Sex & Pancakes
No matter what your pleasure, get health tips with our sex column by Melissa Fuller.
Following last week’s column, this week I’ll be providing an overview of intrauterine devices.
IUDs are a birth control method that consists of a T-shaped device with two threads hanging from the bottom. They are inserted into the uterus while the strings pass through the cervical opening to remain in the vagina for easy verification and removal.
IUDs are popular due to their effectiveness rate of over 99 per cent and because, unlike methods such as the pill, patch or ring, they require no user action once inserted.
Currently, the two types of IUDs in use are hormonal and copper-based. Both have been on the market for over 20 years, are easy to use and are completely reversible. However, each has different benefits, so each is recommended to women for different reasons.
The hormonal IUD works by releasing a low dose of a progestin hormone called levonorgestrel in the uterus. Unlike the pill, which releases hormones into the bloodstream, IUD hormones are released and remain in the uterus. For this reason, women who are sensitive to hormones in the pill generally experience less hormonal side effects when using the IUD.
The hormones in IUDs work in two ways to prevent pregnancy: they thicken the cervical mucus, which prevents sperm from entering the uterus, and they prevent the build up of the uterine lining.
Normally, the uterine lining thickens to prepare for the implantation of a fertilized egg, but the thinner lining makes it difficult for a fertilized egg to attach to the uterine wall. In addition, the physical presence of an IUD affects the movement of sperm, making it more difficult for them to reach the egg for fertilization.
Hormonal IUDs are the more common choice for women with heavier or painful periods. Your period is the result of the monthly shedding of the uterine lining; since hormonal IUDs prevent the full build up of this lining, many women experience lighter and shorter periods, and about one in five stop having a period altogether.
Hormonal IUDs last up to five years without any action on the user’s part, aside from checking on the threads after each period.
The copper IUD works by preventing fertilization. Copper acts as a natural spermicide in the uterus by reacting with your body to increase the level of copper ions and white blood cells, which creates a hostile environment for sperm and inhibits their movement in the uterus.
The copper IUD is non-hormonal, so it’s a good option for women who want to avoid hormones. One of the most common side effects is heavier periods with more cramping, so it’s often recommended for women who don’t already have these menstrual issues, as it may worsen their situation. Like hormonal IUDs, copper IUDs don’t require any action on a user’s part other than checking on the threads after each period, and they can last twice as long as hormonal IUDs.
Serious issues with IUDs are very rare, but include the risk of expulsion from the uterus and perforation of the uterus during insertion. Expulsion can be noticed when checking on the IUD threads monthly, while perforation will usually be immediately noticed by a health professional.
There are a few ways to go about getting an IUD. If you’re under 25, you can visit a CLSC youth clinic to talk to someone and have one inserted. Otherwise, a gynecologist can take care of this for you.
If you don’t have a gynecologist, you can get a referral from your family doctor. Most health professionals will require negative results on pregnancy and STI tests before inserting an IUD, as serious complications can occur if either test is positive.
If you’re hoping to get more information and discuss your options before heading to a clinic, you should call Head and Hands. Their Health Services coordinator, Jos, has weekly call times for sexual health information and is incredibly knowledgeable and easy to talk to. Head and Hands can also handle insertion, or will help you find someone who can.
Finally, it’s important to mention that while IUDs are an effective method of birth control, they offer no protection from STIs. Condoms remain the only effective method for preventing both pregnancy and STIs.
Submit your question anonymously at sex-pancakes.com and check out “Sex & Pancakes” on Facebook. Head and Hands: Ask for Jos at 514-481-0277 Mondays 11 a.m. to 1 p.m., Wednesdays 3 p.m. to 5 p.m. or Thursdays 2 p.m. to 4 p.m. Got a quick health question? Text SextEd at 514-700-0445 for a confidential answer within 24 hours!
There’s been a recent rise in the popularity of intrauterine devices, and I’ve been receiving a lot of questions on this “new” method of birth control. This comes as a surprise to me since IUDs aren’t new at all, and have in fact been available for over 20 years. Why are so many women only now hearing about a very effective, easy to use and widely available method of birth control?
The number of women lacking information about their birth control options is worrisome, and a symptom of a much bigger issue in Quebec’s healthcare system. Next week’s column will be an overview of IUDs, but first this week’s column will explore why information on them and many other areas of sexual health can be difficult to come by.
For most people preventative and long-term healthcare comes from family doctors who know their patient history, have been with the person for a long time and are available for fact-checking and follow-ups. Quebec’s current shortage of general practitioners already makes it hard for people to find a long-term family doctor. In addition, the need for a GP’s referral to get an appointment with a gynecologist makes accessing sexual health services more difficult in the province.
However, routine sexual health care and information don’t have to come from specialized gynecologists. I recently had the opportunity to chat with Dr. Cleve Ziegler, the director of gynecology at the Jewish General Hospital, who explained that GPs in other provinces usually handle routine care such as pap tests, pelvic exams, and STI testing.
The GP is trained to do this and already has your medical history, and this frees up gynecologists to focus on their specialization: the treatment of gynecological issues and complications, such as cysts and abnormal paps rather than prevention.
Quebec’s GP shortage complicates this situation because many people don’t have a GP to begin with. For this and other reasons, many Quebec women start by accessing sexual health services through CLSC youth clinics. They’re easy to access, offer much-needed services and referrals when necessary, and are youth-oriented, so the health professionals focus on non-judgmental care.
However, by virtue of the fact that they’re youth clinics, the main criteria to access them is being between 12 and 24 years old. Due to this, many women find themselves cut off with nowhere to go next after years of consistent access to sexual health services.
And so you probably know how this goes. Many women end up only having checkups at walk-in clinics when they already have symptoms, and dealing with sexual health at places that they might not even return to. Our medical histories end up scattered at clinics across the city, instead of with one designated health professional.
Women who use CLSC youth clinics are also likely put on the pill once they become sexually active, without ever being informed of other available options. Oral contraceptives are often first recommended because they are easily reversible and, unlike IUDs, can be managed or stopped by a patient at any time without physician intervention. The recommended option rarely has anything to do with what might be best suited for an individual.
This is a problem because birth control is not a one-size-fits-all model. Women should be informed about all options available to them and any relevant side effects in order to recognize and know when it might be time to try a different method or brand, but this is difficult to do without a designated health professional following your file.
For some women, that right fit could be the IUD, but they may never find out because so many stick to a method with unpleasant side effects simply because it was the one arbitrarily chosen for them when they were 17, and they don’t know of other options they can try that might be more pleasant than their current choice.
If you can’t find a long-term doctor, or the one you have isn’t very informative, then don’t rely on them to inform you—start informing yourself instead. Learn about your options before heading to a health professional, and ask questions so that you don’t walk away with a prescription for something you know nothing about.
There are many reliable resources for this information, such as sexualityandu.ca, call-in services like Head and Hands, and even text-in services like SextEd. Use them, share them and start managing your own health!
Submit your question anonymously at sex-pancakes.com and check out “Sex & Pancakes” on Facebook. Head and Hands: Ask for Jos at 514-481-0277 Mondays 11 a.m. to 1 p.m., Wednesdays 3 p.m. to 5 p.m. or Thursdays 2 p.m. to 4 p.m.
Got a quick health question? Text SextEd at 514-700-0445 for a confidential answer within 24 hours!
I often receive questions asking for relationship advice, but I’ve realized that I rarely answer them. I do think talking about relationships has a place in a sex column; sex takes place in many different contexts, including romantic relationships, and how a relationship is doing will affect the quality of the sex.
However, there’s no way for an outsider to ever fully understand what’s going on between two people, which is why I don’t usually feel comfortable offering relationship advice.
I do think it’s important to talk about relationships though, which is why I wanted to share the work of psychologist John Gottman with you this week. Gottman specializes in marriage and relationship analysis, and has conducted studies to identify common behaviours among couples that stay together. This research has become the base for seven principles he has identified for making marriage work.
It’s rare to see emphasis placed on personal development or growth in the context of romantic relationships. Having to work on a relationship or the possibility of changing through one is often framed negatively, but openness to change and growth through the people we share experiences with is actually very important.
This doesn’t mean changing who we are for others, but rather being able to question who we are and make the changes we want for ourselves. Many relationships won’t last forever, but there’s always the potential to learn from them.
You don’t need to be married or even heading towards marriage for these principles to be relevant. They can even be applied to close friendships. An awareness of these principles will be helpful for people seeking growth as both part of a couple and as individuals.
1. Enhance your love maps. Love maps are where you store all important information about your partner and are fueled by genuine interest in your partner’s universe. These are the stories they tell that shape your understanding of who they are and what matters most to them.
It’s important to actively listen when they’re telling you about their childhood best friend, or about the co-worker they really don’t get along with.
2. Nurture fondness and admiration. Happy couples have admiration and an overall positive view of each other. Even when frustrated, they are convinced that their partner deserves respect, and can remember that the person in front of them is not an enemy but someone they love.
3. Turning towards each other instead of away. This is about the small, seemingly meaningless gestures that remind your partner that they matter to you. This can literally mean turning toward them when they speak, taking your eyes off your phone to give them your full attention, and acknowledging the things they say.
This is also the difference between saying “I’m too busy” when your partner wants to talk, and saying you’re busy but really want to talk about this later—and making sure you take the time to do so.
4. Let your partner influence you. This means opening yourself up to the possibility of your views changing through your partner’s perspective. It’s not about being passive, but about respecting their input enough to search for common ground and compromise.
5. Solve solvable problems. There are two types of problems in every relationship—solvable and perpetual—and it’s important to be able to tell the difference. Solvable problems are confined to situations and aren’t indicative of a larger problem, but are usually rooted in behaviours.
An example of this would be forgetting to call when someone said they would. Gottman recommends five steps for solvable problems: (1) Avoid criticism or contempt, (2) Make and receive gestures that lessen tension, (3) Soothe yourself and your partner by taking breaks to relax, (4) Compromise and find common ground and (5) Be tolerant of each other’s faults.
6. Overcome gridlock. Perpetual problems involve deep beliefs and dreams that you may never agree on. The most common examples are incompatible views on marriage, having kids, and spiritual or cultural values.
It’s important to identify the dreams that fuel each person’s perspective, and to keep the conversation alive through communication. This can help identify workable areas and minimize resentment by making time for each partner to be heard.
7. Create shared meaning. Couples have their own culture that only they can fully see and understand. This culture involves rituals that become unspoken, like greeting each other the same way every time or having an action that means “I love you.” It also involves shared stories, inside jokes, and all aspects that make the couple’s space unique.
While these seven principles don’t guarantee a successful relationship, Gottman’s model is based on respect and maintaining friendship—two things that every relationship needs. These principles can also easily be modified and applied to any of your interpersonal relationships.
A little over a year ago, I became involved at AIDS Community Care Montreal, an awesome non-profit HIV/AIDS community organization. Since then I’ve become more aware of the misconceptions many people have regarding HIV through the questions I’m often asked about my work environment.
“Aren’t you afraid of catching HIV?” “Do you use the same bathrooms?” “Is it hard to work with people who are dying?” These questions point to the fact that as a society and generation, we’re incredibly misinformed about HIV and AIDS.
What we think we know is often loaded with stigma and myths, and these often act as unnecessary barriers to accessing proper support and prevention. So this week I’ve decided to share five things I wish everyone knew about HIV.
1. HIV and AIDS are not the same thing. HIV stands for human immunodeficiency virus, a virus that attacks a type of white blood cell known as CD4 T cells, which are part of the immune system and are responsible for initiating the body’s response to infections.
HIV progressively weakens the immune system, making the body more susceptible to opportunistic infections, such as pneumonia. AIDS, on the other hand, is an acronym for acquired immunodeficiency syndrome and refers to having an opportunistic infection and/or a white blood cell count below a critical level due to an HIV infection.
People don’t die of AIDS, but from infections that take advantage of the weakened immune system of someone with AIDS. HIV can progress to AIDS but, depending on treatment, someone with HIV won’t necessarily develop AIDS.
2. HIV is not a death sentence and people living with it aren’t dying. As mentioned above, someone living with HIV won’t necessarily develop AIDS and, while HIV results in a weakened immune system, it itself is not a cause of death. Life doesn’t end with an HIV infection; many people still live long, healthy lives thanks to treatments now available.
3. HIV is treatable, not curable. There’s a scary trend among Canadian youth of thinking that everything, including HIV, is curable with a pill. HIV is not curable at present!
However, it is treatable with various medications called anti-retroviral drugs. Many of these medications have side effects that require other medications to treat, and it can take time to find the right combination of medications, and at no point will the need for those medications go away. This doesn’t mean HIV is unmanageable by any means, but it does require some drastic lifestyle changes and commitment. Like any other chronic illness, such as diabetes, an HIV diagnosis will require closer monitoring and awareness of your health.
4. You can’t catch HIV from a toilet seat, from shaking hands or sharing a workspace. HIV is a virus that can be transmitted through five bodily fluids: blood, semen (including pre-cum), vaginal fluid, anal fluid and breast milk, all of which must originate from an HIV-positive person.
For transmission to occur, one of these fluids must make contact with an entry point, like a cut or sore, and enter the body. HIV cannot be transmitted by saliva or skin contact.
Risk of transmission also depends on a person’s viral load, which is the detectable amount of the virus in their blood. With anti-retrovirals, many people’s viral loads are very low, even undetectable, which lowers the risk of transmission even in these situations.
5. The stigma of HIV can be just as dangerous as the virus itself. Unfortunately, managing the HIV virus is not the only challenge faced by people living with HIV. Stigma from others with limited understandings of HIV can lead to social isolation and further barriers to seeking and receiving support.
Stigma also prevents people from getting tested and knowing their status. It perpetuates the idea that HIV only infects a specific kind of person that engages in a specific kind of sex, but HIV doesn’t discriminate, people do.
If you’re interested in learning more about HIV and AIDS you can check out the Concordia HIV/AIDS Project at aids.concordia.ca and ACCM at accmontreal.org.
Got a quick health question? Just need a resource? Text SextEd at 514-700-0445 for a confidential answer within 24 hours!
Submit your question anonymously at sex-pancakes.com and check out “Sex & Pancakes” on Facebook.
My boyfriend and I are disease-free and we both dislike condoms, but neither of us want an accidental pregnancy. I take the pill, and he uses the “pull-out” method, but other than that and peeing before sex to clear out sperm from pre-ejaculate fluid, are we taking every possible precaution? I don’t want to feel like we’re taking a huge gamble every time we have sex, and I don’t really know how big of a risk we’re taking. I feel like the law of probability will catch up to us the longer we stay together. —Law of ProbaPILLity
The pill is a very effective form of birth control. With perfect use, it’s actually more effective against pregnancy than condoms. To put this into perspective, condoms are 85 per cent effective against pregnancy with typical use, and 98 per cent effective with perfect use.*
Perfect use means putting the condom on properly every time, which surprisingly isn’t all that common. Meanwhile, the pill is 92 per cent effective with typical use and 99.7 per cent effective with perfect use. In this case, perfect use means taking it exactly as directed, daily and at the exact same time.
Few people do this, and missing a day or forgetting to take a pill until later in the day affects the constant dosage of hormones and lowers effectiveness rates. Keep in mind this is effectiveness in terms of pregnancy and not STIs, since condoms are the only contraceptive that also provide protection from STIs.
Pulling out, also known as the withdrawal method, is considered 73 per cent effective with typical use and 96 per cent effective with perfect use. Perfect use is also very rare when pulling out since it requires quick action, and accidents do happen. With most methods, the typical use percentages are more realistic.
When pulling out, the concerns come from the potential of pulling out too late, and of sperm being present in pre-ejaculate fluid. Some people believe that if there is sperm in pre-ejaculate fluid, it was left in the urethra from a previous ejaculation.
If this is the case, peeing would clear the urethra and flush sperm out, but I wouldn’t recommend putting too much weight on this as a precaution since we don’t know if this is really where sperm in the fluid originates.
In terms of what we’ll call “fresh” pre-ejaculate fluid, sperm has been found in some men’s fluid, while not in others. It’s good to remember however that if it were present it would be in much smaller quantities than in a full ejaculation.
On being “disease-free,” I’m assuming you mean that you’ve both been tested recently. Testing is great to do regularly and when you enter a monogamous sexual relationship.
It’s important to consider that some STIs can take time to show up in testing however, such as HIV or some strains of HPV, since these tests actually detect antibodies, or cells that have developed as a result of infections, rather than the infections themselves.
It’s also important for women to continue their annual pelvic exams, and for both partners to look out for symptoms of an STI, even in a sexually monogamous relationship.
Overall, it does sound like you’re being pretty careful. It’s worth highlighting that the rate of effectiveness of the pill and withdrawal method are based on when they are used alone, so combining the two is less risky than only using one alone.
Ultimately, choosing a contraceptive method is mostly about personal comfort and risk management because abstinence is really the only way to be completely safe from pregnancy and the risk of STIs.
Since that’s not really realistic (for most people), I would instead suggest identifying and taking the precautions that will make you most comfortable and keep you from constant worry, whatever they may be.
*All stats were taken from a pamphlet created by Sexualityandu.ca called “Choosing a Contraceptive That’s Right for U: Comparative Chart.”
Submit your question anonymously at sex-pancakes.com and check out “Sex & Pancakes” on Facebook. Got a quick health question? Need a resource? Text SextEd at 514-700-0445 for a confidential answer within 24 hours!