your sex drive. It's really a process of stepping back and looking at all aspects of your life. Hormonal changes can cause a change in your sex drive, and hormonal changes can be caused by stress, fatigue, medications, where you are age wise in your life, etc. As a physician I'd love for this question to have an easy, one size fits all answer, but it never does.

Whos on top - first of all I want to applaud you for being supportive and involved. Getting connected into a support group for you will, I'm sure, be very helpful. Post partum depression is difficult on many levels since symptoms, responses to medication and therapy and how the illnes progresses/improves varies significantly from woman to woman. It will take 6-8 weeks for the anti-depressant meds to become fully effective (has to do with reaching a steady state level in her system). Some women notice a response (improved mood or sense of self) as early as 4-5 weeks, but many don't really notice a change for 8-12 weeks. I would encourage you to consider joint counseling - not to work on her issues, but to get help around the communication issue. Having input from a therapist takes out the "blame" aspect and puts it in to the frame work of "this is one more aspect of what we need to address to help you move through the depression and get your life back". Without improved overall communication it is unlikely she will engage in any conversation about sex and if the conversation doesn't happen it highly unlikely that sex will. Once the relationship between your wife, you and therapist is established, commentary about sex can be brought up as a part of the overall communication part of the relationship. In my experience with my patients it is often a long road with improvements (small to moderate) followed by plateau's. While I appreciate your desire to restart your sex life I would encourage you to focus on the communication aspect of the relationship first. In the long run that will most likely bring the results you desire.

If you are diagnosed with an abnormal pap smear the next step should be a colposcopy - this is where your cervix is looked at with a special microscope. It allows the doctor to identify where on your cervix the abnormal cells are. If necessary a biopsy will be done. The biopsy maybe a scrapping from the opening in the middle of the cervix (endocervical currettage) and/or a pinch biopsy from the outer surface of the cervix. One or both of these biopsies should be done prior to any additional treatment so you and your doctor know with certainty what level of abnormal cells are present (mild, moderate, severe or cancer). There are 4 treatment choices - which is done depends on the degree of abnormal cells (mild, moderate or severe dysplasia) and the training/experience/preference of the physician. The four treatment options are: Freezing - oldest form of treatment, tissue is destroyed by freezing with liquid nitrogen, can cause scaring of the cervix, does not provide additional tissue for full pathology diagnosis, can be done in the doctors office, used for mild dysplasia, possibly for moderate dysplasia Laser ablation - similar to freezing, causes tissue destruction, more precise targeting of the area with the abnormal cells, less chance of scarring the cervix, no tissue for full pathology diagnosis, can be done in the doctors office or in an outpatient surgery center, used for mild or moderate dysplasia LEEP - Using a specialized cutting instrument, the area of abnormal cells are cut out of the cervix - essentially a larger biopsy, the biopsy tissue is sent to pathology which allows a definitive diagnosis as well as confirmation that all abnormal cells were removed (margins are checked to be sure they are clean), is done in the doctors office, patient is given an injection of lidocain (anesthestic) on the cervix prior to the procedure, used for mild, moderate or severe dysplasia, typically less painful then freezing ro laser since lidocain is given first. Cone Biopsy - done in the OR with the patient sedated/asleep, this is done for severe dysplasia or cancer in situ of the cervix.

What I tell my patients is that at this time we know it's good for 10 years, possibly longer, but we need more info before we'll know for sure - so for now think 10 years, with the understanding that the information may change at any time.

There is an interesting article on this in the April edition of The Oprah Magazine - "She's So Fine". (Sorry I'm not computer savy enought to provide a link to the article.) It talks about the fact that sexuality is more fluid than previously thought. In addition it is more fluid in women in men - felt to be tied to the fact that many women have a greater desire for a deeper emotional connection.

SusyP - oops - error in my prior post - despite reading it through at least 4 times before hitting the "Add reply" button I missed my mistake regarding the # of high risk HPV types and the # covered by the vaccine. There are 5 high risk subtypes and 4 are covered by the vaccine. Sorry for the error in my post. If you were on depo-provera for birth control that alone could explain your irregular bleeding/spotting. One of the most common side effects of depo-provera is irregular bleeding. Some women completely stop having periods, while others spot on an almost daily basis, most women fall somewhere in between. The longer you are on depo-provera the longer it can take your cycles to return to normal. In fact it can take up to 12 months for some women to regain their own cycle pattern. again, please accept my apology for the error in my prior post. I'm glad you responded otherwise I wouldn't have realized I'd made a mistake.

The HPV Vaccine - surprisingly not an easy question to answer...... First a little bit of info regarding HPV (Human Papilloma Virus) There are approximately 180 different subtypes of the virus (the number varies depending on the studies you read), of those subtypes there are 6 that are considered high risk - in other words six that are known to be associated with cervical cancer. The HPV Vaccine covers 5 of the 6 high risk subtypes, in addition the vaccine is felt to be effective for 10 yrs - not enough data at this time to be sure of its effectiveness beyond that time frame. HPV is sly little virus - you can be exposed and infected and never know it. In addition it can be present in the cells of the cervix for many years before it become active. I have a patient who was celebite for 9 yrs after a divorce before getting her first abnormal pap smear (this was before we had the HPV culture). So if you have never been sexually active, getting the vaccine would be appropriate and reasonable. (This is why when the vaccine was released for use it was recommended that it be given to girls under the age of 12 as they are less likely to have been sexually active.) If you have been sexually active and your HPV culture is negative, then you may want to consider getting the vaccine. It is important to remember that the vaccine covers 5 of the 6 high risk subtypes, so getting the vaccine is not a quarantee that you won't end up with HPV and an abnormal (precancerous) pap smear. Getting the vaccine will decrease your risk, but will not eliminate the risk. Getting the vaccine does not mean that you can stop getting pap smears. It is now considered community standard for a woman to get a HPV culture done at the time of her pap smear. If your physician is not doing this, be sure to ask for it. The HPV culture enables us (physicians) to determine with greater accuracy who is at risk for abnormal changes occuring on their cervix. A positive culture does not mean that you will end up with an abnormal pap smear, it just means that you are in the higher risk group and have to continue getting pap smears once a year. If the culture is negative and you are in a monogomous relationship, studies (lots of them) support the safety of getting pap smears every 2-3 years. As for your comments about midcycle bleeding/spotting. The most common cause of bleeding and spotting at this time is due to hormone fluctuations that occur during ovulation. That is why if you are having irregular bleeding/spotting it is important to record when it is happening on a calendar and take that with you when you see your physician. The pattern or lack there of can be very helpful when figuring out why the irregular bleeding is occuring.

Concerned - here's some additional information that I hope you find helpful - this is a bit long, however I strongly believe that the more we know and understand the better we can participate in maintaining and improving our own health. Your risk of exposure to STD's is based on the number of partners you have as well as the number of partners your partners have had. Many STD's do not cause symptoms in men and/or women. There are some STD's for which men can not get tested or the tests are not very accurate (more info below). Based on your age (21) and you are sexually active, if you were my patient I would recommend the following: 1. Pap smear and HPV culture HPV = Human Papilloma Virus, it is an STD and is the cause of almost all forms of cervical cancer If both are negative and you are in a monogomous relationship - repeat both in 2-3 years If the pap is normal and HPV culture is positive - repeat both in one year If the pap is abnormal - you will need additional followup and testing If you change sexual partners - get a pap and HPV culture 9-18 months after starting the new relationship This is because you now have a new exposure risk 2. Chlamydia and Gonorrhea culture - these are both STD's and can be present without symptoms Women should have them done every time they have a pap smear from age 18 - 40 3. Bimanual exam - this is when the doctor checks your uterus and ovaries This allows the physician to check for uterine and/or ovarian tenderness Also allows the physician to assess the size of your uterus and ovaries If you are having any symptoms of increased discharge, vaginal itching, irritation, or burning A "wet mount" should be done - this is done by the doctor in the office (very quick and easy) Checks for yeast infection, bacterial vaginosis/vaginitis (BV) and trichimonas (which is a STD) If you are having irregular bleeding Bring a record of the bleeding to the doctor - there may be a pattern to the "irregular bleeding" Blood tests to check your hormone levels maybe indicated, based on your history You should get fully tested for STD's every time you change sexual partners (or once a year if multiple partners at the same time). Full STD testing includes the following: HPV culture Men can not be tested for HPV, there is no blood test and the culture does not work on men Chlamydia and Gonorrhea culture Men can get tested for this, however the culture is less sensitive (more adapt to be a false negative) in men HIV Blood test - good for men and women Hepititis B Blood test - good for men and women Hepititis C Blood test - good for men and women Syphillis (VDRL) Blood test - good for men and women Wet Mount - checks for trichimonas This is a test for women only, it is difficult to diagnosis tricimonas in men unless they are having a penile discharge. With respect to Chlamydia, Gonorrhea and Trichimonas - my feeling is if my patient has it I assume her partner does also and he get's treated as well. If your partner is not treated at the same time you will end up passing it back and forth. Since yeast and BV are not STD's your partner does not need to be treated, however it is reasonable and appropriate to obstain from intercourse while you are being treated for either/both of these infections. All of the above tests/exams can be done by either a Family Medicine or Internal Medicine physician or an Obstetrician/Gynecologist. That said there are Family Medicine and Internal Medicine physicians who are not comfortable with doing anything more the the pap and pelvic. Needless to say my bias is that I think woman for the most part are better served seeing and OB/Gyn MD if they need anything other then the routine gyn exam. Ask questions, request info, be your own advocate and if your physician is willing to work with you, great. If you feel they are reluctant to take your concerns and questions seriously, consider finding another physician if possible.

With regard to the bleeding - as both Mikayla and Tyger stated an infection can cause bleeding in some cases. The cervix gets inflammed in response to the infection and bleeds due to the inflammation. In addition if the infection has moved into the uterus unscheduled bleeding can also occur. As for iirregular bleeding and BCP and the IUD - some women do have mid cycle spotting on birth control pills, the same can occur with an IUD. In addition for some women with an IUD, the IUD string and cause cervical irritation/inflammation in the absence of an infection which may cause some intermittant spotting. Because there is a possibility of an infection there is no way to determine the cause of the irregular bleeding without an exam.

It would be best for you to see your doctor and have a pelvic exam. As part of the exam the following things should be done: 1. Pap smear and HPV culture - if it hasn't been done in the past 12-24 months 2. Wet mount - this is done by taking a swab of the discharge in your vagina and looking at it under a microscope - the doctor will be able to determine if you have a yeast infection and/or BV (bacterial vaginosis/vaginitis - see other thread on BV) 3. Chlamydia/Gonorrhea culture 4. Bimanual exam - the doctor will be able to assess your uterus and ovaries. While it is impossible to say what you do or don't have without a pelvic exam based on your description it is possible that you have a yeast infection - not all women get the "itchyness" aspect, some just get discharge which is most often white, with a somewhat thick consistancy and often with little "chunks or curd like pieces". You didn't mention where in your cycle you are or if you are using any type of birth control (pills, IUD). All of this would be important information for you to provide to your gynecologist - in fact he/she should ask you about it. As for your urinary complaint - again there can be a variety of reasons. If you have BV or a yeast infection this can sometimes cause that type of sensation. There are a variety of other possibilities - all of which require an exam. One simple thing you can do until you get in to see your doctor is to try drinking cranberry juice once or twice a day. It won't be harmful and maybe helpful.

Having BV - Bacterial Vaginosis/Vaginitis is nothing to be embarressed about!! It is not an STD. It is essentially an overgrowth of the bacteria that is normally found in the vagina. There are many things that can cause BV - stress, your menses, rectal to vaginal contamination (that's why it's important to wipe front to back and not use toys rectally and then vaginally), early pregnancy, douching (yes douching since is can upset the normal bacterial balance or ph of the vagina), a yeast infection, to name a few. Most women experience BV at some point in their life and many women get repeated bouts (a real frustration). The symptoms can be subtle (an increase in vaginal discharge) to very bothersome (irritation or burning sensation in the vagina). It is common to have a yeast infection and BV together. We all have bacteria and yeast in our vagina - it a normal part of the vaginal flora and is protective in some ways. BV occurs when the bacteria multiply in excess thus setting up a vaginal infection. It can be treated by an oral medication (pills) or by a antibiotic cream - you do need a presciption for either of them. So please don't be embarressed - just get seen and get treated.