Category Archives: Contraception

Communication, Contraception, Pregnancy, Relationships

Mistake Maker: Establishing boundaries in friendship

Dear Sexpert,

Last weekend, I hooked up with my friend, and now things are super awkward since they want to keep seeing each other. I really value this friendship, but I’m not looking for anything more right now and just want to be friends. How do I navigate this situation without ruining our friendship? 

— Mistake Maker 

Dear Student,

Navigating a friendship after a sexual encounter can definitely be challenging. It is natural to think that you may want “more,” and then eventually realize that you want a relationship to be platonic — or vice versa. Since you seem to be clear on what you do want (i.e., just friends), it is important to effectively and respectfully communicate with your friend, and do so soon. Leaving things unsaid or not engaging in an honest discussion can hurt your friendship.  

Before having that conversation, make sure you are certain about what you want. Sex involves feelings. Intimacy from physical touch or emotional connection triggers the hormone oxytocin, which can lead to feelings of attachment, even if unintended. It is normal to feel confused by conflicting emotions.

To address things with your friend, start by acknowledging what happened, and be reassuring. For example, you might say something like “Hey, I’ve been thinking about what happened last weekend, and I wanted to talk about it because I really value our friendship and I wouldn’t want anything to jeopardize that.” 

Clearly communicating how you feel about the situation is crucial, but so is making sure that you are not intentionally hurtful. Try to balance making it clear that you aren’t looking for anything more at this moment with the importance of your friendship. Emphasize that your feelings about the friendship haven’t changed and that you’d like to continue hanging out as friends. Be sure to give them space to share their feelings as well, and understand that it might take a bit of time before the friendship feels completely normal. 

While it may not be ideal to you, ease into the idea that maintaining your friendship may not be possible. Process through those feelings on your own or with a neutral party, such as a counselor. Just as you expect them to respect your wishes to just be friends, you may have to accept their disappointment or desire to no longer be friends. 

Hopefully, you engaged in safer sex by using contraception and/or barrier methods. If not, there are still ways to maintain your sexual health and wellness. 

Let’s say you did practice safer sex by using contraception and/or barrier methods, remember that even with protection, maintaining regular sexual health check-ups is still important! Consistent testing and communication are key to staying informed about your status and ensuring your long-term health and wellness. While it is better to have conversations related to sexual health before engaging in sexual activities, you can know your status and reduce the spread of sexually transmitted infections (STIs) by getting tested. STI testing recommendations vary and depend on multiple factors, including behavioral and identity-based risks. 

Finding out more about whether you need testing is a smart decision, and you should not feel embarrassed about it. Your MyUHS online portal features an online STI screening program for asymptomatic testing, designed to include evidence-based educational information and enable you to make an informed decision about the type of testing you wish to pursue. It also lets you schedule collection at a time that is convenient for you. Additionally, this testing is confidential, so you do not have to be concerned with other individuals, such as your family, finding out from UHS.

Depending on whether pregnancy prevention is a relevant concern, if you did not use contraception or remain uncertain, you and/or your friend are likely outside of the window of emergency contraception being effective. Pregnancy testing is also available at UHS. If you’d like to discuss ongoing contraception options that provide reliable protection without requiring preparation each time, consider meeting with a Sexual Health and Wellness clinician at UHS. They can help you find the method that best fits your needs and lifestyle, ensuring you feel informed and confident in your choice.

Lastly, if you both decide to maintain the friendship, it would benefit you to discuss boundaries moving forward. Will you discuss your romantic or sexual relationships with one another? What types of physical touch are okay? Maybe ease back into the friendship in group social settings only, rather than one-on-one. Depending on the circumstances of the initial hookup, try to avoid similar circumstances.

Good luck with honoring your needs and wants in your conversation, and remember to respect your friend’s feelings as well while navigating this sensitive situation. 

— The Sexpert

Information provided by University Health Services and Harvard Health. 

Contraception, Dating

Puzzled BC-Taker: On birth control

Dear Sexpert,

I’ve been dating my partner for over a year now, but I fear things are not going well, and we are likely close to the end of our relationship. A couple of months into dating, I decided I was ready to begin being sexually active, and I started using birth control pills. My body seems to have adapted well to them, but I am unsure if I should continue using them if my partner and I break up. I’m afraid that if I keep taking them, others will assume it’s because I have already moved on and that I’m seeing other people. What should I do? If I stop taking them, what should I expect? 

— Puzzled BC-taker

Dear Puzzled BC-taker, 

I am sorry to hear that your relationship might be nearing its end. I hope you and your partner ultimately make the decision that is right for you, and if you do break up, do so respectfully.

Regarding your birth control dilemma: birth control pills, also referred to as oral contraceptives, are a reliable, easily reversed form of contraception, but they can also be used for various reasons beyond pregnancy prevention. Oral contraceptives are generally a combination of the hormones estrogen and progestin — two hormones necessary for the sexual development of the female and for the regulation of the menstrual cycle. Consistently taking birth control pills is a reliable form of contraception and can be easily reversed. 

Each different type of birth control pill has a unique dosage of estrogen and progestin. Those with both the hormones estrogen and progestin are known as combination pills. Combination oral contraceptives can be used to treat hormone-related health issues, such as acne, severe menstrual cramps (also known as dysmenorrhea), and irregular menstrual cycles. Birth control pills may even be prescribed to help relieve endometriosis symptoms, a condition during which the tissue that lines the uterus grows outside of it. There are also pills that only contain progestin, colloquially known as “mini-pills.”

Using oral contraceptives can have several benefits besides their main purpose, such as the lessened probability of developing cysts in the breasts and ovaries, and of developing endometrial and ovarian cancers. Of course, this depends on the person and type of combination pill used.  

Evidently, there are several reasons why someone might use oral contraceptives. Nonetheless, there can be a stigma regarding contraceptive use, so your concerns about the assumptions someone may make are completely valid. However, you know your body better than anyone else, and thus should not be afraid of what others may think of your health-related decisions. Of course, that is easier said than done.

The main thing you should consider is your well-being: What would make you feel the most comfortable? If you are not looking to become pregnant, continuing to take birth control may keep your mind at ease. It is important to note that you can become pregnant immediately after you discontinue taking regular or low-dose oral contraceptives, so consider whether you may engage in vaginal sex in the near future before stopping your regimen. Given that oral contraceptives are easily reversible, you can resume taking them at any point (before their expiration date) after stopping, but they may not be effective at preventing pregnancy immediately. Depending on the type of pill, they may become effective only after seven days of usage. If you plan to have vaginal sex, also use a barrier method, like an internal or external condom, to prevent pregnancy.

Something else you should consider before you discontinue taking birth control pills is whether there are additional benefits of using oral contraceptives and how they affect your current lifestyle. Perhaps you are experiencing a lighter menstruation flow and less cramping, which may be a relief, especially in a high-stress environment where you have less time to rest during the day. Ultimately, it is your decision, but those are two factors to consider. 

If you do decide to stop taking the pill, you should expect your menstruation cycle to return to how it was before birth control. This might mean your menstruation flow will become heavier, and you will have more cramping. It might also take a couple of months for your hormone levels to balance themselves, and this readjustment phase may lead to irregular periods. Fortunately, this readjustment phase is based on how long you were on birth control and may last less than three months.

Before making a final decision, it may be helpful to speak with your healthcare provider, or a Sexual Health and Wellness clinician at UHS, to weigh the pros and cons and consider an alternative contraceptive form — for example, an intrauterine device, patch, or hormonal shot. If you would like more guidance but do not feel ready to speak with a professional quite yet, you can schedule a Wellness Chat with a Peer Health Adviser to explore resources and create an “action plan.” Regardless of your decision, remember that there are many resources available to you on campus if you want to talk through your options or simply to have someone listen. 

Sincerely,
The Sexpert 

Information in this article is from MayoClinic, Go Ask Alice Columbia University, Planned Parenthood, and Psychology Today.

Contraception, Pregnancy, STDs/STIs

Summer Fling Seeker: Maintaining sexual health during the summer

Dear Sexpert,

I’ve been using McCosh’s services to remain diligent about my sexual health and have gotten used to the easy, accessible resources on campus. I’m going home for the summer in a few weeks, and I am worried about accessing resources at home, especially without my parents knowing about it. My home state is also extremely strict about abortions, and while I don’t plan to get pregnant, unwanted pregnancies could still happen and I’m not in a place to have a child right now. I could use some guidance regarding this matter.

Sincerely,
Summer Fling Seeker

Dear Summer Fling Seeker, 

Planning ahead and being cautious are certainly important goals! If you intend to be sexually active this summer — especially if you are engaging with new or multiple sexual partners, it is a good idea to have a plan in place to continue practicing safer sex. It’s also great that you’ve been able to take advantage of the services at McCosh while on campus. If you already have a provider at McCosh who you are comfortable with, you can message your provider through your MyUHS portal with non-urgent questions throughout the summer. They may also assist in getting you connected to resources near you. However, this should not be used for urgent or immediate care concerns or services.

If you are not connected with a care provider at home, Planned Parenthood has clinical locations across most of the United States. These clinics offer sexually-transmitted infection (STI) testing, contraception, physical examinations, consultations, pregnancy testing and prenatal services, abortion care, and sex education. Your local pharmacy may also offer consultations, evaluations, STI and pregnancy testing, and vaccinations or treatments, as needed. 

You note being concerned about unwanted pregnancies. If you do not have a consistent or reliable contraception method, consider making an appointment at McCosh with Sexual Health and Wellness (SHAW) to explore your options before your departure from campus. There are a ton of different methods — hormonal, non-hormonal, daily use, or ones that last years once inserted. Remember that external and internal condoms also prevent STIs, in addition to pregnancy.

Even with these options, no method  is 100 percent foolproof, other than abstinence. Should you suspect a pregnancy, it can be more cost efficient to get a test at a Planned Parenthood location (since they accept insurance or offer a sliding scale fee, if paying out-of-pocket) than to pick up an at-home testing at a pharmacy. But at-home testing does ensure more privacy. Just keep in mind that if you are on your family’s insurance plan and use it, an explanation of benefits (EOB) may be mailed to the policy holder. Learn about some strategies to navigate this.

If you find yourself pregnant and want to explore your options, you may want to learn more about state laws and restrictions (e.g., ultrasound and waiting period requirement, parental consent or notification) to know more about your options, including what you could expect at a provider’s office. You can also look to any of these resources for supportive talk or text lines regarding options to navigate pregnancy. Additionally, Hey Jane is a startup that connects menstruating people to healthcare providers who can educate and prescribe contraceptives and abortion medication. This company caters to those who are less than 10 weeks pregnant and over 18 years old, and in the states Calif., Colo., Conn., Ill., Md., N.J., N.M., N.Y. and Wash. (which may not be applicable to your situation). This service is private and will work with you to financially support your decision. Plan C is another resource that has up-to-date information about accessing at-home abortion pills. More than 54% of abortions in the United States are medication abortions, and they are often chosen over surgical abortions because of the desire for privacy.

Taking preventive measures to maintain your sexual health is incredibly important for your overall well-being, as well as to avoid STIs and unwanted pregnancies. Using condoms and other forms of contraception are the easiest ways to stay diligent about this, but the only way to definitively prevent STIs and unwanted pregnancies is practicing abstinence. If you choose to be sexually active, make sure you are on top of your self-protective behaviors, know your options, and can get connected to care. 

Stay safe,

The Sexpert

Information for this article is provided by the Guttmacher Institute, Plan C, Hey Jane, Bedsider and Reproductive Rights.

Contraception, Pregnancy

Forgetful

Hi Sexpert;

I’ve been on birth control the past 2 weeks, being new to it, I’ve either missed a day or taken them hours late numerous times. I’ve had unprotected/no pull-out sex about 5 times this week, including today which was my original ovulation day (before I started BC), am I at risk for pregnancy?

-Forgetful

Dear Forgetful;

Thank you so much for your question! With our busy lives, forgetting to take an oral contraceptive method of birth control (i.e., the pill) happens to lots of people. It is great that you are making efforts to reduce your risk of pregnancy by using contraception; however, not taking it consistently while engaging in unprotected penetrative sex can increase your risk of becoming pregnant.

Birth control pills like many other forms of contraception are not 100% effective at preventing pregnancy. If you use birth control pills perfectly, meaning that you take it every day at the same time, it is over 99% effective. In reality, the pill is 91% effective because people are not perfect and forget to take or miss pills. If you forget to take the pill more than two days, the chance of ovulation (when a mature egg is released from the ovary and has the potential for fertilization) increases, meaning your risk of getting pregnant also increases.

How soon birth control takes effect after starting it depends on what kind of birth control you take. Combination pills (containing estrogen and progestin) can take anywhere from five to seven days after the first dose to become effective depending on when you begin taking the pill. Progestin-only pills, also known as mini pills, are effective after two days of starting the pill. During this time, it is best to use a second form of contraception such as an internal or external condom to prevent pregnancy. Progestin-only pills are really most effective if you take them at the same time every day. If you take the progestin pill three or more hours late, it is recommended that you use a backup-method for the next two days. If you are taking a combo pill and miss a day, you can take two pills the next day to get back on schedule. If you miss two or more consecutive pills anywhere in a combo pill pack, a backup birth control method, such as condoms or a diaphragm, is recommended for seven days. If you are unsure of which kind of birth control you are taking, ask your primary care physician, gynecologist, or a provider at McCosh and they will be able to provide more information regarding the effectiveness of the birth control you use.

If you are concerned about being pregnant, it is best to take a pregnancy test which can be purchased at the University Store, CVS on Nassau Street, or at McCosh Health Center. If you have any questions regarding how to use a pregnancy test or which one to purchase, feel free to make an appointment with a provider at McCosh.

If you choose daily birth control as your preferred method of contraception, is it very important that you take the pill every day to ensure its effectiveness. Missing just one day increases your risk of becoming pregnant. Setting a daily alarm or opting for a text reminder service can be helpful. If you continue to miss pills, it may be advisable to speak to your healthcare provider to discuss other contraceptive options, such as an intrauterine device (IUD), birth control patch, implant, or shot – which are sort of “set it and forget it” methods. If you are ever in doubt in regards to the effectiveness of your birth control or if you want to explore other options of contraception, speak to your primary care provider, gynecologist, or a provider at McCosh Health Services. You can make an appointment online at www.princeton.edu/myuhs.

— The Sexpert

Information on birth control provided Planned Parenthood, WebMD, and Bedsider. 

 

 

Contraception, Protective Barriers

Tear Preventer: What are my Lube Options?

Dear Sexpert,

 Can I use micellar water or v-wash as anal lubricant (since it should be water-based)? What can I use apart from expensive lubes?

Sincerely,

Tear Preventer

Dear Tear Preventer,

Thank you for reaching out to the Sexpert with your question!  Since the anus does not lubricate naturally, many people find that adding a lubricant makes anal penetration a more pleasant experience.  Additionally, using an effective lubricant lowers risk of condom breakage (from friction) and helps protect sensitive tissue.  As you note, making sure a lubricant is water-based (as opposed to oil-based) when using with latex condoms or other latex-based protective barriers is ideal to preventing the latex from breaking down. With such a wide variety of lubricants on the market, and a wealth of information about lubricants on the internet, it can be difficult to choose the option that will be best for you.

First, I’d like to start by talking about micellar water and v-wash for our readers who are not familiar with these products.  V Wash Plus Expert Intimate Hygiene is marketed as a vaginal wash to ease vaginal discomforts (e.g., itching, pain) or infections.  V Wash is a water-based wash that includes the ingredients: lactic acid, tea tree oil, and sea buckhorn oil.  Alternatively, micellar water is a combination of purified water, hydrating ingredients, such as glycerin, and low concentrations of extremely mild surfactants (substances which tend to reduce surface tension of a liquid in which it is dissolved).  The molecules of surfactants group together to form microscopic spheres called micelles, which act like magnets for dirt and oil.  Recently, micellar water has become popular in the United States amongst models, celebrities, and makeup artists as a makeup remover, cleanser, and toner.

I would advise against using v-wash or micellar water as anal lubricants.  First off, these products contain chemicals, such as glycerin, that can cause infections if not cleaned off properly and could damage the lining of the rectum.  Further, in general, lubricants and other care product designed for the vagina*, such as V Wash, are acidic to cater to the slightly acidic pH of the vagina. Since the rectal pH is more neutral, surrounding tissues could be damaged upon exposure to these products.

Now, let’s talk about good lubricants to use depending on sexual act.  If you will be using a latex condom or silicone sex toy, use water-based lube to prevent condom breakage or damage to the toy.  Look for non-flavored (flavored varieties often have sugar and other added ingredients) varieties of water-based lube to minimize sensitive tissue irritation.  Note: it might require some reapplication as water based lube dries more quickly. Some people who have penetrative anal sex may prefer silicone-based lube because it is typically slicker and stays wetter longer, thus reducing friction upon sensitive tissues.  Although safe for use with condoms, silicone-based lube is not safe for use with sex toys unless there is a condom on the toy.  Finally, oil-based lube is not safe for use with latex condoms.  Because of the sensitivity of anal tissues and incompatibility of lubricants with condoms and sex toys, I would also advise against using household products such as petroleum jelly, coconut oil, or olive oil as anal lubricants.  To ensure pleasure and safety for all parties involved in anal stimulation or penetration, it is best to use an unscented product that is suitable to your preferred activity.

To learn more about safer anal sex practices or to get tested for sexually transmitted infections (STIs), you can make an appointment with a University Health Services’ clinician at McCosh Health Center online at MyUHS.

*For more information about care products and cleansers designed for the vagina, see Sexpert article https://thesexpert.princeton.edu/2018/04/are-feminine-hygiene-washes-safe-to-use/

References:

  1. https://www.allure.com/gallery/micellar-water-facial-cleanser
  2. Identification of Personal Lubricants That Can Cause Rectal Epithelial Cell Damage and Enhance HIV Type 1 Replication in Vitro. AIDS RESEARCH AND HUMAN RETROVIRUSES, Volume 27, Number 9, 2011
  3. https://goaskalice.columbia.edu/answered-questions/olive-oil-anal-sex-lubricant

 

 

 

 

 

Contraception

Concerned (Birth) Controller: Is it better to get an IUD?

Dear Sexpert,

I am currently taking birth control because I am sexually active, and the pill has been my contraceptive of choice since I started. However, I have heard of a lot of women rushing to get IUDs instead because they are worried that a repeal of the ACA will make birth control too expensive. That way, they can charge the IUD to their insurance now and avoid purchasing new contraceptives for the next few years. Is this a good idea? Can I get an IUD at McCosh?

–Concerned (Birth) Controller  

Continue reading Concerned (Birth) Controller: Is it better to get an IUD? →

Contraception, Pregnancy

Insemin-Afraid: What should I do if my boyfriend accidentally finishes inside me?

Dear Sexpert,

My boyfriend and I have been have been having sex pretty regularly recently. He’s super great and caring and usually I think we are being pretty safe. He’s pretty good at pulling out, but last time he finished before he could! I’m kind of freaking out, how will I know if I’m pregnant?

–Insemin-Afraid

Continue reading Insemin-Afraid: What should I do if my boyfriend accidentally finishes inside me? →

Contraception

Estrogen Free: What are alternative forms of birth control?

Dear Sexpert,

Now that I’m in college and have become sexually active, I feel like it’s a good idea for me to go on birth control. However, I have a medical condition that precludes me from using any medications that involve estrogen. Does this mean I can’t use any birth control at all? I obviously want to be safe, but I’m not sure what my options are if I can’t use estrogen. Help me out!

–Estrogen Free

Continue reading Estrogen Free: What are alternative forms of birth control? →

Contraception

Curious: What are my options for emergency contraceptives?

Dear Sexpert,

Can you tell me more about the different types of emergency contraceptives that are out there? I know about the morning-after pill (Plan B), but I’ve heard that there are a few others. Also, where can I get emergency contraceptives on campus (if needed)?

–Curious about Contraceptives

Continue reading Curious: What are my options for emergency contraceptives? →

Contraception

First-timers: Can you have sex without a condom if you’re on birth control?

1 Comment

Dear Sexpert,

I’ve been hooking up with the same girl for a while, and we talked about it and decided that we were ready to have sex. The only thing is, we’re both virgins, so we really have no idea what we’re doing or what to expect. On the plus side though, since she’s already on birth control, we won’t have to use a condom, which I’ve heard can make sex less pleasurable. Any tips?

Thanks,

First-time-for-everything

 

Dear First,

It’s great that you two had an open and honest discussion about your sexual wants and needs. In terms of advice, I would tell you to keep up the good communication! It’s important for both partners to be clear about their desires. In terms of actual “sex tips,” a lot of websites offer straightforward advice that might be more helpful than what you find in popular magazines – some places to start might be Planned Parenthood’s site, “Understanding Sexual Pleasure,” or the FAQ section on sexetc.org. Ultimately, what’s most important is what feels good to you and your partner!

After studying up, you might still want to head to McCosh Health Center to pick up free condoms. Even though your partner is taking an oral contraceptive, which helps to prevent pregnancy, there is still a risk of transmitting sexually transmitted infections (STIs). Here’s why: being a “virgin” can mean very different things to different people. For some, it might just mean no penetrative sex, while for others it might mean nothing more than kissing. And even if it only means kissing to both of you, there is still a risk of transmitting infections, like herpes. Furthermore, some people may identify as being a virgin if they are currently abstinent, but have had sexual intercourse previously.  For peace of mind, I would recommend that you both make appointments to get STI testing at the Sexual Health and Wellness clinic at McCosh. It’s cheap and convenient: HIV testing is free, and it’s only $9.50 for a test for gonorrhea and chlamydia – and you can easily schedule the appointment online. Until you and your partner get and share your results, it is safest to use a condom.

For some, using a condom can dull physical pleasure or may lower sexual excitement. However, condoms come many sizes and varieties, including flavored, ribbed, extra lubricated, etc. and some exploration may help find one that provides the most pleasure for both you and your partner. Using condoms during sexplay can also prevent the lowering of excitement by stopping activities to put on a condom.

Once you’re sure that you’re not at risk for STIs, then you can reconsider whether condoms and the pill, oral contraceptives alone, or another form might be the best protective method for the two of you. The staff at SHAW would be happy to discuss your options, and they also provide a wide range of contraceptive products, either free or at a reduced cost.

Be safe and enjoy yourselves!

–The Sexpert

 

Contraception

Condom Queen: What if my partner doesn’t want to use a condom?

Dear Sexpert—

I just started dating a new guy, and he’s really great! But there’s one thing he does that makes me kind of uneasy: he’s really resistant to wearing condoms when we have sex. He always comes up with some excuse and tries to make me feel good about it, and sometimes I go along with it. Usually, I am a real stickler about condom use, so it worries me that he is so against using them. On the one hand, I want to tell him to wear one; but on the other, he’s made it seem like wearing one is a deal-breaker and I don’t want to lose him over it. What should I do?

–Condom Queen

 

Dear Ms. Queen,

There are a lot of different factors and attitudes that go into decision making and preferences, especially when it comes to something as intimate as sex. You have already decided that your preference is to use a condom every time, without exception. However, your boyfriend has other preferences.

Communication is the best way to improve sex. Talk with him about his dislike of condoms at a time when you’re not engaging in sexual activity. Figuring out his reasoning questions may help the two of you to come to an agreement about condom use. It is possible that he has had a bad experience with condoms in the past, or maybe he has not found one with the right fit. Trying out different condom styles or having open communication about wants and needs is a great way for him to see the fun of safer sexual experiences.

It seems like that you are concerned your boyfriend will end things if you push him. You have the right to make a decision for yourself, and he has the right for himself; but when you are making decisions that impact your partner, any and all decisions must mutually be agreed upon. I know it feels like saying something may put your relationship with him in jeopardy, but not saying something could also put your and his safety at risk (See the Sexpert archives.).

Be prepared with a response for the excuses, like “You’re just so sexy, I can’t wait” or “It’ll feel so much better without one”. Having condoms on-hand will discredit his “I can’t wait” argument, and it’ll make it easier for you to stay strong in your decision. Keep some condoms in your purse or bedside table for easy access. (You can get 10 FREE condoms, daily, at McCosh.) Also, there are many ways in which using condoms can be a fun part of the fun of your sexual experiences. Using the ultra-thin, ribbed, or heat-activating varieties or even adding a dab of lube to the inside and outside of the condom can all enhance the overall sexual experience for you both. If you aren’t interested in trying these options, you can always refer to the recent study published in The Journal of Sexual Medicine that stated that both men and women enjoy sex as much with condoms as without. This might alleviate his concerns, or at least make him more open to trying condoms.

When communicating about safer sex with your partner, feel free to be creative with ways to cooperate and come to a conclusion that makes you both happy. Just being willing to acknowledge his desires or worries may get him to acknowledge yours.

Good luck,

~The Sexpert