Jun 15 2009

FAQ – Frequently Asked Questions

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Spotting or Bleeding after Sex or Masturbation?

Light spotting or bleeding after an orgasm may be related to forceful uterine contractions, hormone changes or imbalances. If your cycles are regular and you are not having symptoms otherwise, I would attribute the bleeding to the uterine contractions. You may, at your next evaluation, want to discuss this with your physician.

Women who experience regular or heavy vaginal bleeding during or following sexual intercourse should always visit their doctor to determine the cause of the bleeding.

What causes vaginal bleeding during or after sexual intercourse?

Vaginal bleeding may occur during or after sexual intercourse for a number of reasons including:

  • Injuries to the vaginal wall or introitus (opening to the vagina) during intercourse
  • Infections (for example, gonorrhea, chlamydia, yeast infections) can be a cause of vaginal bleeding after intercourse.
  • Lowered estrogen levels in peri-menopausal or postmenopausal women may cause the lining of the vagina to become thinned and easily inflamed or infected, and these changes can be associated with vaginal bleeding after intercourse.
  • Anatomical lesions, such as tumors or polyps on the cervix or vaginal wall may lead to vaginal bleeding during or after intercourse.
  • Ovulation can cause mid-cycle bleeding.
  • Polycystic ovary syndrome (PCOS) is a hormone imbalance that interferes with normal ovulation which can cause abnormal bleeding.
  • Medicines, such as birth control pills, sometimes cause abnormal vaginal bleeding. You may have minor bleeding between periods during the first few months if you have recently started using birth control pills. You also may have bleeding if you do not take your pills at a regular time each day. For more information, see the topic Birth Control.
  • An intrauterine device (IUD) also may increase your chances of spotting or heavy periods. For more information on the IUD, see the topic Birth Control.
  • Infection of the pelvic organs (vagina, cervix, uterus, fallopian tubes, or ovaries) may cause vaginal bleeding, especially after intercourse or douching. Sexually transmitted diseases (STDs) are often the cause of infections. For more information, see the topic Exposure to Sexually Transmitted Diseases.
  • Pelvic inflammatory disease (PID) causes inflammation or infection of the uterus, fallopian tubes, or ovaries which can cause abnormal bleeding.

Other, less common causes of abnormal vaginal bleeding that may be more serious include:

  • Sexual abuse.
  • An object in the vagina.
  • Uterine fibroids, which are a common cause of heavy periods. For more information, see the topic Uterine Fibroids.
  • Structural problems, such as urethral prolapse or polyps.
  • Cancer of the cervix, uterus, ovaries, or vagina.
  • Breast-feeding.
  • Extreme emotional stress and excessive exercise. But excessive exercise more frequently causes an absence of menstruation (amenorrhea).
  • Other diseases, such as hyperthyroidism or diabetes.

It is normal for some women to bleed after having sexual intercourse for the first time. Bright red in color, the bleeding is caused by stretching of the hymen until it tears. If the bleeding continues, it will turn dark red and trail off until it stops, typically within a few days.

If a woman is penetrated with fingers and experiences bleeding, there are a few causes. If she’s a virgin, it’s likely that her hymen has been torn. It’s also possible that her vaginal walls have been scraped by her partner’s fingernails, in which case it’s important for her to be examined and get treatment so that she does not develop a vaginal infection.

In either case, a woman needs to see a health care provider for a check-up if:

  • bleeding is significant (is heavier than the first couple of days of her period, is constant, and/or soaks through a tampon and a pad)
  • bleeding persists for more than a few days
  • there is pain that does not get better
  • she is worried about anything (for some peace of mind)

In order to heal, it’s important not to have any vaginal penetration (no penises, fingers, tampons, etc.) and orgasm until after the bleeding has completely stopped. If bleeding returns after vaginal penetration or orgasm has resumed, then go to a health care provider for a check-up.

While it’s highly likely that the bleeding is in response to a sexual act, it’s also quite possible that it may not be related. If the bleeding starts out as dark, rather than bright, red in color, then there may be bleeding from the cervix or higher up in the uterus. This is not normal after first sexual intercourse and needs to be looked at by a health care provider as soon as possible.

If you still have your Hymen or it has not been fully broken you may be getting bleeding from tearing it.  If you are inserting your fingers into your vagina, you may be irritating or tearing this thin layer of skin, which could be causing some bleeding and spotting.  This would be completely normal.  Most females’ hymeneal ring breaks at some point in their life either through regular physical activity (like exercise) or through sexual penetration (either by a finger, penis or other object).

If you have long nails, you may also be scratching the inside of your vagina, which could produce some spotting.  If you are experiencing any type of pain or irritation from this bleeding, you should definitely see a doctor.

More Bleeding

Some women have vaginal bleeding associated with penetration or sexual intercourse. Sometimes it’s because they haven’t had penetration in a while; sometimes bleeding just happens. Reasons for this might be:

  • Sexually transmitted infections (STIs), such as Chlamydia, Gonorrhea, and HPV
  • Pregnancy
  • slight blood staining from excessive irritation of the outer or inner lips that can be mistaken for bleeding from the vagina
  • urinary tract infections (UTIs), which can be accompanied by blood in the urine
  • a cervical polyp, if vaginal bleeding is bright red in color
  • bleeding from extremely irritated and/or inflamed vaginal tissue due to excessive or vigorous penetration or vaginal trauma (though this is unusual) — adding water-based lube can help minimize or prevent this from happening

An appointment with a women’s health care provider or gynecologist is your next step. S/he will ask you for details about the bleeding, such as is it brownish or bright red in color? Is it a constant flow or occasional staining/spotting? S/he will examine you to see if the bleeding is coming from your vagina, cervix, vaginal walls, inner lips, and/or urethra. This and other information helps your provider determine or rule out other possible causes, and get appropriate diagnosis and treatment for you.


When to have your first Gynecological Exam

The purpose of a gynecological exam is to evaluate the size and shape of the uterus and ovaries, to do a Pap smear to identify early signs of cervical cancer, and to screen for sexually transmitted diseases.

Teens should start having gynecologic examinations when they turn 18 or when they first become sexually active (if that occurs before the age of 18). The examination may also be necessary before the age of 18 for concerns like abdominal (belly) pain, irregular or painful menstrual periods, or vaginal discharge. A woman who has never had sex before can have a gynecologic exam.

You will have to start by filling out a sexual and menstrual history questionnaire. It is a good idea to keep track of the start and end dates of menstrual bleeding for a few months before the visit. It is always a good idea to chart these dates every month.

The entire exam takes only a few minutes. The doctor will often ask a female nurse to be present to make the patient feel more comfortable. Yu can also ask for a parent, sister or friend to be present. The doctor will explain what he or she is doing during the exam. Feel free to ask questions at any point. Afterwards, it’s normal for the patient to have a small amount of blood spotting over the next day or so. Don’t forget to check the results of the tests for sexually transmitted diseases and the Pap smear, which take a few days to come back.


Why do I not orgasm from sex?

Do you get an orgasm from masturbation? If not, your partner will have a difficult time to figure out how to make you orgasm as you do not even know how to do it yourself. First figure out how you have to be touched, where and how you like to be touched, the speed of the movement, the pressure and how it differs between beginning and end. Practice to concentrate on the feeling and letting it grow more intense. You should also practice to let the tension build and build until your body release it in an orgasm. The old advice to relax is not correct. You should concentrate and tense up during arousal until you orgasm.

If you are on any medicine, it can affect your libido and your ability to orgasm. Especially depression medication or birth control pills. You should also make sure that your partner spends enough time on foreplay. Men are horny when they are aroused. Woman can however be aroused (wet and swollen up) without being horny, so time should be spent on ‘warming you up’. The thing that let you go from aroused to desire for sex is foreplay – kissing, talking, enjoying each other’s company, feeling loved and relaxed, rubbing and massage. Desire comes from your brain, not your genitals. He has to stimulate what is between your ears before moving to between your legs. He should tease you until you beg him to move on.

I have to tell you though that the majority of women do not orgasm from intercourse alone as their clitorises does not get enough stimulation. This is because your and his anatomies and sexual position does not bring your clitoris in contact with him for long enough. In many cases woman with a distance of more than one inch (25 mm) from their vaginal opening to their clitoris (the CV distance) will have this problem. This is more than 70% of all women.

Your clitoris is at the core of your sexual pleasure. You (or him) will have to stimulate it while he is inside you. This is easier done in the doggy position where you both have easy access to your clitoris. Woman on top is also useful where you are in control of the tempo, direction and depth of penetration. In this position you can also slip your hand down there and help yourself. You can also try to position yourself in a position where you can make sure your clitoris grinds on his pubic bone. You can even move in a circular motion rather than just up and down. When you do this, you can lean forward you can sweep your clitoris on his pubic bone in the upwards motion.

There is an advanced sex position that is made to solve the orgasm problem. It is called ‘Coital Alignment Technique’ (or C.A.T.). It is however an advanced position requiring disciplines from you both. You can search for it on the internets. It is normally a bit difficult to understand as it cannot be illustrated.


Help, my boyfriend ejaculates to quickly

Having a rapid ejaculating partner is also problematic. In most cases he has no or little control over it and even more frustrated by it than you are. The easiest way for him to handle that is to make you orgasm first before he enters you. He can do that with a toy, oral sex or his fingers. Then right after that he can enter you and with a bit of luck, you can orgasm again. You should not stimulate his penis before he enters you and he should wear a thick condom to reduce the feeling in his penis. There are also condoms available with a cream that will numb his penis and make him last longer. There are various techniques for him to try to last longer, but most are dubious at best:

  • He can think of something non sexy like his grand mother
  • He can stop thrusting when he comes close and wait for the feeling to subsides before continuing again
  • If you press on his perineum between his legs an between his testicles and anus with one finger, you will close the duct for the semen to come out. This will cause the semen to flow back into his bladder (retrograde ejaculation). He can then just continue.
  • Medication like anti-depressants will suppress his ability to orgasm
  • Erectile dysfunction (ED) pills like Viagra and Ciallis will shorten his refractory period drastically, in many cases keeping him stiff and able to just continue after orgasm
  • Various pharmaceutical companies are working on a pill to delay ejaculation. These pills are a combination of anti depression pills (SSRI depressant) and erectile dysfunction pills.


My girlfriend’s period is late, can she be pregnant?

A woman’s menstrual cycle is controlled by her hormone balance during different phases of her monthly cycle. A woman’s hormonal cycles are not like a machine or computer program that produces the same results every time. It is dependent on her general health, physical health and psychological health. Many things can delay her menstruation. Her body will often delay her periods when conditions are not ideal for her body to support a pregnancy. These conditions include:

  • General bad health
  • Stress and worry
  • Travel across many time zones
  • Low body weight/fat (underweight) or sudden weight loss
  • Extreme fitness or strenuous exercises
  • Poor nutrition and poor sleep
  • Vaginal infections including STDs
  • Taking medicines like antibiotics

A woman’s cycle is considered medically normal if it is between 21 days and 35 days long. The average for all women is around 28 days.

During early puberty, a girl’s menstruation cycle is not regular and it can disappear for months at a time.

A cycle is considered regular if the longest and shortest cycles are no more than 9 days different in length. Normally a regular cycle will be exactly the same length every month or differ by around 2 or 3 days every cycle.

The length of menstruation is considered normal between 2 and 7 days every cycle. Any spotting before her menstruation starts is not considered to be part of her menstrual flow. Her flow will normally start light, but pick up quickly in the amount. It will peak around the end of day 1 or day 2 and then will slow down gradually until it becomes very light or spotty.

If she has any reason to think that she might be pregnant (she had unprotected intercourse and a man ejaculated inside her vagina or her birth control method failed or she failed to use it properly) it is time to take a pregnancy test.

Use an early detection pregnancy test as soon as it is evident that her menstruation is delayed (at the latest 21 days after intercourse). Repeat the test 7 days later to confirm the results. Make sure to read the instructions and follow it. Use the first pee of the morning.

If the test result is positive after the second test and she is underage, it is important for her to tell her parents, it does not matter how difficult it is. If the result is negative, it is important that you find a birth control method that will protect you from unintended pregnancy.


I had unprotected sex with a boy. Am I pregnant?

Please bear with me as I explain your cycle so that you can understand what happens, why and when.

Your menstrual cycle is divided into a few phases:

  1. Menstruation
  2. Follicular phase (FP)
  3. Ovulation
  4. Luteal phase (LP)

From ovulation to the start of your next menstruation is a fairly constant 14 days. If your cycles are less than 28 days or longer than 28 days, the first 2 phases (menstruation and FP) are the ones that are responsible for it. Your LP is 14 days. It can be 2 days shorter or longer for some woman but for 95% of all women, LP is between 12 and 16 days long with the overwhelming average of 14 days.

You do not become pregnant every time you have unprotected intercourse. Your egg can only be fertilized for a few hours after you ovulate. When you have unprotected sex, his sperm will enter your cervix, uterus and fallopian tubes where it will wait for up to 3 days for the egg to be released when you ovulate. After a few days the sperm will just die. If your egg does not get fertilized within a few hours of ovulation, it will also just die.

Ovulation takes only 15 minutes from start to finish. Even though your egg will start to prepare and mature three months before it actually gets released at ovulation, the process where it breaks out of your ovaries takes only 15 minutes.

If the egg released at ovulation does get fertilized, it will float slowly down the fallopian tube (while it grows from 1 cell to 16 cells) to the uterus where it will attempt to implant into your uterus wall between 10 to 12 days after ovulation. Your uterus wall will prepare for implantation from the moment you ovulate by growing thick with blood and oxygen. Once your egg gets fertilized, it starts to give off the hCG hormone (also called the pregnancy hormone). This is the hormone that will give you a positive pregnancy test, make your breasts sore and sensitive, and prevent your uterus from shedding its lining (so, no more menstruation).

If the egg does start to implant and you should menstruate, the pregnancy will abort as the uterus lining is needed to support the implanting egg until the umbilical cord forms to feed the fetus. This does happen more often that women know. About half of all fertilized egg will be aborted like this. It is called a ‘chemical’ pregnancy. It happens because there is something wrong with the DNA in the fertilized egg. If these eggs implants and grow, it will be a hugely deformed and will endanger the mother’s health and life. So this is a way of your body to protect itself. This defective egg will die about 18 to 22 days after you ovulated, and then you will have a late and light menstruation. (TMI WARNING: You can normally see the aborted egg on your pad if you look for it. It is a small white/grey sphere.)

If the egg does not get fertilized, it dies within a few hours of being released at ovulation. 14 days later it will be expelled from your body, together with your menstrual flow.

Menstruation is when this uterus lining that grew rich with nutrients for 14 days to enable it to support a fertilized egg that wanted to implant in it, breaks down, disintegrates and gets expelled from your uterus as menstrual flow. This is why you feel crappy, get cramps, feel bloated and emotional, crave certain foods, and get dull hair and oily bad skin (PMS) when you have your period. This disintegration of the enriched lining is quite traumatic for your uterus and your body will shut down the manufacture of all the hormones that make you feel good, healthy, pretty and horny. Your menstruation will happen 14 days after ovulation.

This whole cycle is under control of your hormones that are very fickle at best. The slightest physical or psychological disturbance can change this balance and cause a weird cycle with delayed or early menstruation. Typical causes are:

· Stress and worry

· Bad sleep

· Poor nutrition

· Health problems

· Travel across time zones

· Poor health

· Medicines like antibiotics

· Low body weight or low body fat

· Sudden weight loss

· Strenuous exercises

· Super fitness

· Sexually transmitted infections

When implantation takes place, you can have light spotting for up to 2 days. This is just very light bleeding or spotting, not a period as you know it. It happens because the fertilized egg punctures the enriched uterus lining when it implants thus releasing some of the blood in the lining.

So if you look at all of this, it is very unlikely that you will have bleeding 6 days after unprotected sex because of pregnancy. This is at the most optimistic 4 days too early but more likely between 6 and 8 days too early for implantation bleeding. This is just how things work. The egg cannot get fertilized, move down and implant in 6 days.

So in short, you get pregnant from semen ejaculated into your vagina before you ovulate. Once you ovulate, it will take 14 days before you menstruate. If the egg got fertilized, you will not menstruate but you may see up to two days of light spotting from 10 to 12 days after ovulation. If the egg got fertilized but your body rejected it, you will have light menstruation 18 to 22 days after ovulation.

Of course I do not know what happened:

· When was your last period?

· When did you have sex after your period?

· When did you get your next unexplained period?

· How regular are your cycles?

· How long is a typical cycle for you?

If you still think you can be pregnant, you can take a pregnancy test from about 17 days after you had unprotected sex. The best kit to use is the ‘FIRST RESPONSE Early Result Pregnancy Test’ http://www.firstresponse.com/earlyPregTest.asp (not the digital one). Read the instructions and follow it. Use the first pee of the morning and repeat the test 7 days later to confirm the results.

The last thing we need to discuss is the fact that you gambled with your future and had unprotected sex. This is a very definite NO NO. You should protect yourself with at the very least having him put on a condom. This will protect you from sexually transmitted diseases and pregnancy. I do not care how well you know the guy. If you do not know every girl he had sex with and that they are healthy, you are endangering your own health. The best and safest method is to use birth control pills and condoms. That way you are guaranteed to protect yourself from pregnancy and nasty infections and have a double protection.


I had sex one day before my period. Am I pregnant?

Let me explain how your monthly cycle works then you can understand why it is very unlikely that sex a day before your could have gotten you pregnant.

Your cycle have 4 phases:

Menstruation – Between 2 and 7 days. The uterus lining disintegrates when there is not a fertilized egg that implanted. It is excreted through the cervix and vagina as menstrual flow. It starts slow, picks up volume quickly and then slows down to a trickle over the next few days. Towards the you’re your flow can turn brown and clotty. Menstruation starts when flow comes from your vulva, not the light spotting which sometimes precedes it. Sore breasts, bloating, headaches and cramps can precede menstruation (called pre-menstrual stress or PMS). During menstruation, you can also experience cramps as the uterus lining dissolves.

Follicular Phase – The next follicle in one of your ovaries starts to mature. This follicle would have started getting active 3 months before. Each month the other side’s ovary releases the egg. This phase differs in length depending on the length of your cycle.

Ovulation – The follicle begins to burst open and release the egg. This process takes 15 minutes. Some women will feel a slight pain in the ovary releasing the egg (ovulation pain) for the 15 minutes it takes. The egg will start to move down the fallopian tube, being pushed along by the hair like cillae in the fallopian tubes. This is a slow process taking between 6 and 10 days. Sperm that got ejaculated into the woman’s vagina in the last 3 days and swam up the cervix, uterus and fallopian tube will wait for the egg close to the ovaries. As soon as the egg is released, they will try to penetrate the outer shell of the egg to fertilize it. If this does not happen within 6 to 10 hours after the egg is released, the egg will just die. Once the egg is fertilized, it will start to secrete hCL hormone. This is the pregnancy hormone that will give the woman her first pregnancy signs and make the pregnancy test come out positive.

A few days before ovulation your cervix starts to get lower in your vagina, it goes softer and it opens up a bit. The cervical mucus turns from dry to sticky to creamy to clear, wet raw egg white like stretchy clear mucus. This is to allow the sperm easy entrance into the cervix and uterus. Your hormones will make you feel good and look good, shiny hair and eyes. You will become horny and your taste in men will become for rugged manly bad boys and men with perfectly symmetrical features. Your clitoris will become slightly engorged with blood and stay that way until after ovulation.

Luteal Phase (LP) – After ovulation, the uterus lining (endometrium) starts to thicken with blood, nutrients and oxygen. This prepares the uterus to accept and support a fertilized egg. Your vagina and cervical mucus will dry up, indicating that you are no longer fertile. LP is 14 days long on average, irrespective of the total cycle length. 95% ov all women will ovulate between 12 and 16 days before their next menstruation. The vast majority of woman ovulates 14 days before their next period. This time is constant for a woman – if LP is 12 days, it will always be 12 days – Menstruation and FP will fluctuate with the cycle length, not LP.

If the fertilized egg reaches the uterus after a journey of 8 to 10 days from ovulation, the fertilized egg will start to drill into the enriched uterus wall. Here it will attach, be fed by the uterus lining until it forms a placenta and are fed by the mom. About 10 to 12 days after ovulation, the mom may experience some pain and light spotting when the egg punctures the uterus lining (implantation bleeding and pain). This spotting is a few days before the expected menstruation and can last for a day or two. It is very light. Sometimes the fertilized egg will be rejected by the mom’s body a few days later. This happens because the egg is not healthy and has genetic problems. This is called a chemical pregnancy. The signs of a chemical pregnancy are that the mom can get a positive pregnancy test result followed by negative test results. Her period is also delayed by a few days and then it is abnormally short and light. She might notice the aborted egg on her pad. It is round and grayish white. When the egg successfully implants in the uterus, it signals the body to stop menstruating. If the woman does menstruate after this, the egg will be aborted with the uterus lining. If the egg did not get fertilized or failed to implant, menstruation will start again.

As soon as the pregnancy hormone hCL is concentrated enough, a pregnancy test will pick it up, your breasts will start to hurt and your nipples will start to darken. This can be as early as 8 days past ovulation to about 7 days after your next missed period. Use a good quality test kit like First Response Early Results (not the digital one). Read and follow the instructions, use the first pee of the day. Use the second test in the box seven days later to test again and confirm the first result.

So in summary:

  • A cycle between 21 and 35 days are considered normal with an average of 28 days.
  • Menstruation between 2 and 7 days long are normal
  • An LP phase of between 12 and 16 days with an average of 14 days are normal for 95% of all women
  • Sperm will survive about 3 days inside you after ejaculation
  • If you get your period, you are not pregnant

Now you know why the day before your period was too close to your period for you to have been fertile. Even if he ejaculated right inside your vagina, you could not get pregnant from it. And you had your period after that.

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