STAYING SEXUALLY HEALTHY

Sexually Transmitted Infections STIs

Sexually transmitted infections (STIs) are infections that are spread through sexual contact. It is important to get tested regularly for STIs if you are sexually active. If left untreated, STIs can cause serious health issues. Listed below are common STIs along with their symptoms and treatments. If you are experiencing any unusual symptoms or think you may have an STI, please schedule an appointment.

What is a menstrual cycle?

A menstrual cycle is defined from the first day of menstrual bleeding (called day 1) of one menstrual period to the first day of the next menstrual cycle. An average menstrual cycle lasts 28 days. In a normal menstrual cycle, an ovary releases an egg (ovulation). In an average menstrual cycle of 28 days, ovulation occurs about 14 days before the start of the next menstrual period. When can I become pregnant? After its release, an egg can survive in the fallopian tube for about 24 hours. You can become pregnant if you have sex anywhere from 5 days before ovulation until 1 day after ovulation. Your chance of pregnancy is highest if live sperm is already present when the egg arrives in the fallopian tube. A man’s sperm can survive inside a woman’s body for about 3 days (and sometimes up to 5 days) after sexual intercourse.
What are the different types of fertility awareness-based methods?

The following methods are based on fertility awareness: The fertile window Cervical mucous method Basal body temperature (BBT) method Ovulation testing
When is the fertile window?

The 'fertile window’ is the days in a woman’s menstrual cycle when pregnancy is possible. The ‘fertile window’ depends on the length of the menstrual cycle, which varies among women. The ‘fertile window’ is the day an egg is released from the ovary (ovulation) and the five days beforehand. Having sex (intercourse) every day or every other day during this time gives you the best chance of getting pregnant. When you know your average menstrual cycle length, you can work out when you ovulate and your fertile window. Ovulation happens about 14 days before your period starts. If your average menstrual cycle is 28 days, you ovulate around day 14, then your fertile window is from day 9 to day 15 If your average menstrual cycle is 35 days ovulation happens around day 21 and your fertile window is from day 16 to day 22 Some women have very irregular cycles or find it difficult to work out an average cycle length. This can make it hard to work out when ovulation happens. If it’s all too hard, having sex every 2-3 days covers all bases and improves your chance of getting pregnant.
What is the cervical mucous method?

A few days before ovulation, you may notice your vaginal mucus becomes clear, slick and slippery, and feels a bit like egg white. This is a sign that ovulation is about to happen. It’s the best time to have sex, as sperm travel more easily in this kind of mucus. What is the basal body temperature method? The BBT is your body’s temperature when you are fully at rest. Your BBT rises after ovulation and remains high until the end of the menstrual cycle. BBT by itself is not a good way to prevent or promote pregnancy. It shows only when ovulation has already occurred, not when it is going to occur.
What is ovulation testing?

You can use a predictor kit from a pharmacy to test your urine for signs of ovulation. It detects the “LH surge” which is the signal the brain sends to the ovary for releasing an egg. If you start testing your urine a few days before the day you next expect to ovulate, a positive result means you are going to ovulate within the next 24 to 36 hours (one to two days). You should have sex the day you test positive and the next day.
Glossary

Basal Body Temperature (BBT): The temperature of the body at rest. Cervix: The lower, narrow end of the uterus at the top of the vagina. Egg: The female reproductive cell made in and released from the ovaries. Also called the ovum. Fallopian Tube: Tube through which an egg travels from the ovary to the uterus. Fertility Awareness: A collection of ways to track a woman’s natural body functioning and determine when she is most likely to get pregnant. Menstrual Cycle: The monthly process of changes that occur to prepare a woman’s body for possible pregnancy. Ovary: Organ in women that contains the eggs necessary to get pregnant and makes important hormones, such as estrogen, progesterone, and testosterone. Ovulation: The time when an ovary releases an egg. Sexual Intercourse: The act of the penis of the male entering the vagina of the female. Also called "having sex" or "making love."
The genetics of Breast and Gynecologic Cancers

The genes most commonly affected in hereditary breast and ovarian cancer are the breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) genes. About 3% of breast cancers (about 7,500 women per year) and 10% of ovarian cancers (about 2,000 women per year) result from inherited mutations in the BRCA1 and BRCA2 genes. Normally, the BRCA1 and BRCA2 genes protect you from getting certain cancers. But some mutations in the BRCA1 and BRCA2 genes prevent them from working properly, so that if you inherit one of these mutations, you are more likely to get breast, ovarian, and other cancers. However, not everyone who inherits a BRCA1 or BRCA2 mutation will get breast or ovarian cancer. Everyone has two copies of the BRCA1 and BRCA2 genes, one copy inherited from their mother and one from their father. Even if a person inherits a BRCA1 or BRCA2 mutation from one parent, they still have the normal copy of the BRCA1 or BRCA2 gene from the other parent. Cancer occurs when a second mutation happens that affects the normal copy of the gene, so that the person no longer has a BRCA1 or BRCA2 gene that works properly. Unlike the inherited BRCA1 or BRCA2 mutation, the second mutation would not be present throughout the person’s body, but would only be present in the cancer tissue. Breast and ovarian cancer can also be caused by inherited mutations in genes other than BRCA1 and BRCA2. This means that in some families with a history of breast and ovarian cancer, family members will not have mutations in BRCA1 or BRCA2, but can have mutations in one of these other genes. These mutations might be identified through genetic testing using multigene panels, which look for mutations in several different genes at the same time. You and your family members are more likely to have a BRCA1 or BRCA2 mutation if your family has a strong history of breast or ovarian cancer. Family members who inherit BRCA1 and BRCA2 mutations usually share the same mutation. If one of your family members has a known BRCA1 or BRCA2 mutation, other family members who get genetic testing should be checked for that mutation. If you are concerned that you could have a BRCA1, BRCA2, or other mutation related to breast and ovarian cancer, the first step is to collect your family health history of breast and ovarian cancer and share this information with your doctor. Breast cancer screening means checking a woman’s breasts for cancer before there are signs or symptoms of the disease. All women need to be informed by their health care provider about the best screening options for them. When you are told about the benefits and risks of screening and decide with your health care provider whether screening is right for you—and if so, when to have it—this is called informed and shared decision-making. Although breast cancer screening cannot prevent breast cancer, it can help find breast cancer early, when it is easier to treat. Talk to your doctor about which breast cancer screening tests are right for you, and when you should have them.
Breast Cancer Screening Tests

MAMMOGRAM A mammogram is an X-ray of the breast. For many women, mammograms are the best way to find breast cancer early, when it is easier to treat and before it is big enough to feel or cause symptoms. Having regular mammograms can lower the risk of dying from breast cancer. At this time, a mammogram is the best way to find breast cancer for most women of screening age. What do mammograms show? Mammograms can often show abnormal areas in the breast. They can’t tell for sure if an abnormal area is cancer, but they can help health care providers decide if more testing (such as a breast biopsy) is needed. The main types of breast changes found with a mammogram are: Calcifications Masses Asymmetries Distortions What are three-dimensional (3D) mammograms? Three-dimensional (3D) mammography is also known as breast tomosynthesis or digital breast tomosynthesis (DBT). As with a standard (2D) mammogram, each breast is compressed from two different angles (once from top to bottom and once from side to side) while x-rays are taken. But for a 3D mammogram, the machine takes many low- dose x-rays as it moves in a small arc around the breast. A computer then puts the images together into a series of thin slices. This allows doctors to see the breast tissues more clearly in three dimensions. (A standard two- dimensional [2D] mammogram can be taken at the same time, or it can be reconstructed from the 3D mammogram images.) Many studies have found that 3D mammography appears to lower the chance of being called back for follow-up testing after screening. It also appears to find more breast cancers, and several studies have shown it can be helpful in women with dense breasts. A large study is now in progress to better compare outcomes between 3D mammograms and standard (2D) mammograms. For more on 3D mammograms, see American Cancer Society Recommendations for the Early Detection of Breast Cancer. Are mammograms safe? Mammograms expose the breasts to small amounts of radiation. But the benefits of mammography outweigh any possible harm from the radiation exposure. Modern machines use low radiation doses to get breast x-rays that are high in image quality. On average the total dose for a typical mammogram with 2 views of each breast is about 0.4 millisieverts, or mSv. (A mSv is a measure of radiation dose.) The radiation dose from 3D mammograms can range from slightly lower to slightly higher than that from standard 2D mammograms. To put these doses into perspective, people in the US are normally exposed to an average of about 3 mSv of radiation each year just from their natural surroundings. (This is called background radiation.) The dose of radiation used for a screening mammogram of both breasts is about the same amount of radiation a woman would get from her natural surroundings over about 7 weeks. If there’s any chance you might be pregnant, let your health care provider and x-ray technologist know. Although the risk to the fetus is very small, and mammograms are generally thought to be safe during pregnancy, screening mammograms aren’t routinely done in pregnant women who aren't at increased risk for breast cancer.
Breast Magnetic Resonance Imaging (MRI)

A breast MRI uses magnets and radio waves to take pictures of the breast. Breast MRI is used along with mammograms to screen women who are at high risk for getting breast cancer. Because breast MRIs may appear abnormal even when there is no cancer, they are not used for women at average risk.
Breast Ultrasound

Breast ultrasound uses sound waves and their echoes to make computer pictures of the inside of the breast. It can show certain breast changes, like fluid-filled cysts, that can be harder to see on mammograms. It can help your healthcare provider find breast problems. It also lets your healthcare provider see how well blood is flowing to areas in your breasts.
Thermography

Thermography, also called thermal imaging, uses a special camera to measure the temperature of the skin on the breast’s surface. Thermography is based on two ideas: Because cancer cells are growing and multiplying very fast, blood flow and metabolism are higher in a cancer tumor. As blood flow and metabolism increase, skin temperature goes up. Thermography has been available for several decades, but there is no evidence to show that it’s a good screening tool to detect breast cancer early, when the cancer is most treatable. On Feb. 25, 2019, the U.S. Food and Drug Administration (FDA) put out a safety communication telling people that thermography is not a substitute for a mammogram. “There is no valid scientific data to demonstrate that thermography devices, when used on their own or with another diagnostic test, are an effective screening tool for any medical condition including the early detection of breast cancer or other diseases and health conditions,” the FDA said. “Mammography (taking X-ray pictures of the breasts) is the most effective breast cancer screening method and the only method proven to increase the chance of survival through earlier detection.” Researchers are developing and testing new versions of thermography that someday may improve the test’s accuracy and usefulness. This information is provided by Breastcancer.org.
Other Exams

Clinical Breast Exam A clinical breast exam is an examination by a doctor or nurse, who uses his or her hands to feel for lumps or other changes. Breast Self-Awareness Being familiar with how your breasts look and feel can help you notice symptoms such as lumps, pain, or changes in size that may be of concern. These could include changes found during a breast self-exam. You should report any changes that you notice to your doctor or health care provider. Having a clinical breast exam or doing a breast self-exam has not been found to lower the risk of dying from breast cancer.
What is menopause?

Menopause is the natural transition in a woman's life that marks the end of her reproductive years. Typically between the ages of 45 and 55, a woman’s ovaries stop producing hormones and she stops having menstrual periods.
What are the signs and symptoms of menopause?

Estrogen is used by many parts of a woman’s body. As levels of estrogen decrease, you could have various symptoms. Many women experience mild symptoms that can be treated by lifestyle changes such as avoiding caffeine or carrying a portable fan. Some women don’t require any treatment at all, but for others, symptoms can be more severe. The severity of symptoms varies greatly around the world and by race and ethnicity. Change in your Period This might be what you notice first. Your periods may no longer be regular. They may be shorter or last longer. You might bleed more or less than usual. These are all normal changes, but to make sure there isn’t a problem, see your doctor if: Your periods happen very close together, less than 21 days You have heavy bleeding. You have spotting. Your periods last more than a week. Your periods resume after no bleeding for more than a year. Hot Flashes Many women have hot flashes, which can last for many years after menopause. They may be related to changing estrogen levels. A hot flash is a sudden feeling of heat in the upper part or all of your body. Your face and neck may become flushed. Red blotches may appear on your chest, back, and arms. Heavy sweating and cold shivering can follow. Hot flashes can be very mild or strong enough to wake you up (called night sweats). Most hot flashes last between 30 seconds and 10 minutes. They can happen several times an hour, a few times a day, or just once or twice a week. Hot Flashes: What can I do? Sleep Problems The years of the menopausal transition are often a time when there are other changes in a woman’s life. You may be caring for aging parents, supporting children as they move into adulthood, taking on more responsibilities at work, and reflecting on your own life journey. Add symptoms of menopause on top of all this, and you may find yourself having trouble sleeping at night. Hot flashes, especially night sweats, and changes in mood — depression in particular — can contribute to poor sleep. Managing these issues may help to manage sleep symptoms as well. Some women who have trouble sleeping may use over-the-counter sleep aids such as Melatonin or Doxylamine. Others use prescription medications to help them sleep, which may help when used for a short time. But these are not a cure for sleep disturbances, such as insomnia, and should not be used long term. Sleep Problems: What Can I Do? What is melatonin and how does it work? Melatonin is a hormone that your brain produces in response to darkness. It helps with the timing of your circadian rhythms (24-hour internal clock) and with sleep. Being exposed to light at night can block melatonin production. Research suggests that melatonin plays other important roles in the body beyond sleep. However, these effects are not fully understood. Melatonin dietary supplements can be made from animals or microorganisms, but most often they’re made synthetically. The information below is about melatonin dietary supplements. Not getting enough sleep can affect all areas of life. Mood changes You might feel moodier or more irritable around the time of menopause. Scientists don’t know why this happens. It’s possible that stress, family changes such as growing children or aging parents, a history of depression, or feeling tired could be causing these mood changes. Talk with your primary care provider or a mental health professional about what you’re experiencing. There are treatments available to help. Your body seems different Your waist could get larger. You could lose muscle and gain fat. Your skin could become thinner. You might have memory problems, and your joints and muscles could feel stiff and achy. Researchers are exploring such changes and how they relate to hormones and growing older. In addition, for some women, symptoms may include aches and pains, headaches and heart palpitations. Follow up with a doctor. Because menopausal symptoms may be caused by changing hormone levels, it is unpredictable how often women will experience symptoms and how severe they will be. Vaginal health and sexuality After menopause, the vagina may become drier, which can make sexual intercourse uncomfortable. Read about options for addressing vaginal pain during sex in Sex and Menopause: Treatment for Symptoms. You may also find that your feelings about sex are changing. You could be less interested, or you could feel freer and sexier because after one full year without a period, you can no longer become pregnant. However, you could still be at risk for sexually transmitted diseases (STDs). Your risk for an STD increases if you have sex with more than one person or with someone who has sex with others. If so, make sure your partner uses a condom each time you have sex.
Sex and Menopause: Treatment for Symptoms

Some women have vaginal dryness with menopause. This can make sex painful. Women may also experience a tightening of the vaginal opening, burning, itching, and dryness (called vaginal atrophy). Fortunately, there are options for women to address these issues. Talk with your provider at Redefined For Her to discuss treatment options. Sex is becoming painful: What can I do? Pain during sexual activity is called dyspareunia. Like other symptoms of the menopausal transition, dyspareunia may be minor and not greatly affect a woman’s quality of life. However, some women experience severe dyspareunia that prevents them from engaging in any sexual activity without pain. Many find relief from vaginal dryness during sex by using a nonprescription water-based lubricant; however, silicone based lubricants can offer longer lasting lubrication. Other women try over-the-counter vaginal moisturizers or natural oils like coconut oil or olive olive oil, which are used regularly and not just during sex to replenish moisture and relieve dryness. Local vaginal treatments (such as estrogen creams, rings, or tablets) are often used to treat this symptom. These treatments provide lower hormone doses to the rest of the body than a pill or patch. The U.S. Food and Drug Administration has approved two nonhormone medications, called ospemifene and prasterone, to treat moderate to severe dyspareunia caused by vaginal changes that occur with menopause. For more information on sex and menopause Office on Women's Health Department of Health and Human Services 800-994-9662 www.womenshealth.gov American College of Obstetricians and Gynecologists 800-673-8444 resources@acog.org www.acog.org North American Menopause Society 440-442-7550 info@menopause.org www.menopause.org Services & Advocacy for Gay, Lesbian, Bisexual & Transgender Elders (SAGE) 212-741-2247 info@sageusa.org www.sageusa.org Sexuality Information and Education Council of the United States 202-265-2405 www.siecus.org
Hormone Therapy: Is it right for you?

Hormone therapy was once routinely used to treat menopausal symptoms and protect long-term health. Then large clinical trials showed health risks. What does this mean for you? -Adapted from By Mayo Clinic Staff Hormone replacement therapy is medication that contains female hormones. You take the medication to replace the estrogen that your body stops making during menopause. Hormone therapy is most often used to treat common menopausal symptoms, including hot flashes and vaginal discomfort. Hormone therapy has also been proved to prevent bone loss and reduce fracture in postmenopausal women. However, there are risks associated with using hormone therapy. These risks depend on the type of hormone therapy, the dose, how long the medication is taken and your individual health risks. For best results, hormone therapy should be tailored to each person and reevaluated every so often to be sure the benefits still outweigh the risks. What are the basic types of hormone therapy? Hormone replacement therapy primarily focuses on replacing the estrogen that your body no longer makes after menopause. There are two main types of estrogen therapy: Systemic Hormone Therapy Systemic estrogen — which comes in pill, skin patch, ring, gel, cream or spray form — typically contains a higher dose of estrogen that is absorbed throughout the body. It can be used to treat any of the common symptoms of menopause. Low-dose vaginal products Low-dose vaginal preparations of estrogen — which come in cream, tablet or ring form — minimize the amount of estrogen absorbed by the body. Because of this, low-dose vaginal preparations are usually only used to treat the vaginal and urinary symptoms of menopause. If you haven't had your uterus removed, your doctor will typically prescribe estrogen along with progesterone or progestin (progesterone-like medication). This is because estrogen alone, when not balanced by progesterone, can stimulate growth of the lining of the uterus, increasing the risk of endometrial cancer. If you have had your uterus removed (hysterectomy), you may not need to take progestin What are the risks of hormone therapy? In the largest clinical trial to date, hormone replacement therapy that consisted of an estrogen-progestin pill (Prempro) increased the risk of certain serious conditions, including: Heart disease Stroke Blood clots Breast cancer Subsequent studies have suggested that these risks vary depending on: Age. Women who begin hormone therapy at age 60 or older or more than 10 years from the onset of menopause are at greater risk of the above conditions. But if hormone therapy is started before the age of 60 or within 10 years of menopause, the benefits appear to outweigh the risks. Type of hormone therapy. The risks of hormone therapy vary depending on whether estrogen is given alone or with progestin, and on the dose and type of estrogen. Health history. Your family history and your personal medical history and risk of cancer, heart disease, stroke, blood clots, liver disease and osteoporosis are important factors in determining whether hormone replacement therapy is appropriate for you. All of these risks should be considered by you and your provider when deciding whether hormone therapy might be an option for you. Who can benefit from hormone therapy? The benefits of hormone therapy may outweigh the risks if you're healthy and you: Have moderate to severe hot flashes. Systemic estrogen therapy remains the most effective treatment for the relief of troublesome menopausal hot flashes and night sweats. Have other symptoms of menopause. Estrogen can ease vaginal symptoms of menopause, such as dryness, itching, burning and discomfort with intercourse. Need to prevent bone loss or fractures. Systemic estrogen helps protect against the bone-thinning disease called osteoporosis. However, a medication category called bisphosphonates, is the usual first medication recommended to treat osteoporosis. But estrogen therapy may help if you either can't tolerate or aren't benefiting from other treatments. Experience early menopause or have estrogen deficiency. If you had your ovaries surgically removed before age 45, stopped having periods before age 45 (premature or early menopause) or lost normal function of your ovaries before age 40 (primary ovarian insufficiency), your body has been exposed to less estrogen than the bodies of women who experience typical menopause. Estrogen therapy can help decrease your risk of certain health conditions, including osteoporosis, heart disease, stroke, dementia and mood changes. If you take hormone therapy, how can you reduce risk? Talk to your provider about these strategies: Find the best product and delivery method for you. You can take estrogen in the form of a pill, patch, gel, vaginal cream, or slow-releasing suppository or ring that you place in your vagina. If you experience only vaginal symptoms related to menopause, estrogen in a low-dose vaginal cream, tablet or ring is usually a better choice than an oral pill or a skin patch. Minimize the amount of medication you take. Use the lowest effective dose for the shortest amount of time needed to treat your symptoms. If you're younger than age 45, you need enough estrogen to provide protection against the long-term health effects of estrogen deficiency. If you have lasting menopausal symptoms that significantly impair your quality of life, your doctor may recommend longer term treatment. Seek regular follow-up care. See your provider regularly to ensure that the benefits of hormone therapy continue to outweigh the risks, and for screenings such as mammograms and pelvic exams. Make healthy lifestyle choices. Include physical activity and exercise in your daily routine, eat a healthy diet, maintain a healthy weight, don't smoke, limit alcohol, manage stress, and manage chronic health conditions, such as high cholesterol or high blood pressure. If you haven't had a hysterectomy and are using systemic estrogen therapy, you'll also need progestin. Your provider can help you find the delivery method that offers the most benefits and convenience with the least risks and cost. What can you do if you can't take hormone therapy? You may be able to manage menopausal hot flashes with healthy-lifestyle approaches such as keeping cool, limiting caffeinated beverages and alcohol, and practicing paced relaxed breathing or other relaxation techniques. There are also several nonhormone prescription medications that may help relieve hot flashes. For vaginal concerns such as dryness or painful intercourse, a vaginal moisturizer or lubricant may provide relief. You might also ask your provider about the prescription medication ospemifene (Osphena), which may help with episodes of painful intercourse. The bottom line: Hormone therapy isn't all good or all bad To determine if hormone therapy is a good treatment option for you, talk to us about your individual symptoms and health risks. Be sure to keep the conversation going throughout your menopausal years. As researchers learn more about hormone therapy and other menopausal treatments, recommendations may change. If you continue to have othersome menopausal symptoms, review treatment options with your doctor on a regular basis.
Osteoporosis

Osteoporosis causes bones to become weak and brittle — so brittle that a fall or even mild stresses such as bending over or coughing can cause a fracture. Osteoporosis-related fractures most commonly occur in the hip, wrist or spine. Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn't keep up with the loss of old bone. Osteoporosis affects men and women of all races. But white and Asian women, especially older women who are past menopause, are at highest risk. Medications, healthy diet and weight-bearing exercise can help prevent bone loss or strengthen already weak bones. Symptoms There typically are no symptoms in the early stages of bone loss. But once your bones have been weakened by osteoporosis, you might have signs and symptoms that include: Back pain, caused by a fractured or collapsed vertebra Loss of height over time A stooped posture A bone that breaks much more easily than expected When to see a provider Talk to your provider at Redefined for Her about osteoporosis if you went through early menopause or took corticosteroids for several months at a time, or if either of your parents had hip fractures.
Bone Health and Dexa Scans

Bone Density Scan (DEXA Scan) DEXA (dual x-ray absorptiometry) scans measure bone density (thickness and strength of bones) by passing a high and low energy x-ray beam (a form of ionizing radiation) through the body, usually in the hip and the spine. This procedure is important for diagnosing (seeing if someone has) osteoporosis or bone thinning and may be repeated over time to track changes in bone density. The amount of radiation used in DEXA scans is very low and similar to the amount of radiation used in common x-rays. Although we all are exposed to ionizing radiation every day from the natural environment, added exposures can slightly increase the risk of developing cancer later in life. What You Should Know Your healthcare provider may recommend a DEXA scan to test for osteoporosis or thinning of your bones. Screening for osteoporosis is recommended for women who are 65 years old or older and for women who are 50 to 64 and have certain risk factors, such as having a parent who has broken a hip. However, there are other risk factors for osteoporosis besides age and gender, such as some intestinal disorders, multiple sclerosis, or low body weight. Your healthcare provider may recommend a DEXA scan if you have any of these other risk factors. DEXA scans should be used when the health benefits outweigh the risks. Talk to your healthcare provider about any concerns you have before a DEXA scan. Nearly 1in 5 women and 1 in 20 men over the age of 50 are affected by osteoporosis. Osteoporosis increases the risk for broken bones and can have serious effects in older adults. What To Expect Before the scan Make sure to let your healthcare provider or radiologist (medical professional specially trained in radiation procedures) if you are pregnant or think you may or could be pregnant. Dress in loose, comfortable clothing. Don’t wear anything that has metal on it like buckles, buttons, or zippers. Metal can interfere with test results. Find information on special considerations pregnant women and children. During the scan You may be asked to remove jewelry, eyeglasses, and any clothing that may interfere with the imaging. You will lay on a table and the radiologist or medical assistant will position your legs on a padded box. They also may place your foot in a device so that your hip is turned inward. While the image is taken, lay still and follow instructions. You may need to hold your breath for a few seconds After the scan The procedure typically lasts about 15-20 minutes. Your healthcare provider will follow up with you with your results. They will show a T-score and a Z-score. The T-score shows how your bone density compares to the optimal peak bone density for your gender. The Z-score shows how your bone density compares to the bone densities of others who are the same age, gender, and ethnicity. Benefits and Risks of DEXA Scans DEXA scans are different from other imaging procedures because they are used to screen for a specific condition. Benefits: Detects weak or brittle bones to help predict the odds of a future fracture Determines if bone density is improving, worsening, or staying the same Can help you and your healthcare provider come up with plans to improve your bone strength and prevent worsening conditions Risks: A very slight increase in possibility of future cancer, similar to the risks from x-rays.
Intra-Uterine Device

Levonorgestrel intrauterine system (LNG IUD)—The LNG IUD is a small T-shaped device like the Copper T IUD. It is placed inside the uterus by a doctor. It releases a small amount of progestin each day to keep you from getting pregnant. The LNG IUD stays in your uterus for up to 3 to 6 years, depending on the device. Typical use failure rate: 0.1-0.4%. Copper T intrauterine device (IUD)—This IUD is a small device that is shaped in the form of a “T.” Your doctor places it inside the uterus to prevent pregnancy. It can stay in your uterus for up to 10 years. Typical use failure rate: 0.8%.
Hormonal Methods

Implant— The implant is a single, thin rod that is inserted under the skin of a women’s upper arm. The rod contains a progestin that is released into the body over 3 years. Typical use failure rate 0.1% Injection or "shot"— Women get shots of the hormone progestin in the buttocks or arm every three months from their doctor. Typical use failure rate: 4%. Combined oral contraceptives— Also called “the pill,” combined oral contraceptives contain the hormones estrogen and progestin. It is prescribed by a doctor. A pill is taken at the same time each day. If you are older than 35 years and smoke, have a history of blood clots or breast cancer, your doctor may advise you not to take the pill. Typical use failure rate: 7%. Progestin only pill— Unlike the combined pill, the progestin-only pill (sometimes called the mini-pill) only has one hormone, progestin, instead of both estrogen and progestin. It is prescribed by a doctor. It is taken at the same time each day. It may be a good option for women who can’t take estrogen. Typical use failure rate: 7%. Patch— This skin patch is worn on the lower abdomen, buttocks, or upper body (but not on the breasts). This method is prescribed by a doctor. It releases hormones progestin and estrogen into the bloodstream. You put on a new patch once a week for three weeks. During the fourth week, you do not wear a patch, so you can have a menstrual period. Typical use failure rate: 7%. Hormonal vaginal contraceptive ring— The ring releases the hormones progestin and estrogen. You place the ring inside your vagina. You wear the ring for three weeks, take it out for the week you have your period, and then put in a new ring. Typical use failure rate: 7%.
Barrier Methods

Diaphragm or cervical cap— Each of these barrier methods are placed inside the vagina to cover the cervix to block sperm. The diaphragm is shaped like a shallow cup. The cervical cap is a thimble-shaped cup. Before sexual intercourse, you insert them with spermicide to block or kill sperm. Visit your doctor for a proper fitting because diaphragms and cervical caps come in different sizes. Typical use failure rate for the diaphragm: 17%. Sponge— The contraceptive sponge contains spermicide and is placed in the vagina where it fits over the cervix. The sponge works for up to 24 hours, and must be left in the vagina for at least 6 hours after the last act of intercourse, at which time it is removed and discarded. Typical use failure rate: 14% for women who have never had a baby and 27% for women who have had a baby. Male Condom— Worn by the man, a male condom keeps sperm from getting into a woman’s body. Latex condoms, the most common type, help prevent pregnancy, HIV and other STDs, as do the newer synthetic condoms. “Natural” or “lambskin” condoms also help prevent pregnancy, but may not provide protection against STDs, including HIV. Typical use failure rate: 13%.Condoms can only be used once. You can buy condoms, KY jelly, or water-based lubricants at a drug store. Do not use oil-based lubricants such as massage oils, baby oil, lotions, or petroleum jelly with latex condoms. They will weaken the condom, causing it to tear or break. Female Condom— Worn by the woman, the female condom helps keeps sperm from getting into her body. It is packaged with a lubricant and is available at drug stores. It can be inserted up to eight hours before sexual intercourse. Typical use failure rate: 21%, and also may help prevent STDs. Spermicides— These products work by killing sperm and come in several forms—foam, gel, cream, film, suppository, or tablet. They are placed in the vagina no more than one hour before intercourse. You leave them in place at least six to eight hours after intercourse. You can use a spermicide in addition to a male condom, diaphragm, or cervical cap. They can be purchased at drug stores. Typical use failure rate: 21%.
Fertility Awareness-Based Methods

Fertility awareness- based methods— Understanding your monthly fertility pattern can help you plan to get pregnant or avoid getting pregnant. Your fertility pattern is the number of days in the month when you are fertile (able to get pregnant), days when you are infertile, and days when fertility is unlikely, but possible. If you have a regular menstrual cycle, you have about nine or more fertile days each month. If you do not want to get pregnant, you do not have sex on the days you are fertile, or you use a barrier method of birth control on those days. Failure rates vary across these methods. Range of typical use failure rates: 2-23%.
Lactational Amenorrhea Method

For women who have recently had a baby and are breastfeeding, the Lactational Amenorrhea Method (LAM) can be used as birth control when three conditions are met: amenorrhea (not having any menstrual periods after delivering a baby) fully or nearly fully breastfeeding, and less than 6 months after delivering a baby. LAM is a temporary method of birth control, and another birth control method must be used when any of the three conditions are not met.
Emergency Contraception

Emergency contraception is NOT a regular method of birth control. Emergency contraception can be used after no birth control was used during sex, or if the birth control method failed, such as if a condom broke. Copper IUD— Women can have the copper T IUD inserted within five days of unprotected sex. Emergency contraceptive pills— Women can take emergency contraceptive pills up to 5 days after unprotected sex, but the sooner the pills are taken, the better they will work. There are three different types of emergency contraceptive pills available in the United States. Some emergency contraceptive pills are available over the counter.
Permanent Methods of Birth Control

Femail Sterilization—Implant Tubal ligation or "tying tubes"— A woman can have her fallopian tubes tied (or closed) so that sperm and eggs cannot meet for fertilization. The procedure can be done in a hospital or in an outpatient surgical center. You can go home the same day of the surgery and resume your normal activities within a few days. This method is effective immediately. Typical use failure rate: 0.5%. Male Sterilization-Vasectomy— This operation is done to keep a man’s sperm from going to his penis, so his ejaculate never has any sperm in it that can fertilize an egg. The procedure is typically done at an outpatient surgical center. The man can go home the same day. Recovery time is less than one week. After the operation, a man visits his doctor for tests to count his sperm and to make sure the sperm count has dropped to zero; this takes about 12 weeks. Another form of birth control should be used until the man’s sperm count has dropped to zero. Typical use failure rate: 0.15%.
Hysterectomy

A hysterectomy is defined as removal of a woman’s uterus (womb). This surgical procedure is done for many reasons that include uterine fibroids or abnormal uterine bleeding, not responsive to medical treatment, cancer and chronic pelvic pain. This procedure can be done using an open abdominal incision, through the vagina or, in a minimally invasive fashion by laparoscopy. Types of hysterectomies include a: total abdominal hysterectomy, laparoscopically assisted vaginal hysterectomy, total laparoscopically hysterectomy (with and without robot assistance), supra-cervical hysterectomy (the cervix remains in place but the top of the uterus is removed) and total vaginal hysterectomy. In recent years, it is customary to remove both fallopian tubes when a hysterectomy is performed. A separate procedure that involves removing one or both of the ovaries may also be performed at the time of a hysterectomy depending on the circumstances.
Laparoscopy

Laparoscopy is a minimally invasive surgical procedure. It is characterized this way because the abdominal incisions in this procedure are much smaller than an open abdominal incision. A special camera and instruments are passed through these small opening in order to visualize the pelvic organs and perform the intended surgery. This approach to surgery, when possible, decreases hospital stay, post operative pain and decreases the time for recovery.
Myomectomy

Myomectomy is a surgery that removes fibroids from the uterus, while leaving the uterus in place. This can be done through an open abdominal incision, by laparoscopy using the assistance of a robot and with hysteroscopy.
Hysteroscopy

Hysteroscopy is done with a tool called a hysteroscope that allows the surgeon to look inside of the uterus through the vagina. The hysteroscope, contains a light, that enables visualization of the uterine cavity. This is often done to evaluate and treat abnormal uterine bleeding by removing fibroids, polyps, scar tissue and to perform endometrial ablations.
Ovarian Cystectomy (removal of cyst(s) on ovary)

This is a procedure done using laparoscopy and occasionally laparotomy (an open abdominal incision) depending on the size and type of cyst.
Oophorectomy

There are times when ovaries become diseased or need to be removed for other reasons and they typically may be removed using the laparoscopic approach.
Lysis of Adhesions

There are certain conditions that may cause a patient to develop adhesions or scar tissue within their pelvis. Adhesions cause pelvic surfaces to stick to each other and can cause pain and dysfunction. This may occur with previous surgeries, pelvic infections or endometriosis. Laparoscopy may be used to remove adhesions, restore function and minimize or relieve associated pain.
Pelvis Prolapse Surgery

It is estimated that up to 50% of women between the age of 50-79 have some degree of pelvic prolapse or pelvic relaxation on physical exam. Not all of these women are symptomatic but for those that are the options of pelvic floor physical therapy, pessary and surgery are available. Symptoms may include bowel or bladder function problems, discomfort with intercourse and pelvic pain.
Sterilization

Removal of the fallopian tubes or the sealing of them are surgical ways that a person who no longer wants to bear children can obtain permanent sterilization.
Loop Electrosurgical Excision Procedure (LEEP)

The loop electrosurgical excision procedure (LEEP) is an outpatient procedure used to remove cells and tissue from the cervix as a means of diagnosing or treating abnormal or cancerous cells.
How common is infertility?

In the United States, among heterosexual women aged 15 to 49 years with no prior births, about 1 in 5 (19%) are unable to get pregnant after one year of trying (infertility). Both men and women can contribute to infertility.
What causes infertility?

Disruption of ovarian function (presence or absence of ovulation) When a woman doesn’t ovulate during a menstrual cycle, it’s called anovulation. Potential causes of anovulation include the following: Polycystic ovary syndrome (PCOS). PCOS is a condition that causes women to not ovulate, or to ovulate irregularly. Some women with PCOS have elevated levels of testosterone, which can cause acne and excess hair growth. PCOS is the most common cause of female infertility. Diminished ovarian reserve (DOR). Women are born with all of the eggs that they will ever have, and the number of eggs declines naturally over time. DOR is a condition in which there are fewer eggs remaining in the ovaries than expected for a given age. It may occur due to congenital (condition present at birth), medical, surgical, or unexplained causes. Women with DOR may be able to conceive naturally, but will produce fewer eggs in response to fertility treatments. Premature ovarian insufficiency (POI). POI, sometimes referred to as premature menopause, occurs when a woman’s ovaries fail before she is 40 years of age. Although certain exposures, such as chemotherapy or pelvic radiation therapy, and certain medical conditions may cause POI, the cause is often unexplained. About 5% to 10% of women with POI conceive naturally and have a normal pregnancy. Menopause is a natural decline in ovarian function that usually occurs around age 50. By definition, a woman in menopause has not had a period for at least one year. Many women experience hot flashes, mood changes, difficulty sleeping, and other symptoms as well. Fallopian tube obstruction (whether fallopian tubes are open, blocked or swollen) Risk factors for blocked fallopian tubes (Tubal occlusion) can include a history of pelvic infection, rupture appendix, gonorrhea, chlamydia, endometriosis, or prior abdominal surgery. Physical characteristics of the uterus Depending on a woman’s symptoms, the uterus may be evaluated by transvaginal ultrasound to look for fibroids or other problems, including intrauterine adhesions, endometrial polyps, adenomyosis, and congenital anomalies of the uterus. A sonohysterogram or hysteroscopy may also be performed to further evaluate the uterine environment. Disruption of testicular or ejaculatory function Varicocele, a condition in which the veins within a man’s testicle are enlarged. This can affect the number or shape of the sperm. Trauma to the testes may affect sperm production and result in lower number of sperm. Heavy alcohol use, smoking, anabolic steroid use, and illicit drug use. Cancer treatment involving certain types of chemotherapy, radiation, or surgery to remove one or both testicles. Medical conditions such as diabetes, cystic fibrosis, certain types of autoimmune disorders, and certain types of infections may cause testicular failure. Hormonal Disorders Improper function of the hypothalamus or pituitary glands. The hypothalamus and pituitary glands in the brain produce hormones that maintain normal ovulation and testicular function. Genetic Disorders Click to take genetic testing quiz
How long should couples try to get pregnant before seeing a doctor?

Most experts suggest women younger than age 35 with no apparent health or fertility problems and regular menstrual cycles should try to conceive for at least one year before seeing a doctor. However, for women aged 35 years or older, couples should see a health care provider after 6 months of trying unsuccessfully. Women over 40 years may consider seeking more immediate evaluation and treatment. Some health problems also increase the risk of infertility. So, couples with the following signs or symptoms should not delay seeing their health care provider when they are trying to become pregnant: For women: Irregular periods or no menstrual periods Endometriosis A history of pelvic inflammatory disease Known or suspected uterine or tubal disease A history of more than one miscarriage Genetic or acquired conditions that predispose to diminished ovarian reserve (chemotherapy, radiation) For men: A history of testicular trauma Prior hernia surgery Prior use of chemotherapy A history of infertility with another partner Sexual dysfunction
How will doctors know if a woman and her partner have fertility problems?

Doctors will begin by collecting medical and sexual history from both partners. The initial evaluation may include a semen analysis, ovulation testing, and tubal evaluation.
How do doctors treat infertility?

Infertility can be treated with medicine, surgery, intrauterine insemination, or assisted reproductive technology. Often, medication and intrauterine insemination are used at the same time. Doctors recommend specific treatments for infertility on the basis of: The factors contributing to infertility. The duration of infertility. The age of the female. The couple’s treatment preference after counseling about success rates, risks, and benefits of each treatment option.
What medicines are used to treat women with infertility?

There are two situations in which fertility drugs may be useful. First, these drugs can be used to induce an egg to develop and be released in women who are not ovulating on their own. This is known as ovulation induction. Fertility drugs can also be used to increase the chances of pregnancy in women who are already ovulating. This is known as superovulation. Some common medicines used to treat infertility in women include: Clomiphene citrate, sold under the trade name Clomid, is a medicine that causes ovulation by acting on the pituitary gland. This medicine is taken by mouth Letrozole, sold under the trade name Femara, is a medication that has been widely used in women with breast cancer. Letrozole belongs to a class of medications known as aromatase inhibitors. Aromatase is an enzyme that is responsible for the production of estrogen in the body. Letrozole works by inhibiting aromatase thereby suppressing estrogen production which causes the brain to naturally make more follicle-stimulating hormone (FSH). This medicine is taken by mouth Human menopausal gonadotropin (hMG) is an injectable medication often used for women who don’t ovulate because of problems with their pituitary gland—hMG acts directly on the ovaries to stimulate development of mature eggs. Follicle-stimulating hormone or FSH is an injectable medication that works much like hMG. It stimulates development of mature eggs within the ovaries. Metformin, sold under the trade name Glucophage, is a medicine doctors use for women who have insulin resistance or diabetes and PCOS. This drug helps lower the high levels of insulin in women with these conditions. This helps the body to ovulate. This medicine is taken by mouth. Bromocriptine is a medication used for women with ovulation problems because of high levels of prolactin. These medications are taken by mouth.
What is intrauterine insemination (IUI)?

Intrauterine insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, specially prepared sperm are inserted into the woman’s uterus. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI. IUI is often used to treat: Mild male factor infertility. Couples with unexplained infertility.
What is Assisted Reproductive Technology (ART)?

Assisted Reproductive Technology (ART) includes all fertility treatments in which either eggs or embryos are handled outside of the body. In general, ART procedures involve removing mature eggs from a woman’s ovaries using a needle, combining the eggs with sperm in the laboratory, and returning the embryos to the woman’s body or donating them to another woman. The main type of ART is in vitro fertilization (IVF).
Fertility treatment offered at RFH

Bullet ovulation induction Tubal surgery: Robotic removal of uterine fibroids (myomectomy) Robotic resection of endometriosis IUI with partner sperm IUI with donor sperm Sperm wash (coming soon)

Low Sex Drive In Women

Overview
Women's sexual desires naturally fluctuate over the years. Highs and lows commonly coincide with the beginning or end of a relationship or with major life changes, such as pregnancy, menopause or illness. Some medications used for mood disorders also can cause low sex drive in women.

If your lack of interest in sex continues or returns and causes personal distress, you may have a condition called sexual interest/arousal disorder.

But you don't have to meet this medical definition to seek help. If you're bothered by a low sex drive or decreased sex drive, there are lifestyle changes and sexual techniques that may put you in the mood more often. Some medications may offer promise as well.

Symptoms
If you want to have sex less often than your partner does, neither one of you is
necessarily outside the norm for people at your stage in life — although your
differences may cause distress.

Similarly, even if your sex drive is weaker than it once was, your relationship may be stronger than ever. Bottom line: There is no magic number to define low sex drive. It varies among women.

Symptoms of low sex drive in women include:

Having no interest in any type of sexual activity, including masturbation Never or only seldom having sexual fantasies or thoughts
Being concerned by your lack of sexual activity or fantasies

When to see a doctor

If you're concerned by your low desire for sex, talk to your doctor. The solution could
be as simple as changing a medication you are taking and improving any chronic
medical conditions such as high blood pressure or diabetes.

Causes
Desire for sex is based on a complex interaction of many things affecting intimacy,
including physical and emotional well-being, experiences, beliefs, lifestyle, and your
current relationship. If you're experiencing a problem in any of these areas, it can affect your desire for sex.

Physical causes
A wide range of illnesses, physical changes and medications can cause a low sex drive, including:

Sexual problems. If you have pain during sex or can't orgasm, it can reduce your desire for sex.
Medical diseases. Many nonsexual diseases can affect sex drive, including arthritis, cancer, diabetes, high blood pressure, coronary artery disease and neurological diseases.
Medications. Certain prescription drugs, especially antidepressants called selective serotonin reuptake inhibitors, are known to lower the sex drive.
Lifestyle habits. A glass of wine may put you in the mood, but too much alcohol can affect your sex drive. The same is true of street drugs. Also, smoking decreases blood flow, which may dull arousal.
Surgery. Any surgery related to your breasts or genital tract can affect your body image, sexual function and desire for sex.
Fatigue. Exhaustion from caring for young children or aging parents can contribute to low sex drive. Fatigue from illness or surgery also can play a role in a low sex drive.

Hormone changes
Changes in your hormone levels may alter your desire for sex. This can occur during:

Menopause. Estrogen levels drop during the transition to menopause. This can make you less interested in sex and cause dry vaginal tissues, resulting in painful or uncomfortable sex. Although many women still have satisfying sex during menopause and beyond, some experience a lagging libido during this hormonal change.
Pregnancy and breast-feeding. Hormone changes during pregnancy, just after having a baby and during breast-feeding can put a damper on sex drive. Fatigue, changes in body image, and the pressures of pregnancy or caring for a new baby also can contribute to changes in your sexual desire.

Psychological causes
Your state of mind can affect your sexual desire. There are many psychological causes of low sex drive, including:

Mental health problems, such as anxiety or depression Stress, such as financial stress or work stress, poor body image, low self-esteem.
History of physical or sexual abuse Previous negative sexual experiences

Relationship issues

For many women, emotional closeness is an essential prelude to sexual intimacy.
Problems in your relationship can be a major factor in low sex drive. Decreased interest in sex is often a result of ongoing issues, such as:

Lack of connection with your partner
Unresolved conflicts or fights
Poor communication of sexual needs and preferences.
Trust issues

Contraception

BIRTH CONTROL METHODS

Many elements need to be considered by women, men, or couples at any given point in their lifetimes when choosing the most appropriate contraceptive method. These elements include safety, effectiveness, availability (including accessibility and affordability), and acceptability. Voluntary informed choice of contraceptive methods is an essential guiding principle, and contraceptive counseling, when applicable, might be an important contributor to the successful use of contraceptive methods.

In choosing a method of contraception, dual protection with condoms from the simultaneous risk for HIV and other STDs also should be considered. Although hormonal contraceptives and IUDs are highly effective at preventing pregnancy, they do not protect against STDs, including HIV. Consistent and correct use of the male latex condom reduces the risk for HIV infection and other STDs, including chlamydial infection, gonococcal infection, and trichomoniasis.

What is a menstrual cycle?

A menstrual cycle is defined from the first day of menstrual bleeding (called day 1) of one menstrual period to the first day of the next menstrual cycle. An average menstrual cycle lasts 28 days. In a normal menstrual cycle, an ovary releases an egg (ovulation). In an average menstrual cycle of 28 days, ovulation occurs about 14 days before the start of the next menstrual period. When can I become pregnant? After its release, an egg can survive in the fallopian tube for about 24 hours. You can become pregnant if you have sex anywhere from 5 days before ovulation until 1 day after ovulation. Your chance of pregnancy is highest if live sperm is already present when the egg arrives in the fallopian tube. A man’s sperm can survive inside a woman’s body for about 3 days (and sometimes up to 5 days) after sexual intercourse.
What are the different types of fertility awareness-based methods?

The following methods are based on fertility awareness: The fertile window Cervical mucous method Basal body temperature (BBT) method Ovulation testing
When is the fertile window?

The 'fertile window’ is the days in a woman’s menstrual cycle when pregnancy is possible. The ‘fertile window’ depends on the length of the menstrual cycle, which varies among women. The ‘fertile window’ is the day an egg is released from the ovary (ovulation) and the five days beforehand. Having sex (intercourse) every day or every other day during this time gives you the best chance of getting pregnant. When you know your average menstrual cycle length, you can work out when you ovulate and your fertile window. Ovulation happens about 14 days before your period starts. If your average menstrual cycle is 28 days, you ovulate around day 14, then your fertile window is from day 9 to day 15 If your average menstrual cycle is 35 days ovulation happens around day 21 and your fertile window is from day 16 to day 22 Some women have very irregular cycles or find it difficult to work out an average cycle length. This can make it hard to work out when ovulation happens. If it’s all too hard, having sex every 2-3 days covers all bases and improves your chance of getting pregnant.
What is the cervical mucous method?

A few days before ovulation, you may notice your vaginal mucus becomes clear, slick and slippery, and feels a bit like egg white. This is a sign that ovulation is about to happen. It’s the best time to have sex, as sperm travel more easily in this kind of mucus. What is the basal body temperature method? The BBT is your body’s temperature when you are fully at rest. Your BBT rises after ovulation and remains high until the end of the menstrual cycle. BBT by itself is not a good way to prevent or promote pregnancy. It shows only when ovulation has already occurred, not when it is going to occur.
What is ovulation testing?

You can use a predictor kit from a pharmacy to test your urine for signs of ovulation. It detects the “LH surge” which is the signal the brain sends to the ovary for releasing an egg. If you start testing your urine a few days before the day you next expect to ovulate, a positive result means you are going to ovulate within the next 24 to 36 hours (one to two days). You should have sex the day you test positive and the next day.
Glossary

Basal Body Temperature (BBT): The temperature of the body at rest. Cervix: The lower, narrow end of the uterus at the top of the vagina. Egg: The female reproductive cell made in and released from the ovaries. Also called the ovum. Fallopian Tube: Tube through which an egg travels from the ovary to the uterus. Fertility Awareness: A collection of ways to track a woman’s natural body functioning and determine when she is most likely to get pregnant. Menstrual Cycle: The monthly process of changes that occur to prepare a woman’s body for possible pregnancy. Ovary: Organ in women that contains the eggs necessary to get pregnant and makes important hormones, such as estrogen, progesterone, and testosterone. Ovulation: The time when an ovary releases an egg. Sexual Intercourse: The act of the penis of the male entering the vagina of the female. Also called "having sex" or "making love."
The genetics of Breast and Gynecologic Cancers

The genes most commonly affected in hereditary breast and ovarian cancer are the breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) genes. About 3% of breast cancers (about 7,500 women per year) and 10% of ovarian cancers (about 2,000 women per year) result from inherited mutations in the BRCA1 and BRCA2 genes. Normally, the BRCA1 and BRCA2 genes protect you from getting certain cancers. But some mutations in the BRCA1 and BRCA2 genes prevent them from working properly, so that if you inherit one of these mutations, you are more likely to get breast, ovarian, and other cancers. However, not everyone who inherits a BRCA1 or BRCA2 mutation will get breast or ovarian cancer. Everyone has two copies of the BRCA1 and BRCA2 genes, one copy inherited from their mother and one from their father. Even if a person inherits a BRCA1 or BRCA2 mutation from one parent, they still have the normal copy of the BRCA1 or BRCA2 gene from the other parent. Cancer occurs when a second mutation happens that affects the normal copy of the gene, so that the person no longer has a BRCA1 or BRCA2 gene that works properly. Unlike the inherited BRCA1 or BRCA2 mutation, the second mutation would not be present throughout the person’s body, but would only be present in the cancer tissue. Breast and ovarian cancer can also be caused by inherited mutations in genes other than BRCA1 and BRCA2. This means that in some families with a history of breast and ovarian cancer, family members will not have mutations in BRCA1 or BRCA2, but can have mutations in one of these other genes. These mutations might be identified through genetic testing using multigene panels, which look for mutations in several different genes at the same time. You and your family members are more likely to have a BRCA1 or BRCA2 mutation if your family has a strong history of breast or ovarian cancer. Family members who inherit BRCA1 and BRCA2 mutations usually share the same mutation. If one of your family members has a known BRCA1 or BRCA2 mutation, other family members who get genetic testing should be checked for that mutation. If you are concerned that you could have a BRCA1, BRCA2, or other mutation related to breast and ovarian cancer, the first step is to collect your family health history of breast and ovarian cancer and share this information with your doctor. Breast cancer screening means checking a woman’s breasts for cancer before there are signs or symptoms of the disease. All women need to be informed by their health care provider about the best screening options for them. When you are told about the benefits and risks of screening and decide with your health care provider whether screening is right for you—and if so, when to have it—this is called informed and shared decision-making. Although breast cancer screening cannot prevent breast cancer, it can help find breast cancer early, when it is easier to treat. Talk to your doctor about which breast cancer screening tests are right for you, and when you should have them.
Breast Cancer Screening Tests

MAMMOGRAM A mammogram is an X-ray of the breast. For many women, mammograms are the best way to find breast cancer early, when it is easier to treat and before it is big enough to feel or cause symptoms. Having regular mammograms can lower the risk of dying from breast cancer. At this time, a mammogram is the best way to find breast cancer for most women of screening age. What do mammograms show? Mammograms can often show abnormal areas in the breast. They can’t tell for sure if an abnormal area is cancer, but they can help health care providers decide if more testing (such as a breast biopsy) is needed. The main types of breast changes found with a mammogram are: Calcifications Masses Asymmetries Distortions What are three-dimensional (3D) mammograms? Three-dimensional (3D) mammography is also known as breast tomosynthesis or digital breast tomosynthesis (DBT). As with a standard (2D) mammogram, each breast is compressed from two different angles (once from top to bottom and once from side to side) while x-rays are taken. But for a 3D mammogram, the machine takes many low- dose x-rays as it moves in a small arc around the breast. A computer then puts the images together into a series of thin slices. This allows doctors to see the breast tissues more clearly in three dimensions. (A standard two- dimensional [2D] mammogram can be taken at the same time, or it can be reconstructed from the 3D mammogram images.) Many studies have found that 3D mammography appears to lower the chance of being called back for follow-up testing after screening. It also appears to find more breast cancers, and several studies have shown it can be helpful in women with dense breasts. A large study is now in progress to better compare outcomes between 3D mammograms and standard (2D) mammograms. For more on 3D mammograms, see American Cancer Society Recommendations for the Early Detection of Breast Cancer. Are mammograms safe? Mammograms expose the breasts to small amounts of radiation. But the benefits of mammography outweigh any possible harm from the radiation exposure. Modern machines use low radiation doses to get breast x-rays that are high in image quality. On average the total dose for a typical mammogram with 2 views of each breast is about 0.4 millisieverts, or mSv. (A mSv is a measure of radiation dose.) The radiation dose from 3D mammograms can range from slightly lower to slightly higher than that from standard 2D mammograms. To put these doses into perspective, people in the US are normally exposed to an average of about 3 mSv of radiation each year just from their natural surroundings. (This is called background radiation.) The dose of radiation used for a screening mammogram of both breasts is about the same amount of radiation a woman would get from her natural surroundings over about 7 weeks. If there’s any chance you might be pregnant, let your health care provider and x-ray technologist know. Although the risk to the fetus is very small, and mammograms are generally thought to be safe during pregnancy, screening mammograms aren’t routinely done in pregnant women who aren't at increased risk for breast cancer.
Breast Magnetic Resonance Imaging (MRI)

A breast MRI uses magnets and radio waves to take pictures of the breast. Breast MRI is used along with mammograms to screen women who are at high risk for getting breast cancer. Because breast MRIs may appear abnormal even when there is no cancer, they are not used for women at average risk.
Breast Ultrasound

Breast ultrasound uses sound waves and their echoes to make computer pictures of the inside of the breast. It can show certain breast changes, like fluid-filled cysts, that can be harder to see on mammograms. It can help your healthcare provider find breast problems. It also lets your healthcare provider see how well blood is flowing to areas in your breasts.
Thermography

Thermography, also called thermal imaging, uses a special camera to measure the temperature of the skin on the breast’s surface. Thermography is based on two ideas: Because cancer cells are growing and multiplying very fast, blood flow and metabolism are higher in a cancer tumor. As blood flow and metabolism increase, skin temperature goes up. Thermography has been available for several decades, but there is no evidence to show that it’s a good screening tool to detect breast cancer early, when the cancer is most treatable. On Feb. 25, 2019, the U.S. Food and Drug Administration (FDA) put out a safety communication telling people that thermography is not a substitute for a mammogram. “There is no valid scientific data to demonstrate that thermography devices, when used on their own or with another diagnostic test, are an effective screening tool for any medical condition including the early detection of breast cancer or other diseases and health conditions,” the FDA said. “Mammography (taking X-ray pictures of the breasts) is the most effective breast cancer screening method and the only method proven to increase the chance of survival through earlier detection.” Researchers are developing and testing new versions of thermography that someday may improve the test’s accuracy and usefulness. This information is provided by Breastcancer.org.
Other Exams

Clinical Breast Exam A clinical breast exam is an examination by a doctor or nurse, who uses his or her hands to feel for lumps or other changes. Breast Self-Awareness Being familiar with how your breasts look and feel can help you notice symptoms such as lumps, pain, or changes in size that may be of concern. These could include changes found during a breast self-exam. You should report any changes that you notice to your doctor or health care provider. Having a clinical breast exam or doing a breast self-exam has not been found to lower the risk of dying from breast cancer.
What is menopause?

Menopause is the natural transition in a woman's life that marks the end of her reproductive years. Typically between the ages of 45 and 55, a woman’s ovaries stop producing hormones and she stops having menstrual periods.
What are the signs and symptoms of menopause?

Estrogen is used by many parts of a woman’s body. As levels of estrogen decrease, you could have various symptoms. Many women experience mild symptoms that can be treated by lifestyle changes such as avoiding caffeine or carrying a portable fan. Some women don’t require any treatment at all, but for others, symptoms can be more severe. The severity of symptoms varies greatly around the world and by race and ethnicity. Change in your Period This might be what you notice first. Your periods may no longer be regular. They may be shorter or last longer. You might bleed more or less than usual. These are all normal changes, but to make sure there isn’t a problem, see your doctor if: Your periods happen very close together, less than 21 days You have heavy bleeding. You have spotting. Your periods last more than a week. Your periods resume after no bleeding for more than a year. Hot Flashes Many women have hot flashes, which can last for many years after menopause. They may be related to changing estrogen levels. A hot flash is a sudden feeling of heat in the upper part or all of your body. Your face and neck may become flushed. Red blotches may appear on your chest, back, and arms. Heavy sweating and cold shivering can follow. Hot flashes can be very mild or strong enough to wake you up (called night sweats). Most hot flashes last between 30 seconds and 10 minutes. They can happen several times an hour, a few times a day, or just once or twice a week. Hot Flashes: What can I do? Sleep Problems The years of the menopausal transition are often a time when there are other changes in a woman’s life. You may be caring for aging parents, supporting children as they move into adulthood, taking on more responsibilities at work, and reflecting on your own life journey. Add symptoms of menopause on top of all this, and you may find yourself having trouble sleeping at night. Hot flashes, especially night sweats, and changes in mood — depression in particular — can contribute to poor sleep. Managing these issues may help to manage sleep symptoms as well. Some women who have trouble sleeping may use over-the-counter sleep aids such as Melatonin or Doxylamine. Others use prescription medications to help them sleep, which may help when used for a short time. But these are not a cure for sleep disturbances, such as insomnia, and should not be used long term. Sleep Problems: What Can I Do? What is melatonin and how does it work? Melatonin is a hormone that your brain produces in response to darkness. It helps with the timing of your circadian rhythms (24-hour internal clock) and with sleep. Being exposed to light at night can block melatonin production. Research suggests that melatonin plays other important roles in the body beyond sleep. However, these effects are not fully understood. Melatonin dietary supplements can be made from animals or microorganisms, but most often they’re made synthetically. The information below is about melatonin dietary supplements. Not getting enough sleep can affect all areas of life. Mood changes You might feel moodier or more irritable around the time of menopause. Scientists don’t know why this happens. It’s possible that stress, family changes such as growing children or aging parents, a history of depression, or feeling tired could be causing these mood changes. Talk with your primary care provider or a mental health professional about what you’re experiencing. There are treatments available to help. Your body seems different Your waist could get larger. You could lose muscle and gain fat. Your skin could become thinner. You might have memory problems, and your joints and muscles could feel stiff and achy. Researchers are exploring such changes and how they relate to hormones and growing older. In addition, for some women, symptoms may include aches and pains, headaches and heart palpitations. Follow up with a doctor. Because menopausal symptoms may be caused by changing hormone levels, it is unpredictable how often women will experience symptoms and how severe they will be. Vaginal health and sexuality After menopause, the vagina may become drier, which can make sexual intercourse uncomfortable. Read about options for addressing vaginal pain during sex in Sex and Menopause: Treatment for Symptoms. You may also find that your feelings about sex are changing. You could be less interested, or you could feel freer and sexier because after one full year without a period, you can no longer become pregnant. However, you could still be at risk for sexually transmitted diseases (STDs). Your risk for an STD increases if you have sex with more than one person or with someone who has sex with others. If so, make sure your partner uses a condom each time you have sex.
Sex and Menopause: Treatment for Symptoms

Some women have vaginal dryness with menopause. This can make sex painful. Women may also experience a tightening of the vaginal opening, burning, itching, and dryness (called vaginal atrophy). Fortunately, there are options for women to address these issues. Talk with your provider at Redefined For Her to discuss treatment options. Sex is becoming painful: What can I do? Pain during sexual activity is called dyspareunia. Like other symptoms of the menopausal transition, dyspareunia may be minor and not greatly affect a woman’s quality of life. However, some women experience severe dyspareunia that prevents them from engaging in any sexual activity without pain. Many find relief from vaginal dryness during sex by using a nonprescription water-based lubricant; however, silicone based lubricants can offer longer lasting lubrication. Other women try over-the-counter vaginal moisturizers or natural oils like coconut oil or olive olive oil, which are used regularly and not just during sex to replenish moisture and relieve dryness. Local vaginal treatments (such as estrogen creams, rings, or tablets) are often used to treat this symptom. These treatments provide lower hormone doses to the rest of the body than a pill or patch. The U.S. Food and Drug Administration has approved two nonhormone medications, called ospemifene and prasterone, to treat moderate to severe dyspareunia caused by vaginal changes that occur with menopause. For more information on sex and menopause Office on Women's Health Department of Health and Human Services 800-994-9662 www.womenshealth.gov American College of Obstetricians and Gynecologists 800-673-8444 resources@acog.org www.acog.org North American Menopause Society 440-442-7550 info@menopause.org www.menopause.org Services & Advocacy for Gay, Lesbian, Bisexual & Transgender Elders (SAGE) 212-741-2247 info@sageusa.org www.sageusa.org Sexuality Information and Education Council of the United States 202-265-2405 www.siecus.org
Hormone Therapy: Is it right for you?

Hormone therapy was once routinely used to treat menopausal symptoms and protect long-term health. Then large clinical trials showed health risks. What does this mean for you? -Adapted from By Mayo Clinic Staff Hormone replacement therapy is medication that contains female hormones. You take the medication to replace the estrogen that your body stops making during menopause. Hormone therapy is most often used to treat common menopausal symptoms, including hot flashes and vaginal discomfort. Hormone therapy has also been proved to prevent bone loss and reduce fracture in postmenopausal women. However, there are risks associated with using hormone therapy. These risks depend on the type of hormone therapy, the dose, how long the medication is taken and your individual health risks. For best results, hormone therapy should be tailored to each person and reevaluated every so often to be sure the benefits still outweigh the risks. What are the basic types of hormone therapy? Hormone replacement therapy primarily focuses on replacing the estrogen that your body no longer makes after menopause. There are two main types of estrogen therapy: Systemic Hormone Therapy Systemic estrogen — which comes in pill, skin patch, ring, gel, cream or spray form — typically contains a higher dose of estrogen that is absorbed throughout the body. It can be used to treat any of the common symptoms of menopause. Low-dose vaginal products Low-dose vaginal preparations of estrogen — which come in cream, tablet or ring form — minimize the amount of estrogen absorbed by the body. Because of this, low-dose vaginal preparations are usually only used to treat the vaginal and urinary symptoms of menopause. If you haven't had your uterus removed, your doctor will typically prescribe estrogen along with progesterone or progestin (progesterone-like medication). This is because estrogen alone, when not balanced by progesterone, can stimulate growth of the lining of the uterus, increasing the risk of endometrial cancer. If you have had your uterus removed (hysterectomy), you may not need to take progestin What are the risks of hormone therapy? In the largest clinical trial to date, hormone replacement therapy that consisted of an estrogen-progestin pill (Prempro) increased the risk of certain serious conditions, including: Heart disease Stroke Blood clots Breast cancer Subsequent studies have suggested that these risks vary depending on: Age. Women who begin hormone therapy at age 60 or older or more than 10 years from the onset of menopause are at greater risk of the above conditions. But if hormone therapy is started before the age of 60 or within 10 years of menopause, the benefits appear to outweigh the risks. Type of hormone therapy. The risks of hormone therapy vary depending on whether estrogen is given alone or with progestin, and on the dose and type of estrogen. Health history. Your family history and your personal medical history and risk of cancer, heart disease, stroke, blood clots, liver disease and osteoporosis are important factors in determining whether hormone replacement therapy is appropriate for you. All of these risks should be considered by you and your provider when deciding whether hormone therapy might be an option for you. Who can benefit from hormone therapy? The benefits of hormone therapy may outweigh the risks if you're healthy and you: Have moderate to severe hot flashes. Systemic estrogen therapy remains the most effective treatment for the relief of troublesome menopausal hot flashes and night sweats. Have other symptoms of menopause. Estrogen can ease vaginal symptoms of menopause, such as dryness, itching, burning and discomfort with intercourse. Need to prevent bone loss or fractures. Systemic estrogen helps protect against the bone-thinning disease called osteoporosis. However, a medication category called bisphosphonates, is the usual first medication recommended to treat osteoporosis. But estrogen therapy may help if you either can't tolerate or aren't benefiting from other treatments. Experience early menopause or have estrogen deficiency. If you had your ovaries surgically removed before age 45, stopped having periods before age 45 (premature or early menopause) or lost normal function of your ovaries before age 40 (primary ovarian insufficiency), your body has been exposed to less estrogen than the bodies of women who experience typical menopause. Estrogen therapy can help decrease your risk of certain health conditions, including osteoporosis, heart disease, stroke, dementia and mood changes. If you take hormone therapy, how can you reduce risk? Talk to your provider about these strategies: Find the best product and delivery method for you. You can take estrogen in the form of a pill, patch, gel, vaginal cream, or slow-releasing suppository or ring that you place in your vagina. If you experience only vaginal symptoms related to menopause, estrogen in a low-dose vaginal cream, tablet or ring is usually a better choice than an oral pill or a skin patch. Minimize the amount of medication you take. Use the lowest effective dose for the shortest amount of time needed to treat your symptoms. If you're younger than age 45, you need enough estrogen to provide protection against the long-term health effects of estrogen deficiency. If you have lasting menopausal symptoms that significantly impair your quality of life, your doctor may recommend longer term treatment. Seek regular follow-up care. See your provider regularly to ensure that the benefits of hormone therapy continue to outweigh the risks, and for screenings such as mammograms and pelvic exams. Make healthy lifestyle choices. Include physical activity and exercise in your daily routine, eat a healthy diet, maintain a healthy weight, don't smoke, limit alcohol, manage stress, and manage chronic health conditions, such as high cholesterol or high blood pressure. If you haven't had a hysterectomy and are using systemic estrogen therapy, you'll also need progestin. Your provider can help you find the delivery method that offers the most benefits and convenience with the least risks and cost. What can you do if you can't take hormone therapy? You may be able to manage menopausal hot flashes with healthy-lifestyle approaches such as keeping cool, limiting caffeinated beverages and alcohol, and practicing paced relaxed breathing or other relaxation techniques. There are also several nonhormone prescription medications that may help relieve hot flashes. For vaginal concerns such as dryness or painful intercourse, a vaginal moisturizer or lubricant may provide relief. You might also ask your provider about the prescription medication ospemifene (Osphena), which may help with episodes of painful intercourse. The bottom line: Hormone therapy isn't all good or all bad To determine if hormone therapy is a good treatment option for you, talk to us about your individual symptoms and health risks. Be sure to keep the conversation going throughout your menopausal years. As researchers learn more about hormone therapy and other menopausal treatments, recommendations may change. If you continue to have othersome menopausal symptoms, review treatment options with your doctor on a regular basis.
Osteoporosis

Osteoporosis causes bones to become weak and brittle — so brittle that a fall or even mild stresses such as bending over or coughing can cause a fracture. Osteoporosis-related fractures most commonly occur in the hip, wrist or spine. Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn't keep up with the loss of old bone. Osteoporosis affects men and women of all races. But white and Asian women, especially older women who are past menopause, are at highest risk. Medications, healthy diet and weight-bearing exercise can help prevent bone loss or strengthen already weak bones. Symptoms There typically are no symptoms in the early stages of bone loss. But once your bones have been weakened by osteoporosis, you might have signs and symptoms that include: Back pain, caused by a fractured or collapsed vertebra Loss of height over time A stooped posture A bone that breaks much more easily than expected When to see a provider Talk to your provider at Redefined for Her about osteoporosis if you went through early menopause or took corticosteroids for several months at a time, or if either of your parents had hip fractures.
Bone Health and Dexa Scans

Bone Density Scan (DEXA Scan) DEXA (dual x-ray absorptiometry) scans measure bone density (thickness and strength of bones) by passing a high and low energy x-ray beam (a form of ionizing radiation) through the body, usually in the hip and the spine. This procedure is important for diagnosing (seeing if someone has) osteoporosis or bone thinning and may be repeated over time to track changes in bone density. The amount of radiation used in DEXA scans is very low and similar to the amount of radiation used in common x-rays. Although we all are exposed to ionizing radiation every day from the natural environment, added exposures can slightly increase the risk of developing cancer later in life. What You Should Know Your healthcare provider may recommend a DEXA scan to test for osteoporosis or thinning of your bones. Screening for osteoporosis is recommended for women who are 65 years old or older and for women who are 50 to 64 and have certain risk factors, such as having a parent who has broken a hip. However, there are other risk factors for osteoporosis besides age and gender, such as some intestinal disorders, multiple sclerosis, or low body weight. Your healthcare provider may recommend a DEXA scan if you have any of these other risk factors. DEXA scans should be used when the health benefits outweigh the risks. Talk to your healthcare provider about any concerns you have before a DEXA scan. Nearly 1in 5 women and 1 in 20 men over the age of 50 are affected by osteoporosis. Osteoporosis increases the risk for broken bones and can have serious effects in older adults. What To Expect Before the scan Make sure to let your healthcare provider or radiologist (medical professional specially trained in radiation procedures) if you are pregnant or think you may or could be pregnant. Dress in loose, comfortable clothing. Don’t wear anything that has metal on it like buckles, buttons, or zippers. Metal can interfere with test results. Find information on special considerations pregnant women and children. During the scan You may be asked to remove jewelry, eyeglasses, and any clothing that may interfere with the imaging. You will lay on a table and the radiologist or medical assistant will position your legs on a padded box. They also may place your foot in a device so that your hip is turned inward. While the image is taken, lay still and follow instructions. You may need to hold your breath for a few seconds After the scan The procedure typically lasts about 15-20 minutes. Your healthcare provider will follow up with you with your results. They will show a T-score and a Z-score. The T-score shows how your bone density compares to the optimal peak bone density for your gender. The Z-score shows how your bone density compares to the bone densities of others who are the same age, gender, and ethnicity. Benefits and Risks of DEXA Scans DEXA scans are different from other imaging procedures because they are used to screen for a specific condition. Benefits: Detects weak or brittle bones to help predict the odds of a future fracture Determines if bone density is improving, worsening, or staying the same Can help you and your healthcare provider come up with plans to improve your bone strength and prevent worsening conditions Risks: A very slight increase in possibility of future cancer, similar to the risks from x-rays.
Intra-Uterine Device

Levonorgestrel intrauterine system (LNG IUD)—The LNG IUD is a small T-shaped device like the Copper T IUD. It is placed inside the uterus by a doctor. It releases a small amount of progestin each day to keep you from getting pregnant. The LNG IUD stays in your uterus for up to 3 to 6 years, depending on the device. Typical use failure rate: 0.1-0.4%. Copper T intrauterine device (IUD)—This IUD is a small device that is shaped in the form of a “T.” Your doctor places it inside the uterus to prevent pregnancy. It can stay in your uterus for up to 10 years. Typical use failure rate: 0.8%.
Hormonal Methods

Implant— The implant is a single, thin rod that is inserted under the skin of a women’s upper arm. The rod contains a progestin that is released into the body over 3 years. Typical use failure rate 0.1% Injection or "shot"— Women get shots of the hormone progestin in the buttocks or arm every three months from their doctor. Typical use failure rate: 4%. Combined oral contraceptives— Also called “the pill,” combined oral contraceptives contain the hormones estrogen and progestin. It is prescribed by a doctor. A pill is taken at the same time each day. If you are older than 35 years and smoke, have a history of blood clots or breast cancer, your doctor may advise you not to take the pill. Typical use failure rate: 7%. Progestin only pill— Unlike the combined pill, the progestin-only pill (sometimes called the mini-pill) only has one hormone, progestin, instead of both estrogen and progestin. It is prescribed by a doctor. It is taken at the same time each day. It may be a good option for women who can’t take estrogen. Typical use failure rate: 7%. Patch— This skin patch is worn on the lower abdomen, buttocks, or upper body (but not on the breasts). This method is prescribed by a doctor. It releases hormones progestin and estrogen into the bloodstream. You put on a new patch once a week for three weeks. During the fourth week, you do not wear a patch, so you can have a menstrual period. Typical use failure rate: 7%. Hormonal vaginal contraceptive ring— The ring releases the hormones progestin and estrogen. You place the ring inside your vagina. You wear the ring for three weeks, take it out for the week you have your period, and then put in a new ring. Typical use failure rate: 7%.
Barrier Methods

Diaphragm or cervical cap— Each of these barrier methods are placed inside the vagina to cover the cervix to block sperm. The diaphragm is shaped like a shallow cup. The cervical cap is a thimble-shaped cup. Before sexual intercourse, you insert them with spermicide to block or kill sperm. Visit your doctor for a proper fitting because diaphragms and cervical caps come in different sizes. Typical use failure rate for the diaphragm: 17%. Sponge— The contraceptive sponge contains spermicide and is placed in the vagina where it fits over the cervix. The sponge works for up to 24 hours, and must be left in the vagina for at least 6 hours after the last act of intercourse, at which time it is removed and discarded. Typical use failure rate: 14% for women who have never had a baby and 27% for women who have had a baby. Male Condom— Worn by the man, a male condom keeps sperm from getting into a woman’s body. Latex condoms, the most common type, help prevent pregnancy, HIV and other STDs, as do the newer synthetic condoms. “Natural” or “lambskin” condoms also help prevent pregnancy, but may not provide protection against STDs, including HIV. Typical use failure rate: 13%.Condoms can only be used once. You can buy condoms, KY jelly, or water-based lubricants at a drug store. Do not use oil-based lubricants such as massage oils, baby oil, lotions, or petroleum jelly with latex condoms. They will weaken the condom, causing it to tear or break. Female Condom— Worn by the woman, the female condom helps keeps sperm from getting into her body. It is packaged with a lubricant and is available at drug stores. It can be inserted up to eight hours before sexual intercourse. Typical use failure rate: 21%, and also may help prevent STDs. Spermicides— These products work by killing sperm and come in several forms—foam, gel, cream, film, suppository, or tablet. They are placed in the vagina no more than one hour before intercourse. You leave them in place at least six to eight hours after intercourse. You can use a spermicide in addition to a male condom, diaphragm, or cervical cap. They can be purchased at drug stores. Typical use failure rate: 21%.
Fertility Awareness-Based Methods

Fertility awareness- based methods— Understanding your monthly fertility pattern can help you plan to get pregnant or avoid getting pregnant. Your fertility pattern is the number of days in the month when you are fertile (able to get pregnant), days when you are infertile, and days when fertility is unlikely, but possible. If you have a regular menstrual cycle, you have about nine or more fertile days each month. If you do not want to get pregnant, you do not have sex on the days you are fertile, or you use a barrier method of birth control on those days. Failure rates vary across these methods. Range of typical use failure rates: 2-23%.
Lactational Amenorrhea Method

For women who have recently had a baby and are breastfeeding, the Lactational Amenorrhea Method (LAM) can be used as birth control when three conditions are met: amenorrhea (not having any menstrual periods after delivering a baby) fully or nearly fully breastfeeding, and less than 6 months after delivering a baby. LAM is a temporary method of birth control, and another birth control method must be used when any of the three conditions are not met.
Emergency Contraception

Emergency contraception is NOT a regular method of birth control. Emergency contraception can be used after no birth control was used during sex, or if the birth control method failed, such as if a condom broke. Copper IUD— Women can have the copper T IUD inserted within five days of unprotected sex. Emergency contraceptive pills— Women can take emergency contraceptive pills up to 5 days after unprotected sex, but the sooner the pills are taken, the better they will work. There are three different types of emergency contraceptive pills available in the United States. Some emergency contraceptive pills are available over the counter.
Permanent Methods of Birth Control

Femail Sterilization—Implant Tubal ligation or "tying tubes"— A woman can have her fallopian tubes tied (or closed) so that sperm and eggs cannot meet for fertilization. The procedure can be done in a hospital or in an outpatient surgical center. You can go home the same day of the surgery and resume your normal activities within a few days. This method is effective immediately. Typical use failure rate: 0.5%. Male Sterilization-Vasectomy— This operation is done to keep a man’s sperm from going to his penis, so his ejaculate never has any sperm in it that can fertilize an egg. The procedure is typically done at an outpatient surgical center. The man can go home the same day. Recovery time is less than one week. After the operation, a man visits his doctor for tests to count his sperm and to make sure the sperm count has dropped to zero; this takes about 12 weeks. Another form of birth control should be used until the man’s sperm count has dropped to zero. Typical use failure rate: 0.15%.
Hysterectomy

A hysterectomy is defined as removal of a woman’s uterus (womb). This surgical procedure is done for many reasons that include uterine fibroids or abnormal uterine bleeding, not responsive to medical treatment, cancer and chronic pelvic pain. This procedure can be done using an open abdominal incision, through the vagina or, in a minimally invasive fashion by laparoscopy. Types of hysterectomies include a: total abdominal hysterectomy, laparoscopically assisted vaginal hysterectomy, total laparoscopically hysterectomy (with and without robot assistance), supra-cervical hysterectomy (the cervix remains in place but the top of the uterus is removed) and total vaginal hysterectomy. In recent years, it is customary to remove both fallopian tubes when a hysterectomy is performed. A separate procedure that involves removing one or both of the ovaries may also be performed at the time of a hysterectomy depending on the circumstances.
Laparoscopy

Laparoscopy is a minimally invasive surgical procedure. It is characterized this way because the abdominal incisions in this procedure are much smaller than an open abdominal incision. A special camera and instruments are passed through these small opening in order to visualize the pelvic organs and perform the intended surgery. This approach to surgery, when possible, decreases hospital stay, post operative pain and decreases the time for recovery.
Myomectomy

Myomectomy is a surgery that removes fibroids from the uterus, while leaving the uterus in place. This can be done through an open abdominal incision, by laparoscopy using the assistance of a robot and with hysteroscopy.
Hysteroscopy

Hysteroscopy is done with a tool called a hysteroscope that allows the surgeon to look inside of the uterus through the vagina. The hysteroscope, contains a light, that enables visualization of the uterine cavity. This is often done to evaluate and treat abnormal uterine bleeding by removing fibroids, polyps, scar tissue and to perform endometrial ablations.
Ovarian Cystectomy (removal of cyst(s) on ovary)

This is a procedure done using laparoscopy and occasionally laparotomy (an open abdominal incision) depending on the size and type of cyst.
Oophorectomy

There are times when ovaries become diseased or need to be removed for other reasons and they typically may be removed using the laparoscopic approach.
Lysis of Adhesions

There are certain conditions that may cause a patient to develop adhesions or scar tissue within their pelvis. Adhesions cause pelvic surfaces to stick to each other and can cause pain and dysfunction. This may occur with previous surgeries, pelvic infections or endometriosis. Laparoscopy may be used to remove adhesions, restore function and minimize or relieve associated pain.
Pelvis Prolapse Surgery

It is estimated that up to 50% of women between the age of 50-79 have some degree of pelvic prolapse or pelvic relaxation on physical exam. Not all of these women are symptomatic but for those that are the options of pelvic floor physical therapy, pessary and surgery are available. Symptoms may include bowel or bladder function problems, discomfort with intercourse and pelvic pain.
Sterilization

Removal of the fallopian tubes or the sealing of them are surgical ways that a person who no longer wants to bear children can obtain permanent sterilization.
Loop Electrosurgical Excision Procedure (LEEP)

The loop electrosurgical excision procedure (LEEP) is an outpatient procedure used to remove cells and tissue from the cervix as a means of diagnosing or treating abnormal or cancerous cells.
How common is infertility?

In the United States, among heterosexual women aged 15 to 49 years with no prior births, about 1 in 5 (19%) are unable to get pregnant after one year of trying (infertility). Both men and women can contribute to infertility.
What causes infertility?

Disruption of ovarian function (presence or absence of ovulation) When a woman doesn’t ovulate during a menstrual cycle, it’s called anovulation. Potential causes of anovulation include the following: Polycystic ovary syndrome (PCOS). PCOS is a condition that causes women to not ovulate, or to ovulate irregularly. Some women with PCOS have elevated levels of testosterone, which can cause acne and excess hair growth. PCOS is the most common cause of female infertility. Diminished ovarian reserve (DOR). Women are born with all of the eggs that they will ever have, and the number of eggs declines naturally over time. DOR is a condition in which there are fewer eggs remaining in the ovaries than expected for a given age. It may occur due to congenital (condition present at birth), medical, surgical, or unexplained causes. Women with DOR may be able to conceive naturally, but will produce fewer eggs in response to fertility treatments. Premature ovarian insufficiency (POI). POI, sometimes referred to as premature menopause, occurs when a woman’s ovaries fail before she is 40 years of age. Although certain exposures, such as chemotherapy or pelvic radiation therapy, and certain medical conditions may cause POI, the cause is often unexplained. About 5% to 10% of women with POI conceive naturally and have a normal pregnancy. Menopause is a natural decline in ovarian function that usually occurs around age 50. By definition, a woman in menopause has not had a period for at least one year. Many women experience hot flashes, mood changes, difficulty sleeping, and other symptoms as well. Fallopian tube obstruction (whether fallopian tubes are open, blocked or swollen) Risk factors for blocked fallopian tubes (Tubal occlusion) can include a history of pelvic infection, rupture appendix, gonorrhea, chlamydia, endometriosis, or prior abdominal surgery. Physical characteristics of the uterus Depending on a woman’s symptoms, the uterus may be evaluated by transvaginal ultrasound to look for fibroids or other problems, including intrauterine adhesions, endometrial polyps, adenomyosis, and congenital anomalies of the uterus. A sonohysterogram or hysteroscopy may also be performed to further evaluate the uterine environment. Disruption of testicular or ejaculatory function Varicocele, a condition in which the veins within a man’s testicle are enlarged. This can affect the number or shape of the sperm. Trauma to the testes may affect sperm production and result in lower number of sperm. Heavy alcohol use, smoking, anabolic steroid use, and illicit drug use. Cancer treatment involving certain types of chemotherapy, radiation, or surgery to remove one or both testicles. Medical conditions such as diabetes, cystic fibrosis, certain types of autoimmune disorders, and certain types of infections may cause testicular failure. Hormonal Disorders Improper function of the hypothalamus or pituitary glands. The hypothalamus and pituitary glands in the brain produce hormones that maintain normal ovulation and testicular function. Genetic Disorders Click to take genetic testing quiz
How long should couples try to get pregnant before seeing a doctor?

Most experts suggest women younger than age 35 with no apparent health or fertility problems and regular menstrual cycles should try to conceive for at least one year before seeing a doctor. However, for women aged 35 years or older, couples should see a health care provider after 6 months of trying unsuccessfully. Women over 40 years may consider seeking more immediate evaluation and treatment. Some health problems also increase the risk of infertility. So, couples with the following signs or symptoms should not delay seeing their health care provider when they are trying to become pregnant: For women: Irregular periods or no menstrual periods Endometriosis A history of pelvic inflammatory disease Known or suspected uterine or tubal disease A history of more than one miscarriage Genetic or acquired conditions that predispose to diminished ovarian reserve (chemotherapy, radiation) For men: A history of testicular trauma Prior hernia surgery Prior use of chemotherapy A history of infertility with another partner Sexual dysfunction
How will doctors know if a woman and her partner have fertility problems?

Doctors will begin by collecting medical and sexual history from both partners. The initial evaluation may include a semen analysis, ovulation testing, and tubal evaluation.
How do doctors treat infertility?

Infertility can be treated with medicine, surgery, intrauterine insemination, or assisted reproductive technology. Often, medication and intrauterine insemination are used at the same time. Doctors recommend specific treatments for infertility on the basis of: The factors contributing to infertility. The duration of infertility. The age of the female. The couple’s treatment preference after counseling about success rates, risks, and benefits of each treatment option.
What medicines are used to treat women with infertility?

There are two situations in which fertility drugs may be useful. First, these drugs can be used to induce an egg to develop and be released in women who are not ovulating on their own. This is known as ovulation induction. Fertility drugs can also be used to increase the chances of pregnancy in women who are already ovulating. This is known as superovulation. Some common medicines used to treat infertility in women include: Clomiphene citrate, sold under the trade name Clomid, is a medicine that causes ovulation by acting on the pituitary gland. This medicine is taken by mouth Letrozole, sold under the trade name Femara, is a medication that has been widely used in women with breast cancer. Letrozole belongs to a class of medications known as aromatase inhibitors. Aromatase is an enzyme that is responsible for the production of estrogen in the body. Letrozole works by inhibiting aromatase thereby suppressing estrogen production which causes the brain to naturally make more follicle-stimulating hormone (FSH). This medicine is taken by mouth Human menopausal gonadotropin (hMG) is an injectable medication often used for women who don’t ovulate because of problems with their pituitary gland—hMG acts directly on the ovaries to stimulate development of mature eggs. Follicle-stimulating hormone or FSH is an injectable medication that works much like hMG. It stimulates development of mature eggs within the ovaries. Metformin, sold under the trade name Glucophage, is a medicine doctors use for women who have insulin resistance or diabetes and PCOS. This drug helps lower the high levels of insulin in women with these conditions. This helps the body to ovulate. This medicine is taken by mouth. Bromocriptine is a medication used for women with ovulation problems because of high levels of prolactin. These medications are taken by mouth.
What is intrauterine insemination (IUI)?

Intrauterine insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, specially prepared sperm are inserted into the woman’s uterus. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI. IUI is often used to treat: Mild male factor infertility. Couples with unexplained infertility.
What is Assisted Reproductive Technology (ART)?

Assisted Reproductive Technology (ART) includes all fertility treatments in which either eggs or embryos are handled outside of the body. In general, ART procedures involve removing mature eggs from a woman’s ovaries using a needle, combining the eggs with sperm in the laboratory, and returning the embryos to the woman’s body or donating them to another woman. The main type of ART is in vitro fertilization (IVF).
Fertility treatment offered at RFH

Bullet ovulation induction Tubal surgery: Robotic removal of uterine fibroids (myomectomy) Robotic resection of endometriosis IUI with partner sperm IUI with donor sperm Sperm wash (coming soon)

Talking to Your Partner

Talking about your sexual needs can help bring you and your partner closer together and promote sexual fulfillment. Try these tips for talking to your partner.

Women's sexual health, like men's, is important to emotional and physical well-being. But achieving a satisfying sex life takes self-reflection and candid communication with your partner. Although talking about sexuality can be difficult, it's a topic well worth addressing.

For help in talking about sex with your partner, follow this guide.

Many people think that your body's physical desire for sex motivates sexual activity, which leads to sexual arousal and then orgasm. Although this might be true for most men, it's not necessarily true for most women. Different factors help many women feel aroused and desire sex, and different factors dampen desire.

For many women, particularly those who are older than 40 or who have gone through menopause, physical desire isn't the primary motivation for sex. A woman might be motivated to have sex to feel close to her partner or to show her feelings.

Sexual satisfaction differs for everyone. Many factors influence sexual response, including how you feel about your partner, how you feel about yourself, your health, and your religious and cultural upbringing. If you have concerns about your sex life, or you just want to find ways to enhance it, a good first step is talking with your partner.

It might not be easy for you to talk about your sexual desires, but your partner can't read your mind. Sharing your thoughts and expectations about your sexual experiences can bring you closer and help you achieve greater sexual enjoyment.

To get started:

Admit your discomfort. If you feel anxious, say so. Opening up about your concerns might help you start the conversation. Tell your partner if you feel shy about discussing what you want and ask for reassurance that your partner is open to the conversation.
Start talking. Talking might help you increase your confidence and comfort level.
Set a time limit. Avoid overwhelming each other with a lengthy talk. By devoting 15-minute conversations to the topic, you might find it easier to stay within your emotional comfort zones.
Talk regularly. Your conversations about sex will get easier the more you talk.
Use a book or movie. Invite your partner to read a book about women's sexual health or recommend chapters or sections that address your questions and concerns. You might also use a movie scene as a starting point for a discussion.

When you're talking to your partner about your sexual needs, try to be specific. Consider addressing these topics:

Time. Are you setting aside enough time for sexual intimacy? If not, what can you do to change things? How can you make sexual intimacy a priority? Think about how you and your partner can support each other to help create time and energy for sex.
Your relationship. Talk about challenges between you and your partner that might be interfering with sex, and ways that you can address them.
Romance. Do you and your partner have the same definition of romance? Is it missing? How can you reignite it? How can romance set the stage for sexual intimacy?
Pleasure. What gives you individual and mutual enjoyment? Be open to hearing your partner's requests and coming up with compromises if one of you is uncomfortable with the other's requests. Talk about what sexual activities make you uncomfortable.
Routine. Has sex become too routine or predictable? What changes might you make? For instance, explore different times to have sex or try new techniques.

Consider more cuddling, a sensual massage, self-stimulation, oral sex or using a vibrator — depending on what interests you. Talk about what you like, what you don't like and what you'd like to try.

Emotional intimacy. Sex is more than a physical act — it's also an opportunity for emotional connection, which builds closeness in a relationship. Try to take the pressure off each other when it comes to having sexual intercourse or achieving orgasm. Enjoy touching each other, kissing, and feeling physically and emotionally close.
Physical and emotional changes. Are physical changes, such as an illness, weight gain, changes after surgery or hormonal changes, affecting your sex life? Also address emotional factors that might be interfering with your enjoyment of sex, such as being stressed or depressed.
Beliefs. Discuss your beliefs and expectations about sex. Consider whether misconceptions — such as the idea that women become less sexual after menopause — are affecting your sex life.

Sexual needs vary. Many factors can affect your sexual appetite, including stress, illness, aging and family, career and social commitments. Whatever the cause, differences in sexual desire between partners can sometimes lead to feelings of isolation, frustration, rejection or resentment.

Talk to your partner about:

Your intimacy needs. Intimacy is more than just sexual needs. Intimacy also includes emotional, spiritual, physical and recreational needs. If your emotional intimacy needs aren't being met, you might be less interested in sex. Think about what your partner could do to enhance your emotional intimacy and talk about it openly and honestly.
Your differences in sexual desire. In any long-term relationship, couples might experience differing levels of sexual desire. Discuss your differences and try to explore options that will satisfy both of you.

If your difficulty persists, consider turning to a doctor or sex therapist for help. If you take medications that might affect your desire for sex, review your medications with your doctor. Your doctor may be able to suggest an alternative.

Likewise, if a physical sign or symptom — such as vaginal dryness — is interfering with your sexual enjoyment, ask about treatment options. For example, a lubricant or other medication can help with vaginal dryness associated with hormonal changes or other factors.

Condoms: Do's and Dont's

Condom Dos and Don’ts

DO use a condom every time you have sex.
DO put on a condom before having sex.
DO read the package and check the expiration date.
DO make sure there are no tears or defects.
DO store condoms in a cool, dry place.
DO use latex or polyurethane condoms.
DO use water-based or silicone-based lubricant to prevent breakage.
DON’T store condoms in your wallet as heat and friction can damage them.
DON’T use nonoxynol-9 (a spermicide), as this can cause irritation.
DON’T use oil-based products like baby oil, lotion, petroleum jelly, or cooking oil because they will cause the condom to break.
DON’T use more than one condom at a time.
DON’T reuse a condom.

How To Put On and Take Off a Male Condom

Carefully open and remove condom from wrapper.
Place condom on the head of the erect, hard penis. If uncircumcised, pull back the foreskin first.
Pinch air out of the tip of the condom.
Unroll condom all the way down the penis.
After sex but before pulling out, hold the condom at the base. Then pull out, while holding the condom in place.
Carefully remove the condom and throw it in the trash.

Low Sex Drive Causes, Symptoms & Treatments

Diagnosis

You may be diagnosed with hypoactive sexual desire disorder if you frequently lack
sexual thoughts or desire, and the absence of these feelings causes personal distress.

Whether you fit this medical diagnosis or not, your doctor can look for reasons that
your sex drive isn't as high as you'd like and find ways to help.

In addition to asking you questions about your medical and sexual history, your doctor may also:

Perform a pelvic exam. During a pelvic exam, your doctor can check for signs of physical changes contributing to low sexual desire, such as thinning of your genital tissues, vaginal dryness or pain-triggering spots.
Recommend testing. Your doctor may order blood tests to check hormone levels and check for thyroid problems, diabetes, high cholesterol and liver disorders.
Refer you to a specialist. A specialized counselor or sex therapist may be able to better evaluate emotional and relationship factors that can cause low sex drive.

Treatment

Most women benefit from a treatment approach aimed at the many causes behind this condition. Recommendations may include sex education, counseling, and

sometimes medication and hormone therapy.

Sex Education and counseling

Talking with a sex therapist or counselor skilled in addressing sexual concerns can help with low sex drive. Therapy often includes education about sexual response and techniques. Your therapist or counselor likely will provide recommendations for reading materials or couples' exercises. Couples counseling that addresses relationship issues may also help increase feelings of intimacy and desire.

Medication

Your doctor will want to review the medications you're already taking, to see if any of them tend to cause sexual side effects. For example, antidepressants such as
paroxetine (Paxil) and fluoxetine (Prozac, Sarafem) may lower sex drive. Switching to
bupropion (Wellbutrin SR, Wellbutrin XL) — a different type of antidepressant —
usually improves sex drive and is sometimes prescribed for women with sexual
interest/arousal disorder.

Along with counseling, your doctor may prescribe a medication to boost your libido.
Food and Drug Administration (FDA)-approved options for premenopausal women
include:

Flibanserin (Addyi), a pill that you take once a day at bedtime. Side effects include low blood pressure, dizziness, nausea and fatigue. Drinking alcohol or taking fluconazole (Diflucan), a common medication to treat vaginal yeast infections, can make these side effects worse.
Bremelanotide (Vyleesi), an injection you give yourself just under the skin in the belly or thigh before anticipated sexual activity. Some women experience nausea, which is more common after the first injection but tends to improve with the second injection. Other side effects include vomiting, flushing, headache and a skin reaction at the site of the injection.

These medications aren't FDA-approved for use in postmenopausal women.

Hormone Therapy

Dryness or shrinking of the vagina, one of the hallmark signs of genitourinary syndrome of menopause (GSM), might make sex uncomfortable and, in turn, reduce your desire. Certain hormone medications that aim to relieve GSM symptoms could help make sex more comfortable. And being more comfortable during sex may improve your desire.

Possible hormone therapies include:

Estrogen. Estrogen is available in many forms, including pills, patches, sprays and gels. Smaller doses of estrogen are found in vaginal creams and a slow-releasing suppository or ring. Your doctor can help you understand the risks and benefits of each form. But, estrogen won't improve sexual functioning related to hypoactive sexual desire disorder.
Testosterone. The male hormone testosterone plays an important role in female sexual function, even though testosterone occurs in much lower amounts in women. Testosterone isn't approved by the FDA for sexual dysfunction in women, but sometimes it's prescribed off-label to help lift a lagging libido. The use of testosterone in women is controversial. Taking it can cause acne, excess body hair, and mood or personality changes.
Prasterone (Intrarosa). This vaginal insert delivers the hormone dehydroepiandrosterone (DHEA) directly to the vagina to help ease painful sex. You use this medication nightly to ease the symptoms of moderate to severe vaginal dryness associated with GSM. Ospemifene (Osphena). Taken daily, this pill can help relieve painful sex symptoms in women with moderate to severe GSM. This medication isn't approved in women who have had breast cancer or who have a high risk of developing breast cancer.

Lifestyle and Home Remedies

Healthy lifestyle changes can make a big difference in your desire for sex:

Exercise. Regular aerobic exercise and strength training can increase your stamina, improve your body image, lift your mood and boost your libido.

Stress less. Finding a better way to cope with work stress, financial stress and daily hassles can enhance your sex drive.
Communicate with your partner. Couples who learn to communicate in an open, honest way usually maintain a stronger emotional connection, which can lead to better sex. Communicating about sex also is important. Talking about your likes and dislikes can set the stage for greater sexual intimacy.
Set aside time for intimacy. Scheduling sex into your calendar may seem contrived and boring. But making intimacy a priority can help put your sex drive back on track.
Add a little spice to your sex life. Try a different sexual position, a different time of day or a different location for sex. Ask your partner to spend more time on foreplay. If you and your partner are open to experimentation, sex toys and fantasy can help rekindle your sexual desire.
Ditch bad habits. Smoking, illegal drugs and excess alcohol can all dampen your sex drive. Ditching these bad habits may help give your sex drive a boost and improve your overall health.

Alternative medicine
Talking about low sex drive with a doctor may be difficult for some women. Some women may turn to over-the-counter herbal supplements. However, the FDA doesn't regulate such products, and in many cases, they haven't been well-studied. Herbal supplements can have side effects or interact with other medications you may be taking. Always talk with a doctor before using them.

One herbal supplement blend is called Avlimil. This product has estrogen-like effects on the body. While estrogen may boost your sex drive, it may also fuel the growth of certain breast cancers.

Another choice is a botanical massage oil called Zestra. It's applied to the clitoris, labia and vagina. One small study found that Zestra increased arousal and pleasure when compared with a placebo oil. The only reported side effect was mild burning in the genital area.

Coping and support

Low sex drive can be very difficult for you and your partner. It's natural to feel frustrated or sad if you aren't able to be as sexy and romantic as you want or you used to be.

At the same time, low sex drive can make your partner feel rejected, which can lead to conflicts and strife. And this type of relationship turmoil can further reduce desire for sex.

It may help to remember that fluctuations in the sex drive are a normal part of every relationship and every stage of life. Try not to focus all your attention on sex. Instead, spend some time nurturing yourself and your relationship.

Go for a long walk. Get a little extra sleep. Kiss your partner goodbye before you head out the door. Make a date night at your favorite restaurant. Feeling good about yourself and your partner can be the best foreplay.

Preparing for your appointment

Primary care doctors and gynecologists often ask about sex and intimacy as part of a routine medical visit. Take this opportunity to be candid about your sexual concerns.

If your doctor doesn't broach the subject, bring it up. You may feel embarrassed to talk about sex with your doctor, but this topic is perfectly appropriate. In fact, your sexual satisfaction is a vital part of your overall health and well-being.

What you can do:

To prepare for this discussion with your doctor:

Take note of any sexual problems you're experiencing, including when and how often you usually experience them.

Make a list of your key medical information, including any conditions for which you're being treated, and the names of all medications, vitamins or supplements you're taking.

Consider questions to ask your doctor and write them down. Bring along notepaper and a pen to jot down information as your doctor addresses your questions.

Some basic questions to ask your doctor include:

What could be causing my problem?

Will my level of desire ever get back to what it once was?

What lifestyle changes can I make to improve my situation?

What treatments are available?

What books or other reading materials can you recommend?

Questions your doctor may ask:

Your doctor will ask questions about the symptoms you're experiencing and assess your hormonal status. Questions your doctor may ask include:

Do you have any sexual concerns?

Has your interest in sex changed?

Do you have trouble becoming aroused?

Do you experience vaginal dryness?

Are you able to have an orgasm?

Do you have any pain or discomfort during sex?

How much distress do you feel about your sexual concerns?

How long have you experienced this problem?

Are you still having menstrual periods?

Have you ever been treated for cancer?

Have you had any gynecological surgeries?

Everything You Need to Know About Sex Toy Care and Cleanliness

From maintenance to materials, here are the basics on keeping things safe and sexy. When choosing and caring for a sex toy, there are a few things to consider regarding safety.

The sex toy business is hot, hot, hot. Current estimates say it is a nearly $30 billion industry — and that could jump to more than $50 billion by 2026. These days, everyone is in on the action, from solo users to couples, millennials to baby boomers. Physicians even recommend sex toys for health purposes.

Sex toy safety, however, isn’t always top of mind, although experts say it should be. For one, the sex toy industry isn’t regulated by watchdogs groups like the Food and Drug Administration (FDA) or Consumer Product Safety Commission, which means there is no one ensuring that toys are safe. And sex toys are, of course, used in very intimate ways.

So how can you protect yourself while enjoying all the fun that sex toys have to offer?

Here are five crucial safety tips every savvy sex toy consumer should be aware of.

Know What Materials Your Toys Are Made Of

DEHP phthalates plasticizer molecules are commonly used to make plastic flexible. Although there is not scientific literature analyzing the body safety of various sex toy materials, there are some materials that consumers may choose to avoid. Some toys are made with phthalates. These chemicals, which are present in some plastics, have been banned for use in such products as children’s toys and pacifiers because they may disrupt human hormones. The FDA says it is unclear what (if any) impact phthalates have on human health. But if you have made a personal decision to avoid them elsewhere in your life — for example, your cosmetics — it is important to know they could be lurking in your sex toys.

Many products state they are phthalate-free, but because the industry is largely unregulated, no outside organization checks the veracity of those claims. So, one thing to keep in mind is whether the toys you are using are soft and jellylike. Phthalates are used as softeners. They are more likely to be present in squishier toys, made from more porous materials.

Porous sex toys are also “more likely to transmit infection,” says Alyssa Dweck, MD, a gynecologist based in Westchester County, New York, and author of The Complete A to Z for Your V. That is because their surfaces are more permeable.

That does not mean there is any research literature out there that says jellylike sex toys are inherently unsafe, but it is something to be aware of.

Wash — and Dry — Your Sex Toys Regularly

Like, regularly. “Sex toys should be cleaned between every sex act and in between every partner,” Dr. Dweck says.

You probably know that sexual activity increases a woman’s risk for urinary tract infections (UTI); you may not realize that the bacteria that cause a UTI live in the area around the anus. Sex increases the chances that the nearby bacteria migrate into a woman’s urethra, where they can multiply and trigger a UTI.

UTI prevention calls for strict genital hygiene, which includes keeping anything that comes into contact with sensitive areas as germ-free as possible. That’s why Planned Parenthood’s website warns, “Anything that touches or goes into your anus — like a finger, penis, or sex toy — should be thoroughly washed before touching other genitals.”

Toys can also spread infections, including sexually transmitted infections (STIs), because they can retain bacteria and viruses.

In addition, sex toys can get covered in dust and other particles while they’re stored.

Your toy’s manufacturer should be your first stop for washing instructions. Some toys can go in the dishwasher, for example. Others cannot. Soapy warm water is a good place to start.

And be careful to dry them, too. Damp toys can grow mold.

Consider a Condom to Reduce the Risk of Infection

Condoms most certainly should be used to cover penis-shaped toys for people who are sharing toys with a partner. That is because even if you diligently clean your toys, there is still a chance of transmitting infection. A study published in November 2014 in the journal Sexually Transmitted Infections found traces of the human papillomavirus on vibrators a full day after they’d been used and cleaned.

The condom should be switched out if you change the body parts coming into contact with the toy, so from oral use to vaginal use, for example

Frequently Asked Questions

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How often is it normal to have sex?

“Normal” is whatever feels fulfilling for you and your partner, and communication plays a key role in making sure both parties feel fulfilled.

A healthy sex life doesn't center on how many times you have sex or even how often you orgasm. Good sex centers around intimacy, and sometimes a good massage or holding each other can be enough. Alternatively, this type of touching can add to sexual chemistry, an important part of intimacy.

What happens if you don't have sex for a long time?

If you do not have sex on a regular basis, you are at a higher risk of developing cardiovascular disease. In addition to being a source of exercise, sexual intercourse helps keep your estrogen and progesterone levels in balance, which can lower your risk of heart disease.

I'm having a problem with sex. Is this normal?

Yes. About 4 in 10 women have problems with sex at some point during their lives. If you are having a sexual problem, and it is worrying or upsetting you, you may want to find a solution. Some problems can be solved by you alone, with a partner, or with the help of a gynecologist or other health care professional.

What causes sexual problems in women?

Some common causes of sexual problems in women include the following:

Hormonal changes at certain times in a woman’s life, such as during pregnancy or menopause
Cancer treatments and their side effects
Some illnesses and medications
Relationship problems with your partner
Past negative experiences
Depression, anxiety or stress

What types of sexual problems affect women?

“Female sexual dysfunction” is a general term for a problem with sex. The problem can be a lack of interest in sex. It also can be a lack of response to sexual activity. Sexual problems fall into four groups, which often overlap:

Desire and arousal problems
Orgasmic problems
Sexual pain
Sexual problems caused by medication or substances.

What are desire problems or low sex drive?

Lack of desire is common and can affect women of any age. For some women, it is normal to not feel desire until sexual activity has started. A lack of desire is considered a disorder when at least three of the following are true for a minimum of 6 months and cause anxiety or sadness:

A woman does not want to engage in any type of sexual activity, including masturbation.
A woman does not have (or has very few) sexual thoughts or fantasies.
A woman does not want to initiate sexual encounters with a partner.
A woman does not have any pleasure during sexual activity.

What are arousal problems?

Arousal is the name for the physical and emotional changes that happen with sexual stimulation. Some women with arousal problems may not feel mental or physical excitement from sex. Other women may feel only mental excitement or only physical excitement.

Arousal can be affected by many things, including:

changes in how a woman feels about herself or her body
pregnancy and nursing
not getting enough exercise
not getting enough sleep
medications for depression
use of alcohol or drugs
relationship problems

What are orgasmic problems?

Di3fficulty reaching orgasm is common. For many women, sharing love and closeness without having an orgasm is satisfying. But other women may feel that not having an orgasm is a problem. They may want to find a solution. Women with orgasmic disorder may

take longer to have an orgasm
have fewer orgasms
have less intense orgasms
have never had an orgasm
not recognize their physical experience as orgasm

For some women, orgasmic disorder may be caused by

a new health problem or mental health condition

a change in a relationship
surgery or radiation in the pelvic area (this is rare)

What is sexual pain?

When gynecologists or other health care professionals talk about sexual pain, they often refer to two conditions: vaginismus and dyspareunia. These conditions can cause several symptoms, including:

tightening of the vaginal muscle that makes penetration di4cult
tension, pain, or burning in the vagina when penetration is attempted
less desire or no desire for penetration
avoidance of sexual activity
intense fear of pain

A pain disorder is diagnosed if the pain interferes with sexual function. Women whose sexual activity does not include penetration also can have a pain disorder. Some women develop sexual pain problems after pregnancy. See FAQ020 When Sex Is Painful for more information.

What medication can cause sexual problems?

Some women have sexual problems soon after starting or stopping some medications. Drugs that may cause problems with sex include the following: including drugs to treat asthma, , chronic obstructive pulmonary disease (COPD), depression/anxiety, diarrhea, dizziness, hypertension, insomnia, nausea, overactive bladder, and vomiting.

Using alcohol, marijuana, and pain-relieving drugs such as opioids also can lead to problems with sex.

What are some self-help options?

There are many things you can do alone or with a partner to address a sexual problem, including the following:

Read books about sex.
Learn about your body and how it works.
Explore oral sex, touching with a partner, and masturbation with and without a partner.
Try nonsexual, sensual activities like massage.
Talk with your partner about what you like.
Try to reduce sources of stress in your life.

What can I do to enhance desire?

Work on issues that may be affecting your relationship.
Focus less on physical acts and more on emotional closeness.
Improve your sex knowledge and skills.
Make time for sexual activity and enjoying each other.

What can help me have an orgasm?

Increase sexual stimulation.
Try sexual toys.
Use mental imagery and fantasy.

How can I lessen sexual pain?

Use a vaginal moisturizer. There are several brands you can buy online or at your local pharmacy.

Use a lubricant. If you use condoms, use only water-based or silicone lubricants.
Empty your bladder before sex.
Allow plenty of time for arousal before penetration.
Try different positions or sexual activities that do not involve intercourse.

How can I talk about sex with my gynecologist or other health care professional?

“I am having some concerns about my sex life.”
“I do not enjoy sex like I used to.”
“Lately, I have been having trouble with physical intimacy. What can I do?”
“I am just not interested in sex. Do you have any advice?”
“I’m not satisfied with how often I have sex. What can I do?”

It may help to track your symptoms in a journal. Then you can explain your symptoms to your gynecologist or other health care professional.

If you have further questions, please ask your provider at Redefined For Her

Sexual Health

Sexual health relates to healthy relationships, family planning and prevention of sexually transmitted diseases. Sexual health is not limited to the expression of sexuality but includes the mental, emotional, spiritual and psychological aspects of one’s being. Sexual wellness includes a respectful approach to sexual relationships that is free of harassment, prejudice and violence. The World Health Organization states that sexual health is not merely the absence of disease, dysfunction or infirmity.

Everything you need to know about Lubricants

When a woman is sexually aroused, the vagina normally self-lubricates. This makes the overall experience a lot more fun.

Intercourse without lubricant can be painful and damage the vaginal lining. Your body may produce less lubricant as a result of hormonal changes, menopause, aging, or medication. That’s usually where artificial lubricant comes in.

Artificial lubricant can help enhance arousal, boost sexual pleasure, keep your vaginal skin soft, and, most importantly, reduce friction during penetration — whether it’s by a partner or your favorite sex toy. You can buy lubricant online or at your local drugstore.

Who can benefit?

Lubricants can be used by everyone, regardless of whether their body produces lubrication naturally.

If you’re dealing with vagina dryness, you may find lubricant especially beneficial. Using lubricant before sexual activity can help prevent itching, burning, chaffing, and other discomfort.

Dryness commonly affects people who:

take certain medications, including antihistamines and antidepressants
struggle with daily water intake or are often dehydrated.
use hormonal birth control
smoke cigarettes
are breastfeeding.
are in perimenopause or menopause
have an autoimmune disorder, such as Sjögren syndrome
are undergoing chemotherapy

Some lubricants are designed to enhance sexual function and arousal. If you want to try something new, these lubricants can be a great way to spice things up with your partner or set the mood for some solo play.

What are the different types to try?

There are different types of lubricants to suit different needs. It’s totally normal if you favor one over the rest, or if you like to switch things up depending on the situation. Whether you’re a first-time buyer or looking to expand your lubricant collection, there’s one out there for you, guaranteed.

Water-based lubricant

Water-based lubricants are the most common. They come in two varieties: with glycerin, which has a slightly sweet taste, or without glycerin. Both types of water-based lubricant are cost-effective, easy to find, and safe to use with condoms. They typically don’t stain sheets, either.

Glycerin-free products are less likely to cause vaginal irritation. They also have a longer shelf life.

Flavored or warming lubricants often contain glycerin. Although these products have their perks, they dry out quickly. Because of their sugar content, they’re also known to contribute to yeast infections.

Glycerin-free lubricant can taste bitter. It may not be the best option if you like to switch things up between oral and penetrative sex.

date of publication.

Silicone-based lubricant
Silicone-based lubricants are odorless and tasteless, slippery and smooth. They last the longest out of any lubricant. They don’t need to be reapplied as often as water-based lubricants. They’re safe to use with latex condoms and — if you’re in the mood for a steamy shower session — will hold up under water. Silicone-based lubricants are also hypoallergenic.

However, this type of lubricant may last longer, but it’s harder to wash off. You’ll need to give the area a soapy scrub to remove any residue. Silicone-based lubricants aren’t recommended for silicone sex toys because it can break them down, making them gummy and gross over time.

Oil-based lubricant
There are two types of oil-based lubricants: natural (think coconut oil, olive oil or butter) and synthetic (think mineral oil or Vaseline).

Generally, oil-based lubricants are safe to use, inexpensive, and easily accessible.

Natural-based oil lubricants — like avocado, coconut, vegetable, and olive oils — are great for genital massages and all types of sexual play. They’re also safe for the vagina and safe to eat.

Synthetic oil-based lubricants, including body lotions and creams, are good for external masturbation, but not much else.

Be Careful: both natural and synthetic oil-based lubricants can destroy latex condoms, cause condom failure, and stain fabrics.

Natural lubricant

Natural oil-based lubricants aren’t the only natural products on the market. Some companies have produced organic or vegan lubricants made of botanicals or other eco- friendly ingredients.

Many natural lubricants are free of paraben, a commonly used preservative with established health risks. They also use organic ingredients, which are better for the environment and safe for your vagina.

All-natural lubricants may have a shorter shelf life. They may also cost more than a traditional lubricant.

Things to consider when choosing the right lubricant for you
Of course, not all vaginal lubricants are created equal. Some brands will work better for you than others, depending on your needs.

If you’re dealing with dryness. “Warming” lubricants may not help, as they contain glycerin and can dry quickly. Long-lasting silicone lubricants are your best bet.
If you’re prone to yeast infections. Stay away from lubricants with glycerin. The compound can irritate your vagina and kill good bacteria, triggering an infection.
If you’re trying to conceive. Look for a lubricant that says it’s “sperm friendly” or “fertility friendly” on its packaging.
If you’re going to use a condom. Avoid oil-based lubricants at all costs. Nothing destroys a latex condom quicker than oil-based lubricant.
If you’re going to use a sex toy. Stick with a water-based lubricant. If your sex toy is made of silicone, silicone-based lubricants can break down a toy’s rubber over time.
If you’re going to play in the shower, opt for a silicone-based lubricant. Water- based products will rinse off as soon as you’re under the showerhead.

Is there anything to avoid entirely?

Although oil-based lubricants are safe to use, they can render most condoms ineffective. They may cause vaginal irritation too.

You should also limit your use of lubricant with fragrance or flavoring. These chemicals may cause irritation.

Some ingredients in lubrications are more likely to result in inflammation or irritation and should be avoided by those who are sensitive. These ingredients include:

glycerin
nonoxynol-9
propylene glycol
chlorhexidine gluconate

Is lubricant the same thing as vaginal moisturizer?

Vaginal moisturizers can help prevent general itching and irritation, but they don’t provide enough wetness to prevent discomfort during penetration.

That’s because moisturizers, unlike lubricants, are absorbed into the skin. They need to be used regularly in order to ease dryness.

If you’re planning on having any type of sexual activity, you may still need to use a lubricant to increase comfort.

How to use lubricant effectively

There really isn’t a “right” or “wrong” way to use lubricant effectively. But there are a few things you can do to make the process easier:

Lay down a towel to prevent staining.•
Warm up the lubricant in your hands before applying.
Include lubricant as a part of foreplay to boost arousal.
Apply lubricant right before penetration during partner or solo play.
Be liberal when applying so that your vulva and vagina are sufficiently wet. Apply lubricant to the penis or sex toy.
Reassess how much lubricant is still on as you go and reapply as needed.

Are there any side effects?

Most lubricants are free of side effects. However, it’s possible to have an allergic reaction to something in the lubricant.

See your doctor if you develop any of the following symptoms after use:

difficulty breathing
any swelling, especially of the tongue, throat, or face
hives
rash
itching

Also see your doctor if you develop more frequent yeast infections when lubricant is a part of your regular routine.

The bottom line

Vaginal lubricants can be a great way to help ramp up your partner or solo sex session. The added wetness can reduce any friction or discomfort and help increase arousal.

When deciding between different lubricants, keep your comfort and safety in mind. With the wrong product, your vagina may feel irritated instead of frisky.