Real Talk: Fall 2022

Deciding between a hormonal or non-hormonal option for birth control is a personal choice that sometimes depends on your medical condition. Hormonal birth control works by using estrogen and/or progesterone to change your body’s chemistry to prevent ovulation (the release of an egg) and to keep sperm from entering the uterus by thickening the cervical mucus. Added benefits of hormonal birth control include regulation of your menstrual cycle, relief from painful cycles, and reduction in size of ovarian cysts. Common forms of hormonal birth control are the pill, patch (ex: Xulane), vaginal ring (ex: NuvaRing), shot (ex: Depo- Provera), implant (ex: Nexplanon), and intrauterine device (ex: Mirena or Liletta). Side effects can include mood swings, nausea, headaches, or spotting between cycles. Some medical conditions, like a history of blood clots or breast cancer, may make hormonal birth control an unsafe option for some people.

Non-hormonal birth control works by creating a barrier that keeps the sperm from reaching the egg and/or by slowing down sperm. Common forms of non-hormonal birth control include the copper intrauterine device (ex: Paragard), cervical cap (FemCap), diaphragm (ex: Milex), sponge (ex: Today), vaginal gel (ex: Phexxi), and condoms. Side effects include the risk of urinary tract infections with vaginal gel and irregular, heavy bleeding with the copper IUD. Keep in mind that there is not a “best” birth control option for everyone. It is important to discuss with your doctor which birth control method most appropriately fits your needs. Don’t forget, even if you are on birth control—hormonal or non-hormonal—the only way to protect yourself from a sexually transmitted disease (STD) is to use a condom!

Akshay Goswami MD, MPH

The contraceptive implant is a small rod that is placed just beneath the skin in the upper arm in the doctor’s office. It is one of the most effective forms of birth control out there. Like any medicine, it can have some downsides. One of the most commonly reported side effects is bothersome bleeding. Many girls and women experience irregular bleeding in the first 6-12 months of use. This may range from daily spotting to heavier periods or even infrequent periods or no bleeding at all. About 1 in 10 women will have the implant removed by the end of the first year due to the bleeding. While bleeding on the implant can be pesky, it is not necessarily dangerous and may be alleviated with medications. However, if your bleeding is accompanied by pain, nausea, vomiting, fevers, or chills, visit your doctor to make sure you don’t have an infection and to rule out any other causes. The bottom line is that you should be prepared to give your body a few months to get used to your implant as period changes are normal.

Sara Lever, MD

There are many different period products available that are safe to use and allow for flexibility and protection regardless of your lifestyle. Sanitary pads come in a variety of absorbencies and attach to your underwear (with the sticky side down!). These are easy to use but need to be changed often—about every 4-6 hours—to avoid odor or leakage. They aren’t necessarily environmentally friendly, but there are now washable/reusable kinds. Tampons are a small absorbable cotton device that you insert into the vagina to catch the menstrual blood. These are also easy to use and discreet, but it takes some time to learn how to place them comfortably. Tampons don’t compromise virginity or increase your risk for vaginal infections. A rare complication called toxic shock syndrome can occur when someone leaves a tampon in for longer than recommended. You should make sure to use the lowest absorbency for your flow and change the tampon frequently. Period panties look like regular underwear but have an absorbable layer that can hold up to five tampons worth of blood! They are costly but are machine washable and last for years. They are not leakproof, so you may need to use another period product on your heavy days, but overall, they have great reviews and provide good odor control. Menstrual cups are small silicone (or rubber) cups that you place inside the vagina. It is a bit tricky to learn how to place and remove them, but they are environmentally friendly, can be used for up to 12 hours, and are easily cleaned. They might be a bit intimidating, but they work great for active people who don’t want to worry about changing their period product often. Menstrual discs are a disposable version of the menstrual cup. They hold a similar amount of blood and can be worn for longer periods of time but are one-time use only, so not great for the environment or your wallet.

Eleanor Germano, MD

Social media and advertisement campaigns continue to lead consumers to believe that vaginas should smell like roses. But that is simply not true or healthy! It’s important to remember that all healthy vaginas have an individual smell. The vaginal pH level is acidic, which helps keep the bad bacteria away and the good bacteria happy. Depending on where you are in your menstrual cycle, the normal odor of the vagina may vary from tangy to musty to metallic. The sweat glands around the outer part of the female genitalia can also be a contributing factor. However, there is no research that shows a direct relationship between certain types of foods and vaginal odor. Here are a few general recommendations to keep your vagina fresh and healthy: 1. Stay hydrated! Drinking enough water is important for the pH balance of the vagina. 2. Wear loose-fitting underwear and clothing to allow the area to breathe and stay cool. 3. Contrary to popular belief, you should not wash the inside of the vagina. Only wash the external part (vulva) with warm water. You can use a mild soap if you like, but DO NOT use scented soaps or lotions and stay away from perfume in the genital area. Remember, the vagina has a very delicate balance of bacteria. Interrupting that balance can lead to infections and unhealthy odors. 4. Embrace your vagina and all its uniqueness! It’s normal!

Aleah Singleton, MD

An orgasm is a release of pressure in the body that people may experience in response to sexual excitement and stimulation. There are a number of things that happen in the female body before and during an orgasm: the heart starts beating faster, blood rushes to the genitals, the vagina produces lubrication (or “gets wet”), the spongy, highly sensitive tissue above the urethra known as the clitoris swells, vaginal muscles tense and contract. A male orgasm is usually accompanied by the release of semen, a fluid containing sperm that is ejected from the erect penis and may fertilize an egg inside the female body and lead to pregnancy without the use of birth control. Many factors influence whether and how a person is able to reach orgasm, such as individual likes and dislikes and whether someone feels comfortable and safe. In other words, there is no right answer to what an orgasm is “supposed” to feel like. It’s a complex process that involves both the body and the brain, and it does not feel the same for everyone.

La’Nasha Tanner, MD