Posted in contraception

Feeling Hormonal…

*** n.b. This is intended to give people some idea of how contraception works, for educational purposes. It is not medical advice. I would STRONGLY encourage anyone thinking of starting contraception to talk this through with a healthcare professional, who can give you detailed and individualised advice***

A big (and varied) type of contraceptives are ones that rely on hormones. A hormone is a chemical that is made by one part of the body and is carried by the blood to another part of the body, where it has some sort of effect. Insulin is a type of hormone – produced in the pancreas, it helps our bodies store the sugars that we eat for when we need them later. People with uteruses also make special hormones that control their fertility cycle – when they release an egg from their ovaries and when their period comes.

Remember, people with uteruses can’t get pregnant all the time – but for a few days when they are ovulating, which is just a fancy word for when they have released an egg. If this egg meets a sperm before it deteriorates and is shed with a period, then it can implant (‘dig into’) the uterus and eventually develop in to a baby.

So hormonal contraception is only for people with uteruses to take. And it affects their cycle, so there isn’t this a bit where they are capable of getting pregnant. Exactly how that happens depends on what kind of hormones are in a particular type of contraception, and how they are delivered in to the body (more on that later). But they can do things like stop ovulation from happening, help keep a layer of mucus over the entrance to the womb so sperm can’t get in, or keep the lining of the uterus (the endometrium) very thin, so an egg can’t implant and grow there.

A very simple way of getting hormones in to the body is swallowing them as medicines – the contraceptive pill. There are two main types – the combined pill and the progesterone only pill. They need to be taken regularly (sometimes every day) at about the same time of day, to work.

Pills are usually available from a doctor – for example a GP, or one you could see at a sexual health clinic. In the UK, you can also get the progesterone pill from some pharmacies without a prescription, by talking to the Pharmacist instead.

Which pill to choose can depend on a few things, like whether or not certain illnesses are common in your family. It’s a good idea to make an appointment with a healthcare worker who can talk you through this if you’re considering the pill, so that they can go through this with you.

The Contraceptive Pill. Image Credit: Anastasia Szakowski, via Flickr.com.

‘Birth control pills’ were some of the earliest types of contraception available that also worked really well. Because it can be tricky to remember to take them though, there are lots of other ways of getting contraceptive hormones in to the body without having to remember to take them every day.

Hormonal IUSs (‘intrauterine systems’) are small plastic devices that are put in the uterus. They contain hormones, which they slowly release into the body over 3-5 years (depending on what type). Because it stays in the body for a long time, you don’t have to remember to take it and it is *very* unlikely to fail as contraception.

The same can be said of the hormonal implant. This is a rod, about the size of a match, that is made from slightly bendy material and also contains hormones that are slowly released in to the body over several (three) years. It is usually placed in the arm, just under the skin. People that have them can usually feel them through the skin, but don’t notice them all the time.

As they last for several years, the implant and the IUS are sometimes described as ‘long-acting’. They are also described as ‘reversible’ because if and when they are removed from the body, they no longer have an effect and that person is likely to be able to get pregnant again. Because they go inside the body, they need to be put in and taken out by a healthcare professional – usually a doctor or a nurse.

Hormonal injections are also given by healthcare professionals and not something you can give yourself at home! This is where a dose of hormones is injected in to the body and lasts for several weeks (eight to 13, depending on the type of injection). If you want to keep using them as contraception, you need to be able to keep going back for appointments to have another one after this. They aren’t reversible, but do wear off if you stop having the injections.

Last but not least, there are two types of hormonal contraception that you don’t need to remember every day and you can give yourself at home – although you would still need to talk to a doctor or nurse to get them in the first place.

The first is a vaginal ring – a flexible ring that is inserted in to the vagina. The muscles that make up the walls of the vagina then hold this ring in place. It is usually kept in for three weeks then removed for several days, before being re-inserted. A user can put it in and take it out themselves, much like they would a tampon!

Vaginal Ring. Image credit: Anastasia Szakowski, via Flickr.com

Another hormonal device that someone can set-up themselves in the contraceptive patch. This is a big plaster-like device, that releases hormones through your skin. It is removed and replaced every week – for as long as you need contraception for.

So – there are lots of different ways of getting hormones in to the body! These can be really popular because they tend to be very effective, especially if they are released by a means where you don’t have to remember every day.

Hormonal contraception doesn’t create a barrier between a penis and a vagina during PIV sex, so it isn’t a kind of protection. This means that, although it can make it very unlikely that you will get pregnant from this type of sex, it doesn’t stop STIs (sexually transmitted infections) from being passed from person to person. For this reason, some people might choose to use something like condoms as well as hormonal contraception. Even though condoms are also contraception, they don’t work quite as well at preventing pregnancy as the methods we’ve described here.

One negative aspect of hormonal contraception is that it can have side effects – it can effect the body in unpleasant and unwanted ways. Lots of people seem to report that they have negative effects on mood, for example.

Not all of the side effects are bad – some can be welcome, for example they can cause good skin changes, or make periods less heavy.

And of course bodies work differently – one person can get on really well with a particular type of hormonal contraception, whilst another doesn’t at all.

Because healthcare professionals try to help lots of people, then can sometimes forget these individual responses. You know your body best though. If you are ever struggling with the side-effects of any type of contraception, it’s completely your choice if you want to stop using it – even if a doctor or nurse thinks that it’s ‘good’ or suggests that you should try it for longer and ‘see how it goes’. Ultimately it’s your decision. It’s fine to ask for a second opinion (ask to see another health worker) if you feel you aren’t being listened to. It’s your body, after all!

References:

Contraception, Sexwise.org.uk.

Your Contraception Guide, www.NHS.uk

What are the side effects of the birth-control pill? Planned Parenthood.

Robinson et al., 2004.

Posted in sexual health, Uncategorized

Protection

We sometimes think of protection – things that make it less likely to pass infections from person to person during sex- as synonymous with contraception – things that stop people from getting pregnant.

But when we think about it, we know that not all types of sex can lead to pregnancy…

Condoms are, of course, are both. They create a barrier between a penis and a vagina during penetrative PIV sex. This means that sperm can’t get in to the vagina, the uterus and ultimately can’t meet an egg. In this way, condoms that go over the penis can reduce the chance of pregnant.

Different shaped condoms. Image credit: Andy Hassall, via Flickr

In creating a barrier between one person’s body parts and another during sex, it also means that there’s less chance of passing infections from person to person too! That’s because there’s less direct contact, as well as less fluids (like semen, blood or mucus) from one person touching another. This greatly reduces the chance of an STI (sexually transmitted infection) from being transferred. So condoms are also protection.

When we think of condoms, we often think only of external condoms – ones that fit over the penis like the ones in the image above. But you can get internal condoms too. These are made of the same thin material, but are inserted into a vagina.

They act as contraception for penis-in-vagina (PIV) sex, preventing sperm from getting in to the vagina. But they can also be used as protection in PIV and other types of sex involving the vagina, creating a barrier between the vagina and fingers, mouths, tongues, sex toys used by another person, or anything else that might potentially transfer an STI from one person to another.

An internal condom. Image credit: James Mill via Flickr.

Similarly, external condoms are also a type of contraception, but can also be used as protection in other types of sex involving a penis – such as anal or oral sex.

Condoms are often made from latex, but some people have allergies to this material. So lots of brands make condoms that are latex-free. This includes condoms made from animal products – but it’s worth noting that although these act as contraception, they are known to be less effective as protection. That’s because they contain microscopic holes, too small for sperm to pass through, but not for some STIs to cross.

One type of protection that is not a form of contraception is a dental dam. This is a sheet of plastic, similar to that condoms are made of, that can be placed over a vulva for oral sex. Again, it’s creating a barrier between one person’s body parts and another’s during sex.

Dental dams. Image credit: inga via Flickr.

Dental dams can be a bit trickier than condoms to get hold of, at least in the UK. They tend not to be available in supermarkets and chemists like external condoms. They can sometimes be picked up at sexual health clinics, or ordered online. Because they can be harder to get hold of, sometimes people make their own using an external condom and cutting it to create one flat sheet.

Protection is designed around genitals because those are the bits of our bodies that are good at passing on STIs. Bits of our bodies like our hands are covered in relatively tough skin that makes a strong barrier against fluids. Some people use protection like plastic gloves or finger cots (‘finger condoms’) if there is a break in their skin from things like eczema though, or if they have cuts and they are using their hands in sex.

Finger cot. Image credit: Barbara Hastings-Asatourian via Flickr.

We can see that just as sex isn’t limited to PIV sex, protection isn’t just limited to condoms for penises!

Posted in reproductive rights

Bound and Gagged

As a new President has been elected in the US, you might hear campaigners in sexual health talk about ‘The Global Gag Rule’. But what is it and why does it matter to people working in sex and relationship education?

The Global Gag Rule is US policy which forbids NGOs (Non Governmental Organisations – for example, health charities) from taking part in certain activities if they receive US funding.

These activities include providing abortion care directly. But it also includes referring pregnant people to abortion services, simply providing them with information about abortion, or campaigning around legal reform in this area.

So NGOs (Non-Governmental Organisations) that want to receive US funding are effectively ‘gagged’ from working in abortion care – hence the name.

This policy was originally called The Mexico City Policy and was first introduced by the then President Reagan in 1984. Under the Mexico City Policy, the ‘gag’ applies to all of the work that an NGO does. For example, an organisation cannot use funds from another source to fund work in abortion care.

How big a deal is this? Well the US provides a huge amount funding to overseas NGOs. The US can be a major source of funding for NGOs. The Global Gag forces them to balance the importance of abortion care with the need for financial stability.

In addition to this, US culture and political ideology is hugely influential around the world. This is true, even if you are living in a high income country which doesn’t rely on overseas funding from foreign powers, like the UK.

The US position on abortion care is really important right now, at a time when some countries are rolling back on abortion laws – for example in Poland.

Remember, the WHO (World Health Organisation) recognises that abortions are both incredibly common and also continue to take place where they are not legally allowed – but in unsafe conditions.

So why are we talking about the Global Gag Rule at this particular time? Well, since it was first introduced this policy has been removed and reintroduced several times. There has been a pattern of Presidents from the Democratic Party to overturn the Global Gag Rule, and for it to be reinstated the next time a Republican President gets in to power.

The outgoing US (Republican) President – Donald Trump – is noted to have reinstated the Global Gag Rule. In fact, some people say that his version of the Mexico City Policy made it even more restrictive – for example by making it apply to all of the global health assistance funding, not just that set aside for family planning.

Many people hope that new US President will, as the pattern has been, remove the Global Gag Rule and allow NGOs to be supported in providing essential health care. At the time of writing this, there is an international petition to call on him to do just this.

Posted in Anatomy, SRE

Lark in A Park

As well as facilitating Sex Ed workshops in schools for the last month, I’ve been involved in a few events aimed exclusively at adults.  Although the style of presentation has been different, these have all involved using an arts & crafts or D.I.Y approach.  These events reaffirmed my belief in this as a particularly good medium for exploring personal issues in a fun, engaging and accessible way.

The first was a ‘genital making’ workshop, hosted by the Candid Collective.  Adapted from an activity used to teach children about anatomy, puberty and health, this saw us showing adults how to make vulvas and penises with air drying clay to then be turned in to fridge magnets!  Held in a cosy upstairs room of a pub in South London, it had a very different feel to the classroom and was lots of fun.

The second was a talk for the antiuniversity lecture series – in which a group of us took to a local park to talk about arts and craft as a medium for discussing bodies and our own experiences of sex ed.  This culminated in making a ‘zine page about some of the issues that had been brought up.

There are a couple of future crafting themed sex and relationship events (in London) for adults that you may be interested in:

Thanks to Lisa, Leah, Adam and Bel for the images!

 

 

 

Posted in Genitals: A User's Guide

Trouble Down Below

**TW:  mentions of rape**

There are a wealth of products designed specifically for genitals.   Some for aesthetics, some for convenience, some for hygiene, some for pleasure.  It’s certainly true that there needs to be less stigma around products to help with basic bodily functions and/or sexual pleasure.  Take the stigma surrounding period products for example – literally decades of advertising aimed at showing us how unacceptable and dirty periods are.   However, not all products are equal.  Some things that are sold to help your genitals are unnecessary or problematic.   Here are four of (what I think are) the worst!

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Femfresh (other brands exist). 

Femfresh is a range of products for ‘feminine hygiene’ – e.g. washes and scented wipes.   The vagina is self cleaning and the only thing you need to use to keep a vulva clean is warm water and unscented soap.  However Femfresh and its ilk push an agenda that they are vital, with their vagina friendly pH balance giving them the edge over soap (which is the same for water, which is free and comes out of the tap).  The Femfresh website promotes the products using a smiling face of a gynaecologist, ‘Dr Sara’, with a list of advice on how to ‘care for down there’.  Much like the period adverts, euphemisms abound – the implication being that your vulva is smelly and dirty and only buying this type of product can fix that.  The branding is phenomenally successful.  As a facilitator for Sex Ed classes to young people, I am often asked about this product, by name.  It can be quite difficult to assert that it is unnecessary and a person’s genitals are completely normal and healthy in the face of such advertising and branding.

 

Vaginal Douches

Like Femfresh, but super-charged!  Vaginal douches are devices and products that ‘flush out’ the vagina – unfortunately taking all of the natural bugs and secretions that keep the vagina health with them.  Just say no!

 

The Consent Condom

This is definitely one from the ‘road to hell is paved with good intentions’ department.  Sold with the tagline ‘consent is the most important thing in sex’, this is a condom that requires two people (or at least four hands working together) to open the packet.   It received quite a backlash when it came out.  People were quick to point out that flaws – such as rapists not necessarily caring about using condoms, or having the ability to work in pairs.  The consent condom also implicitly buys in to the idea of consent as a single moment of ‘yes’/ ‘no’.  Consent should be reversible and always up for discussion.  Even if you’re in a long term relationship and sex is something you do regularly.  Even if you said ‘yes’ at first and then changed your mind.  Even if you helped someone open a condom packet holding two of the four pressure points.

 

Anti-Rape Wear

This is underwear marketed as only being able to be removed by the wearer.  It is reinforced to prevent cutting and tearing off by an attacker.  Originally designed and crowdfunded by a victim of sexual assault, this is probably again something made and marketed with noble intentions in mind as well as profit margins.  Given the state of the world, fear of sexual assault is very understandable.  However, I just don’t want to live in a society we focus our efforts on designing things to make people less rapeable.  We need social and structural change, not ‘rape-proof’ clothing.  Additionally, anti-rape wear reinforces the idea that sexual attacks are committed by strangers when a person is out and about in the world.  In fact, most victims of sexual assault know their attacker – be it a family member, friend or partner.   It is hard to see how anti-rape wear will be of much use  unless it is worn at all times and in all places – except for those brief moments when you need to either pee or have penetrative sex with someone and definitely won’t change your mind at any point (which we’ve already established you have a complete right to do).

These are my four.  Tweet me if you think of any more or disagree – @squisquasque…

Posted in Genitals: A User's Guide

Hidden Depths

The clitoris used to be  represented and thought of as a small ‘pea’ like structure, sitting above the urethra (Enright, 2019).  It wasn’t until relatively recently when Professor Helen O’Connell fully investigated and modelled the full extent of the clitoris in 1998 (Fyfe, 2018).  O’Connell is a Urologist (a type of doctor, who specialises in surgery in areas of the body including the bladder and urethra).  She used cadavers to map fully map out the clitoris, demonstrating that it was a much bigger structure.  Like this:

2019-03-21 18.07.16
The structure of the clitoris, showing its relation to the urethra and vaginal opening (After Drake  et al., 2010).

It includes structures that are hidden deep to other tissue, such as the corpus cavernosum and the bulbs of the clitoris.  As you can see from the diagram the bulbs of the clitoris are very close to the vagina – even more so when a person is aroused, as they become swollen and more erect by blood being diverted to them, just as the penis does (Drake et al. 2010).

There is an excellent and short French cartoon about the structure, function and history of ‘Le Clitoris’- the only organ that is just for pleasure – here.

2018-10-19 08.40.58
3D printed, scale-sized model of the clitoris

 

References:

Drake, R. L., Vogl, A. W. & Mitchell, A. W. M. (2010) Gray’s Anatomy for Students. Second Edition. Canada: Churchill Livingstone Elsevier.

Enright, L. (2019) Vagina a Re-Education. Croydon: Allen & Unwin.

Fyfe, M. (October 2018) Get Clitorate: how a Melbourne doctor is redefining sexuality. The Sunday Morning Herald.  Accessed online on 21.03.2019 at [https://www.smh.com.au/lifestyle/health-and-wellness/get-cliterate-how-a-melbourne-doctor-is-redefining-female-sexuality-20181203-p50jvv.html}

 

Posted in Genitals: A User's Guide

Dare to Hair

Pubic hair and body positivity can be a tricky issue. On the one hand, people absolutely have the right to cut, shape, dye, remove or in any other way sculpt their own personal body space! I get how it can be liberating and a way of taking control of your own body and quite literally shaping your intimate identity.

On the other hand, there seems to be a growing repulsion for body hair that isn’t manicured. A dislike for ‘natural’ hair, particularly (but not exclusively) when it comes to vulvas. Some people specifically find it ‘unhygienic‘. This despite the fact that pubic hair, like the hair on your head, has specifically protective functions.

So trim and go as bare as you dare around your nether regions if you want to. But maybe think about why your doing it!

Posted in Genitals: A User's Guide

Luscious Lips

‘Labia Minora’ is latin for ‘smaller lips’.  It’s the word used to describe the flaps of tissue that sit inside the larger labia majora (‘large lips’) and surround the innermost structures of the vulva – like the clitoris and the vagina.

Exactly what an individual’s labia minora look like in terms of shape and size vary hugely.  Some have fairly minimal tissue, which doesn’t tend to be visible unless the labia majora are spread (i.e. legs akimbo!).  Some people have much larger amounts of tissue.  When people talk about having cosmetic surgery to the vulva, they often call it a ‘designer vagina’.  However, it is surgery to the labia minora (a ‘labiaplasty’ or ‘vulval surgery’) that they are in fact referring to, not surgery to the vagina itself.   Some people feel that this type of surgery is almost always unnecessary and related to unfounded fears that people have about larger labia minoras being ‘abnormal’.