EDUC 193S: Peer Counseling on
Comprehensive Sexual Health
Fall, Winter and Spring
2009-2010
Course Leader:
Donnovan Yisrael
Teaching Assistants:
Lizz Fay & Eric Tran
Educ 193S: Peer Counseling on Comprehensive Sexual Health
Fall, Winter, and Spring 2009-2010
Course Leader:
Donnovan Yisrael <donnovan@stanford.edu>
Teaching Assistants:
Lizz Fay <eifay@stanford.edu>
Eric Tran <erictran@stanford.edu>
Class Time: Tuesdays 7:00pm-9:00pm
Room: Vaden Second Floor Conference Room
Office Hours: By appointment.
Required Text: An electronic coursereader will be available, and hard
copies of the course reader are available for upon request. Students are
required to cover the cost of printing for hard copies.
Description: Presented by the Sexual Health Peer Resource Center
(SHPRC), this class is intended for and required of students planning on
becoming counselors at the SHPRC. It provides information on sexually
transmitted infections and diseases, and on all methods of birth control.
Additionally, the class explores other topics related to sexual health such as
communication, societal attitudes and pressures, pregnancy, abortion, and
the range of sexual expression. This information should empower any
student to make educated and responsible decisions about their own
sexual interactions, and allow them to advise others appropriately. Trained
student counselors and guest speakers teach the class in a sexually
positive, supportive meeting environment. Discussions, role-plays, and the
peer-education outreach project at the culmination of the course will allow
students to apply their knowledge and develop counseling skills.
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Objectives: Students who complete this class should be able to:
 Describe typical normal male and female anatomy and the physiology of
reproduction.
 Identify risks, benefits and side effects of all modern methods of birth
control.
 Develop an awareness of the nature, epidemiology, and prevention of
sexually transmitted infections.
 Discuss misconceptions that influence decision-making in the use of
contraception and other sexual health practices.
 Feel comfortable discussing a wide variety of sexual health issues in
both counseling and peer settings.
 Be familiar with the community resources available on and off campus
offering sensitive, appropriate health care.
Assignments:
 Class Attendance and Participation (10%): Since so much material is
covered in each class, only one absence is allowed. Students must
inform the TAs prior to missing class and complete a makeup
assignment. This is a discussion-driven class, and students are expected
to actively participate in each class.
 Shift Attendance (5%): All students will be required to attend one shift
to familiarize themselves with the SHPRC.
 Outreach (20%): Students will design their own educational outreach
and implement it on campus.
 Midterm (20%): There will be a take-home midterm to review material
to date.
 Final (35%): The final will encompass all course topics and evaluate
students’ readiness to counsel.
 Co-counsel (10%): Informal meeting with TA during the final to practice
counseling techniques.
 Extra credit reading assignment (5%): Students will check out a book of
their choosing from the SHPRC library and write a short report due the
week before the final.
In order to counsel at the SHPRC, each student must receive a 90% or
higher on the final, and an 85% overall. In addition, he or she must take
EDUC 193A (the Bridge class) concurrently with their first quarter of
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counseling, if not earlier.
4
INTRODUCTION ............................................................................................................. 8
Introduction ........................................................................................................................................................ 9
SHPRC Philosophy......................................................................................................................................... 11
Sexual Rights ........................................................................................................................................................................................ 11
Comprehensive Sexual Education .............................................................................................................................................. 12
Sexual Orientation and Gender Identity .................................................................................................................................. 13
SHPRC Counseling Guidelines ...................................................................................................................................................... 15
Vaden Policies ................................................................................................................................................. 18
Outreach Information .................................................................................................................................. 19
Sexual Beings .............................................................................................................. 22
Anatomy and Physiology of Reproduction .......................................................................................... 23
Female Anatomy and Physiology ............................................................................................................................................... 23
General Menstrual Issues ........................................................................................................................... 29
Menstrual Cycle .................................................................................................................................................................................. 29
Male Anatomy and Physiology..................................................................................................................................................... 32
Female Sexual Health Maintenance ........................................................................................................................................... 36
Male Sexual Health Maintenance ................................................................................................................................................ 38
Sexual Health Exams .................................................................................................................................... 40
Female Sexual Health Exam .......................................................................................................................................................... 41
Male Sexual Health Exam ............................................................................................................................................................... 44
Cancer Self-Exams ......................................................................................................................................... 46
Breast Cancer....................................................................................................................................................................................... 46
Testicular Cancer ............................................................................................................................................................................... 48
Section Review Questions .......................................................................................................................... 50
Sexual Expression, Pleasure, & Their Many Forms ........................................ 51
Sexual Expression .............................................................................................................................................................................. 52
Safer Sex Choices ............................................................................................................................................................................... 53
Sexual Response Cycle ..................................................................................................................................................................... 54
Self-Pleasure (Masturbation) ....................................................................................................................................................... 57
Section Review Questions .......................................................................................................................... 59
Genital Health Issues ................................................................................................ 60
General Menstrual Issues ........................................................................................................................... 61
Menstrual Cramps (Dysmenorrhea): ........................................................................................................................................ 61
Premenstrual Syndrome (PMS): ................................................................................................................................................. 62
Irregular Periods (Oligomenorrhea): ....................................................................................................................................... 64
Missed Periods (Amenorrhea): ................................................................................................................................................... 64
Toxic Shock Syndrome (TSS)........................................................................................................................................................ 66
Erection and Ejaculatory Issues............................................................................................................... 68
Premature Ejaculation ..................................................................................................................................................................... 68
Erectile Dysfunction ......................................................................................................................................................................... 71
Sexually-Related Issues ........................................................................................... 74
Urinary Tract Infection ................................................................................................................................................................... 74
Pelvic Inflammatory Disease ........................................................................................................................................................ 77
Mononucleosis .................................................................................................................................................................................... 79
Section Review Questions .......................................................................................................................... 81
Sexually Transmitted Infections .......................................................................... 82
Education and Prevention .......................................................................................................................... 83
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Testing At and Around Stanford .............................................................................................................. 86
Vaden ...................................................................................................................................................................................................... 86
HIV*PACT .............................................................................................................................................................................................. 88
Planned Parenthood ......................................................................................................................................................................... 90
Parasitic ............................................................................................................................................................. 92
Scabies .................................................................................................................................................................................................... 92
Crabs ........................................................................................................................................................................................................ 93
Bacterial ............................................................................................................................................................ 95
Chlamydia ............................................................................................................................................................................................. 95
Gonorrhea ............................................................................................................................................................................................. 97
Syphilis ................................................................................................................................................................................................... 99
Viral................................................................................................................................................................... 102
Human Papilloma Virus (HPV) .................................................................................................................................................. 102
Gardasil: The HPV Vaccine........................................................................................................................................................... 105
Genital Herpes ................................................................................................................................................................................... 107
HIV/AIDS ............................................................................................................................................................................................. 110
Vaginitis........................................................................................................................................................... 114
Yeast Infections (Candidiasis).................................................................................................................................................... 114
Bacterial Vaginosis:......................................................................................................................................................................... 116
Trichomoniasis Infections ........................................................................................................................................................... 117
Section Review Questions......................................................................................................................... 119
Pregnancy ................................................................................................................... 120
General Pregnancy Information ............................................................................................................ 121
What is pregnancy? ......................................................................................................................................................................... 121
Possible Pregnancy Complications: ...................................................................................................... 123
From Fertilization to Implantation....................................................................................................... 124
Pregnancy Testing ....................................................................................................................................... 126
SHPRC: First Response® Pregnancy Test ............................................................................................................................ 128
Vaden .................................................................................................................................................................................................... 129
Planned Parenthood ....................................................................................................................................................................... 130
Home Pregnancy Tests .................................................................................................................................................................. 130
Infertility ......................................................................................................................................................... 131
Menopause ..................................................................................................................................................... 132
Section Review Questions ........................................................................................................................ 133
CONTRACEPTION ..................................................................................................... 134
Fundamentals ............................................................................................................................................... 135
Choosing a Method .......................................................................................................................................................................... 135
Abstinence ...................................................................................................................................................... 138
Methods That Provide NO Protection from Pregnancy ................................................................ 140
Non-Methods of Contraception .............................................................................................................. 141
Withdrawal ......................................................................................................................................................................................... 141
Douching: ............................................................................................................................................................................................ 143
Barrier Methods ........................................................................................................................................... 144
Male Condom ..................................................................................................................................................................................... 144
Female Condom ................................................................................................................................................................................ 149
Spermicide .......................................................................................................................................................................................... 151
Hormonal Methods: Combination......................................................................................................... 153
General ................................................................................................................................................................................................. 153
Combination Oral Contraceptive Pill ...................................................................................................................................... 155
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Vaginal Ring ....................................................................................................................................................................................... 156
Transdermal Contraceptive Patch ........................................................................................................................................... 158
Hormonal Methods: Progestin-Only .................................................................................................... 161
General ................................................................................................................................................................................................. 161
Progestin-Only Oral Contraceptive Pill .................................................................................................................................. 162
Contraceptive Implant ................................................................................................................................................................... 163
Contraceptive Injection ................................................................................................................................................................. 165
Continuous Hormonal Contraception.................................................................................................. 167
Birth control pills ............................................................................................................................................................................. 167
NuvaRing® ......................................................................................................................................................................................... 167
Combination Contraceptive Methods .................................................................................................. 168
Diaphragm .......................................................................................................................................................................................... 169
Cervical Cap ........................................................................................................................................................................................ 170
Cervical Shield ................................................................................................................................................................................... 172
Contraceptive Sponge .................................................................................................................................................................... 173
Intrauterine Device (IUD) ........................................................................................................................ 175
Mirena ................................................................................................................................................................................................... 175
ParaGard .............................................................................................................................................................................................. 177
Permanent Methods ................................................................................................................................... 179
Tubal Ligation ................................................................................................................................................................................... 179
Vasectomy ........................................................................................................................................................................................... 181
Natural Family Planning ........................................................................................................................... 183
Basal Body Temperature (BBT) ................................................................................................................................................ 184
Mucus/Ovulation Method ............................................................................................................................................................ 185
Calendar/Rhythm Method ........................................................................................................................................................... 187
Standard Days Method .................................................................................................................................................................. 188
Emergency Contraception (EC) ............................................................................................................. 189
Plan B .................................................................................................................................................................................................... 189
ParaGard IUD ..................................................................................................................................................................................... 191
Birth Control Pills ............................................................................................................................................................................ 191
Section Review Questions ........................................................................................................................ 193
The More Serious Side of Sexual Health........................................................... 194
Abortion .......................................................................................................................................................... 195
Sexual Assault ............................................................................................................................................... 201
Section Review Questions ............................................................................................................................................................ 204
Sexual Expression, Pleasure, and Their Many Forms, Part 2.................... 205
Accessories ..................................................................................................................................................... 206
Care and Maintenance ................................................................................................................................................................... 207
Where to Buy ..................................................................................................................................................................................... 207
Modes of Expression .................................................................................................................................. 209
Section Review Questions ........................................................................................................................ 212
Resources at Stanford ................................................................................................................................ 213
7
INTRODUCTION
INTRODUCTION
SHPRC PHILOSOPHY
Sexual Rights
Comprehensive Sex Education
Sexual Orientation and Gender Identity
Counseling Guidelines
VADEN POLICIES
OUTREACH INFORMATION
FORMS
Outreach Form
Shift Attendance Form
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Introduction
About the Class
People take this class for many reasons: some want to be counselors, while
others just want to learn more about sexual health, and a few people have no
idea what to do with their lives now that they are at college so they're taking
all the classes with sex in the title. But whatever your reason, we’re glad to
have you.
This class works best when people feel
comfortable talking about sometimes
embarrassing and/or explicit subjects with
the group. To this end, your TAs try to
promote a comfortable, non-judgmental
atmosphere. Your questions, no matter
how basic or “weird” you might think they
are, are always appreciated. Plus, a
question you have is probably something
someone else has, too!
About the Course Reader
While much of what we do in this class
is ensure that you learn the relevant facts,
the most interesting part of the class is
often the group discussions. The less that
we need to go over what's clearly written
in the course reader, the more we can talk
about the issues in their broader contexts
and discuss complexities relevant to
contemporary generations. (ex: Is oral sex
really sex? Can lesbians lose their virginity
to another woman? Should “losing"
virginity even exist as a concept?) Please
read the assignments so we can have more
discussions in class.
History of the SHPRC
Adapted from Carole Pertofsky, Director of
Wellness and Health Promotion Services
In the mid-1970s, a group of
Stanford students started the
“Contraceptive Information
Center,” located in the Fire Truck
House. Soon, the group moved to
Cowell, with a branch at the Fire
Truck House, called “Ye Olde
Safer Sex Shoppe.” In the mid1990s, in response to a need to
educate students about and
protect students from AIDS,
broadened the mission from
contraception to the full range of
Sexual Health and voila – became
the SHPRC. The class for the
SHPRC counselors, as well as for
the Bridge, the PHEs, and HIV
counselors began around the
same time, when the Psych
department became more
research-focused.
In 1993, Carole Pertofsky
launched the HIV peer-counseling
program (HIV*PACT), which is
separate from but similar to
SHPRC. Carole also runs Health
Promotions Services (HPS) is
another related department, next
door to the SHPRC.
9
This course reader is a product of the time and energy of the many
dedicated SHPRC teaching assistants, faculty advisors, and health
professionals. Sexual health is a very dynamic subject: new research
frequently revises or expands the current vision of sexual health, and we
aspire to keep the reader up to date. Thus, this reader is always a work in
progress. Please let your TAs know if you find typos, worthless sections, out of
date information, or possible factual inaccuracies.
About Being Inclusive and Sensitive
In all of this teaching and discussing, we try to be sensitive and respectful.
Being inclusive is very important to us, as sexual health is not just about
pregnancy and STIs, and certainly not just for heterosexual people. We will try
to cover topics for people of all sorts of sexual orientations (gay, bisexual,
lesbian, etc.) and gender identities. Where possible, this course reader is
gender-neutral and sexual orientation-neutral.
About You
Unlike a math class, people in this class come with significantly different
levels of knowledge about the subject, and also with inhibitions, beliefs, and
experiences that affect their comfort with the material. It is our hope that we
can explore the sensitive topics in this class by challenging people's beliefs
and assumptions without offending or upsetting anyone. Please let your TAs
know if you are feeling uncomfortable in the class, or if you are concerned
about anything.
If this class excites you and you want to teach it or work on the course
reader, help is always appreciated. The class, the reader and the SHPRC would
not exist without the generous donation of the time and talent of many, really
cool people. It’s great to have you in the class, and we hope you’ll have as
much fun learning this stuff as we do teaching it.
Your TAs,
Lizz Fay
Eric Tran
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SHPRC Philosophy
This SHPRC is based on a foundation of several important core values. The
leaders of the SHPRC believe these values are integral in promoting safe,
healthy, and fun sexuality. While we do not expect you to agree with
everything we teach, we hope that by the end of this class you can appreciate
the importance of the following core values.
Sexual Rights
Adapted from the World Association for Sexual Health’s Universal Declaration of Sexual Rights
1. The right to sexual freedom - to express all forms of sexual expression, as
long as all parties are consenting and safe.
2. The right to sexual autonomy, sexual integrity, and safety of the
sexual body –to make one’s own decisions with respect to one’s own life
and social ethics, which includes freedom from exploitation, abuse, and
violence.
3. The right to sexual privacy – to have a private intimate life.
4. The right to sexual equity – to freely and fully express oneself sexually,
regardless of sex, gender, sexual orientation, age, race, social class, religion,
or physical and emotional differences.
5. The right to sexual pleasure –to feel comfortable in experiencing sexual
pleasure, whether by oneself or with others.
6. The right to emotional sexual expression – to express one’s sexuality
through communication, touch, emotional expression and love.
7. The right to sexually associate freely – to able to marry; to divorce; and
to establish and maintain other types of responsible sexual associations; or
to do none of the above, as long as all parties are consenting and safe.
8. The right to make free and responsible reproductive choices – to able
to decide for oneself whether or not to have children, the number and
spacing of children, and the right to full access to the means of fertility
regulation.
9. The right to comprehensive sexuality education and information
based upon scientific inquiry – have easily accessible and scientifically
accurate information about sexuality and sexual health, as well as a safe
11
place in which to discuss these matters.
10. The right to sexual health care – to have access to competent and
comprehensive prevention and treatment of all sexual concerns, problems
and situations.
Comprehensive Sexual Education
SIECUS Public Policy Fact Sheet, “What the Research Says…”
http://www.siecus.org/_data/global/images/research_says.pdf
The SHPRC is an organization that seeks to inform the Stanford community
about safer sex practices and choices. And while abstinence is the only true
100% safe sexual practice, the SHPRC does not support or practice
abstinence-only education because there is no evidence to show that such an
approach works. In fact, studies show that, at best, abstinence-only education
is no better than comprehensive sexual health, and, at worst, is correlated
with riskier sexual behaviors. Some of the most compelling evidence:
 Students in comprehensive and those in abstinence-only programs had
similar ages of first sex, numbers of sexual partners, and rates of
pregnancy and STI transmission
 In fact, areas with higher rates of “virginity pledge” programs had
overall higher rates of STIs
 Students who were in enrolled in “virginity pledge” programs did have
later first intercourses, but were 1/3 less likely to use contraception and
were less likely to seek treatment and testing
In addition, students in abstinence-only programs were less likely to feel that
teachers and staff cared for them and were less likely to feel like they had “the
right to refuse to have sex with someone.” The SHPRC does not participate in
programs that foster negative attitudes towards oneself or others – we believe
that sexuality is a wonderful part of human life.
Moreover, we are a non-judgmental organization that does not preach morals
in either direction: we believe that choosing abstinence is as valid as choosing
to be sexually active while using protection. Our goal is that in whatever
activity a student chooses to participate in, he or she has the information to
help him or her choose the safest option.
12
Sexual Orientation and Gender Identity
Sexual orientation refers to someone’s physical and/or emotional attraction to
others. Gender identity refers to how someone identifies in terms of gender.
The SHPRC recognizes that not everyone identifies as heterosexual and not
everyone identifies with their birth gender.
Sexual Orientation: Someone’s sexual orientation (different from sexuality)
can be straight, gay, bisexual, lesbian, asexual, pansexual, or something
else. Some people do not have exclusive orientations (ex, only being
attracted to men) and may engage in sex outside of their orientation (ex, a
man can have sex with another man and identify as straight).
Gender Identity: Gender identities may be male, female, transgender,
another gender, or no gender. Gender identity can be a very complicated
topic (ex, if a person who was born female identifies as male, are they
transgender or male?) but there is an easy way to think about it: a person is
whatever gender they feel that they are. Just remember that someone’s
body does not define their gender: they do.
As a counselor, never assume a student or their partner(s) is/are of any
particular orientation or gender identity. Use gender-neutral terms (“they” is
fine) and don’t ask for specifics unless necessary.
Glossary
Planned Parenthood Glossary
http://www.plannedparenthood.org/health-topics/glossary-4338.htm
Asexual: one who does not experience sexual attraction or has no desire for sex.
Biological sex: determined by a person’s sexual anatomy, chromosomes, and hormones.
Biological sex identifies a person as either male, female, or intersex.
Bisexual: someone who has sexual desire for people of both genders.
Coming out: revealing one’s sexual orientation or gender identity to oneself and/or others;
one who has done this can identify as “being out.”
Cross-dresser: a person who sometimes wears clothing associated with the opposite sex
in order to have fun, entertain, gain emotional satisfaction, or make a political
statement about gender roles.
Female-to-male transsexual (F to M; F2M; FTM): A person whose sex assignment at
birth was female but whose gender identity is male. Can also refer to those surgically
13
assigned female at birth, in the case of intersex people, whose gender identity is male.
Often, FTM transsexuals will seek hormonal and/or surgical treatment in order to live
successfully as men in society.
Gender dysphoria: the conflict between one’s sexual anatomy and one’s gender identity.
Gender Identity Disorder (GID): a medical diagnosis of significant discomfort with one’s
assigned sex, gender, and gender role.
Genderqueer: one who does not identify as male or female and does not otherwise
identify with any particular defined gender.
Gender role: social norms about behaving as female or male. What one says or does as an
expression of one’s sex as female, male, intersex, or genderqueer.
Intersex: the condition of being born with external sex organs that are not easily
distinguishable as female or male and/or the development of secondary sex
characteristics that are not easily distinguishable as female or male. The term
“hermaphrodite” was previously used to describe people with this condition, but is now
considered offensive.
LGBT: lesbian, gay, bisexual, transgender (also known as GLBT).
Male-to-female transsexual (M to F; M2F; MTF): A person whose sex assignment at birth
was male but whose gender identity is female. Can also refer to those surgically
assigned male at birth, in the case of intersex people, whose gender identity is female.
Often, MTF transsexuals will seek hormonal and/or surgical treatment in order to live
successfully as women in society.
Pansexual: one who is attracted to people regardless of their gender identity or biological
sex.
Polyamory: the ongoing sexual and emotional relationship among three or more people.
Polyandry: the marriage of one woman to more than one man.
Polygamy: having more than one spouse.
Polygyny: the marriage of one man to more than one woman.
Queer: an umbrella and loose term for those who identify as LGBT; sometimes used for
those who don’t want to identify with any particular “label.”
Questioning: being unsure of one’s sexual orientation/gender identity; feeling
uncomfortable with or unwilling or unable to self-categorize with traditional labels
such as gay, straight, male, female, etc.
Transgender: gender expression and gender identity that differ from conventional
expectations based on biological sex.
Transsexual: one whose gender identities do not match the sex that was assigned at birth
and who desire and/or seek medical treatment to bring their bodies into alignment
with their gender identities.
Transvestite: one who cross-dresses for sexual pleasure. (Often offensive).
14
SHPRC Counseling Guidelines
These are the general guidelines for sexual health counseling at the SHPRC.
1. Try to establish a rapport with the counselee. Help make him or her feel
comfortable with you and the topic. You don't have to have a whole
conversation with them, but small things can go a long way. Try: making
lots of eye contact, leaning in to listen to them, turning off the music if
there's some playing, smiling and encouraging where appropriate.
2. Let him or her tell you what the concern or problem is, rather than the
other way around. Realize that they bring with them fears, concerns,
stereotypes, cultural biases, and other factors that may influence their
perspective on the situation. These may not come out all at once, but listen
for clues about what is really important to them. Especially listen for risky
behavior or activities, which may lead to an STI or a contraceptive
misuse/failure.
3. Never be surprised at what people do not know. Try to give them the most
important and relevant information first - there is no need to disinterest a
counselee with superfluous or tangential facts. They may not come back
(even though you are going to encourage them to!), so make sure that what
matters most is conveyed. Invite them to pick up some of the literature, use
the lending library, or to schedule a counseling appointment. On the other
hand, watch for out for the "glazed-eye look"- they may already know what
you are telling them.
4. Prioritize the information. Emphasize and repeat the most important
points.
5. Use models and encourage them to practice as well.
6. Ask them questions to see what they understand.
7. Repeat, rephrase, reflect. "So you are saying—you think your problem is—
." Then ask yourself, "Why does this person have this problem? What are
the possible solutions?"
15
8. Don't ask the most private questions first. Start with general questions,
then ask more specific ones as needed. Ease in and if they seem
uncomfortable, back off. Try not to ask the person "Why?" because it may
make him or her more defensive. If you do ask them something very
personal, give then the option of not answering.
9. Avoid being hetero/homo-sexist. Always use the same gender pronoun
your counselee uses in referring to sexual partners and don't be afraid of
using "them" and "they." If unsure use "partner." Don't assume that sex
acts are limited to one type of relationship.
10. Match the person's energy.
11. Try to encourage safe behaviors (visiting a clinician regularly, getting
tests, using barrier methods, abstaining from or postponing sex if not
ready, etc.) This does not mean deciding the method for them; it means
giving them the facts and helping them to put in perspective their future
plans for their own bodies.
12. Remember that if you make the decision for them, it is likely that they will
not be satisfied, not use safer behaviors, and instead put themselves at
risk. Let them make the decision, but help them to explore their
"preconceived ideas" when appropriate.
13. Let them know that if one method or brand doesn't work, they can try
another. It takes more than one try to find something that works: trial and
error can be a frustrating method, but remind them that the results are
worth it!
14. Use personal disclosure only when appropriate. In general it will not be
appropriate to talk about yourself or give opinions.
15. Protect and respect their confidentiality.
16. Encourage counselees to talk with their partners and to come into the
SHPRC together. Tell them to tell their friends about us!
16
About you:
1. Write down your feelings, suggestions, hard questions, etc. in the blog so
that the group can benefit from them. It helps us to discuss how to handle
various situations and allows us to give advice to other counselors with
tough counsels
2. Get support from your fellow counselors. Call/email someone (remember
that your TAs will always be there for you!) or bring up an issue in the blog
or email the counselors list.
3. As a sexual health and contraceptive counselor, you need to be more than
familiar with the information. You need to be understanding and a good
listener. Most importantly though, you should be comfortable with your
own sexuality and ability to discuss the topics (with the counselee, your
partner, your family, etc.)
4. Do the best you can and keep reminding yourself that even on those days
you are providing a valuable service. You are helping others and they do
appreciate you (even when they rush out as soon as they get their free
stuff).
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Vaden Policies
Who May Use Vaden Services?
Registered Stanford students may use Vaden Health Center. Most services are
free for students who have paid the Campus Health Service Fee ($167 per
quarter beginning the 2009-2010 academic year).
Sexual Health Related Services








Women’s Health
Peer Contraceptive Counseling
Sexually Transmitted Infection testing
Confidential HIV testing
Anonymous HIV testing
Emergency Contraception
Counseling and Psychological Services (CAPS)
Pharmacy
Insurance
Services are free whether a student has Cardinal Care or outside insurance.
Many students worry about information from Vaden services (such as STI
screens or pregnancy tests) being sent home. This generally isn’t an issue for
students with Cardinal Care, especially if they list their local address at
Stanford on the insurance form as the location to contact them. If a student
has outside insurance and the parents' address is listed, they will get a bill
for charges but no details are given except diagnosis codes to help protect
privacy. They can contact our insurance office if they have specific concerns.
How to Schedule an Appointment:
Call (650) 498-2336 extension 1
Visit http://vadenpatient.stanford.ed
18
Outreach Information
The SHPRC is strongly committed to spreading knowledge and clarity of
sexual health related issues to all members of the Stanford community. In
addition to staffing the SHPRC, active SHPRC counselors are encouraged to
participate in at least one outreach per quarter. Groups typically targeted
include freshman dorms, row houses, fraternities, sororities, and community
centers.
Drawing upon the knowledge gained in this class, each of you will be
required to arrange such an outreach. You will be able to work in groups of
two to four, and it is suggested that you schedule your outreach for the last
third of the quarter. One of the TAs from the class will attend each outreach
in case you run into any sticky questions, but you’re going to do great and
you’ll be amazed at how much useful information you will be able to share!
Some counselors prefer to do outreaches that are already written so that
all they have to do is lead the activities. However, the best outreaches are
ones that the counselors create themselves, because they are full of passion
and creativity. SHPRC counselors are required to complete one outreach per
quarter, though they are encouraged to do more.
Questions to ask yourself when creating an outreach:
 What is something about sexual health that really surprised or
interested me? A fact? A statistic? Something else?
 What is something I know that most students probably do not?
 What communities on campus could really benefit from tailored sexual
health information?
 What is the most important information I didn't know before I took
this class?
 What are some fun activities I've done in the SHPRC class that I could
bring to another group?
 What general sexual health knowledge could anyone benefit from?
 What do people usually not talk about that really needs to be talked
about?
Possible venues and audiences for outreaches

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Women's Community Center
LGBT Community Resource Center
Ethnic community centers
Fraternities
Sororities
Sports teams
Freshman dorms
Upperclassmen dorms
Row Houses
White Plaza
Bathroom flyering campaign
Before/during/after large events like concerts, plays, and parties
Tips for constructing a great outreach
 Come by the SHPRC for ideas. Browse the library for research, look
through the materials, and ask the counselor on duty about outreaches
they have done.
 Time and place of the outreach are important. Don't schedule it during
a time that people are really busy or distracted. A comfortable, fairly
quiet room is best so that there's not too much distraction.
 Advertising is key. If people don't know about it, they won't
come. Good ways to advertise are facebook events, e-flyers, and
physical flyers. If you're coordinating with an RA or a PHE, ask them
to help you advertise.
 Keep it fun an interactive. Icebreakers are really important. Try to
break up talking with demonstrations, games, and contests.
 Bring props. Although your audience will undoubtedly be staring at
your lovely face, they will probably want something else to look
at. Plus, vagina puppets and colorful dildos always get a
laugh. Consider bringing testers of different kinds of lubes so that
people can feel the difference between the different kinds.
 Keep it organized. Write an outline, use a powerpoint, or verbally
outline your presentation. This gives you more legitimacy and helps
your audience stay focused.
 Always mention the SHPRC. Even if people learn lots and have a great
20
time, if they still don't know who we are, they can't continue to benefit
from our resources. Explain where we're located, our hours, and the
services we provide.
E-Resources:
 Materials inventory: http://stanfordshprc.wordpress.com/stafflog/outreach-resources/outreach-materials-inventory/
 Sample outreaches: http://stanfordshprc.wordpress.com/stafflog/outreach-resources/sample-outreaches/
 Outreach games: http://stanfordshprc.wordpress.com/stafflog/outreach-resources/outreach-games/
 Materials checkout form:
http://spreadsheets.google.com/viewform?key=pacw6PdYjNsh3aEOX
iUntYg
21
SEXUAL BEINGS
ANATOMY AND PHYSIOLOGY OF REPRODUCTION
Female Anatomy and Physiology
Menstrual Cycle
Male Anatomy and Physiology
SEXUAL HEALTH MAINTENANCE
Female
Male
SEXUAL HEALTH EXAMS
Female
Male
CANCER SELF-EXAMS
Breast Cancer
Testicular Cancer
SEXUAL EXPRESSION
Safer Sex Choices
Sexual Response Cycle
The Range of Sexual Expression
Self-pleasure
22
Anatomy and Physiology of Reproduction
Female Anatomy and Physiology
Vulva: A woman’s external sex organs.
23
Internal Structure of
the Clitoris
Clitoris
 The only organ in the human body whose sole purpose is sexual
pleasure.
 Analogous to the penis- made of spongy tissue that swells with
blood during sexual excitement and is highly sensitive to touch (the
clitoris has more nerve endings than a man's entire penis!)
 The external tip of the clitoris is visible at the top of the vulva,
where the inner labia come together.
 The internal structure includes a shaft and two crura (roots or
legs) of tissue that extend up to five inches into a woman’s body on
both sides of her vagina to attach to the pubic bone.
 A small flap of skin called the clitoral hood protects the clitoris.
Labia minora and majora
 The sets of lips on the vulva.
 The labia majora are analogous to the male scrotum, and are
typically fatty and covered with pubic hair.
 The labia minora, analogous to the skin on the shaft of the male's
penis, are typically thinner and hairless, and vary widely in shape,
24
color, and texture.
Many women worry that they are abnormal because their inner labia
are longer than their outer labia, but this is in fact extremely common
and perfectly normal.
Mons
 The fleshy, triangular mound above the vulva that is covered with
pubic hair in adult women. It cushions the pubic bone.
Bartholin’s Glands
 Located on each side of the vaginal opening.
 Analogous to the male bulbourethral glands.
 Secrete minute amounts of lubrication just before orgasm. The
amount of secretion from these glands is very small in comparison
to the secretions from inside the vagina.
Urethra
 The orifice just below the clitoris from which women urinate.
 Very close to the vaginal opening, so bacteria can easily be spread
to it, leading to Urinary Tract Infections (UTIs).
25
Internal Structures
26
Vagina
 The flexible passageway that connects the vulva to the uterus.
 Three functions: to allow menstrual blood to leave the body, to
allow sexual penetration, and to allow a fetus to pass during vaginal
delivery.
G-Spot
 A spongy tissue located about one-third of the way up the vagina on
the anterior (facing the bellybutton) side.
 Stimulation of the G-Spot can produce intense sexual stimulation
and orgasm, and is associated with female ejaculation in about ten
percent of women.
 Stimulation of the G-Spot can be accompanied by the urge to
urinate, but this is just because the organs are all located in very
close proximity. Sufficient arousal before G-Spot stimulation can
lessen this urge.
Skene’s Glands
 The glands that gush fluid during female ejaculation.
 Located on opposite sides of the opening to a woman’s urethra
(part of the reason why some people think that female ejaculate is
just urine).
Cervix
 The opening to the uterus, located at the top of the vagina.
 The cervical opening is very small, and apart from special
circumstances like birthing, sperm and menstrual blood are the
only things that can get in and out.
Ovaries
 Analogous to the male testicles.
 They are paired structures in the body cavity that house the
enlargement and development of the egg.
Ovulation
 Approximately every four weeks, a mature egg is released from the
ovaries into the body cavity.
27
Fallopian Tubes
 After ovulation, the egg is almost immediately swallowed by the
end of one of the fallopian tubes, which are attached to the uterus.
 While in the fallopian tube, the egg is viable for two to three days
and it is here that fertilization will occur.
 There are small hair-like structures (cilia) lining the inside of the
tube that propel the otherwise non- mobile egg toward the uterus.
Uterus
 A muscular, thick-walled cavity, the size of a fist.
 Lined by the endometrium, a layer of cells that thicken one week
before ovulation and become laced with blood vessels.
 If fertilization occurs, the fertilized egg (zygote) implants itself in
the endometrium and a placenta develops. Nutrients and waste
products are exchanged between the mother and the embryo
through the placenta.
28
General Menstrual Issues
Menstrual Cycle
NetWellness: Pregnancy
http://www.netwellness.org/healthtopics/pregnancy/pregmenstrualcycle
The menstrual cycle reflects the complex interaction of two different cycles
of hormones: the ovarian and uterine cycles. Most cycles are about 28 days
long, but variation of a few days or more and small variations from cycle to
cycle is also normal. Day 1 of menstrual bleeding is referred to as day 1 of
the menstrual cycle. The length of the cycle is measured from Day 1 of one
cycle (bleed) to Day 1 of the next cycle (bleed).
Ovulation occurs on approximately day 14 of a woman’s cycle and is when a
mature egg is released from the ovary, moved down the fallopian tube and is
available to be fertilized. At this point, the lining of the uterus has thickened
to prepare for a fertilized egg. If fertilization does not occur, the uterine
lining, which at this point is thick with blood vessels and glandular tissue,
will be shed. This shedding is what is known as menstruation.
29
Ovarian Cycle
The ovarian cycle involves changes in the ovaries, and can be further
divided into two phases:
Follicular Phase
The follicular phase (days 1 through 13) is the time from the first day of
menstruation until ovulation, when a mature egg is released from the
ovary. It's called the follicular phase because growth or maturation of the
egg is taking place inside the follicle, a small sac where the egg matures.
Ovulation occurs around day 14 of the cycle, in response to a surge of
luteinizing hormone (LH).
Luteal Phase
The luteal phase (days 14 through 28) is the time from when the egg is
released (ovulation) until the first day of menstruation. It refers to the
corpus luteum, a mass of cells in the ovary that release hormones after
ovulation.
Important Facts to Know About Ovulation:
 An egg (ovum) lives in the fallopian tube 12-24 hours after leaving
the ovary
 Normally only one egg is released each time of ovulation
 Ovulation can be affected by stress, illness or disruption of normal
routines
 Some women may experience some light blood spotting during
ovulation
 Implantation of a fertilized egg normally takes place 6-12 days after
ovulation
 Each women is born with millions of immature eggs that are
awaiting ovulation to begin
 A menstrual period can occur even if ovulation has not occurred
 Ovulation can occur even if a menstrual period has not occurred
 Some women can feel a bit of pain or aching, near the ovaries
during ovulation. This is called "mittleschmerz"
 If an egg is not fertilized, it disintegrates and is absorbed into the
uterine lining
30
 Sperm can live in a woman's body up to 5 days after intercourse,
though more often 2 days.
 Pregnancy is most likely if intercourse occurs anywhere from 3
days before ovulation until 2-3 days after ovulation.
Uterine Cycle
The uterine cycle involves changes in the uterus. It occurs in tandem with
the ovarian cycle, and is divided into two phases:
Proliferative phase: days 5 through 14
The time after menstruation and before the next ovulation, when the
lining of the uterus increases rapidly in thickness and the uterine glands
multiply and grow.
Secretory phase: days 14 through 28
The time after ovulation. When an egg is not fertilized, the corpus luteum
gradually disappears, estrogen and progesterone (hormone) levels drop,
and the thickened uterine lining is shed in a menstrual period.
31
Male Anatomy and Physiology
External Structures
Male external genitalia come in
many shapes and sizes. It's normal
for the penis to be several shades
darker than the rest of the body, and
also for it to change colors when it's
erect. Many men have pubic hair
that extends down the shaft of their
penises, and many notice that veins
appear along the length of their
penises upon erection.
Many men are concerned about the
length of their penises. The average length of a penis is 5-6 inches, but keep
in mind that this is purely an average. There are plenty of penises that are
both longer and shorter than this that are healthy, normal, and desirable.
32
Urethra
 Where urine, pre-ejaculatory fluid, and ejaculate all come out.
 This is different from the woman's urethra, which only serves
urinary purposes.
Glans
 Also known as the head of the penis.
 A mushroom-shaped section that makes up the end of the penis.
Corona
 A ridge that runs along the edge of the glans, and turns into a "V" on
the bottom of the penis.
Frenulum
 The area just below this "V" shape below the corona.
 Can be the most sensitive spot on a man's penis.
Foreskin
 In uncircumcised men, the loose piece of skin that covers the head
of the penis.
A little more than half of US men have their foreskin removed in a
circumcision in infancy (American Academy of Pediatrics).
33
Erectile Tissue
Corpus Cavernosa
 Two spongy bodies of tissue that run along the top of the penis.
 Contain most of the blood in the penis during erection.
 These tissues extend into the body to give the leverage necessary
for the penis to become erect.
Corpus Spongiosum
 Spongy body of tissue that runs along the urethra.
 Its purpose is to prevent the urethra from pinching closed during
erection so that semen can be ejaculated upon orgasm.
Spermatogenesis, Emission, and Ejaculation
Spermatogenesis, the production and development of sperm, occurs
optimally at the temperature approximately 6 degrees F below body
temperature. This is why sperm are produced in the testicles, located in the
scrotum, which hangs down from the body.
Testicles
 Two glands that hang inside the scrotum.
 Site of spermatogenesis.
 Produce hormones, including testosterone.
Seminiferous Tubules
 A network of tightly coiled, tiny tubules in the testes that constantly
produce sperm.
Epididymis
 Structure that sits on top of the testes.
 Where sperm are stored to mature and become motile.
 Sperm that are not ejaculated live in the epididymis for 4-6 weeks
before they die and are reabsorbed into the body.
Vas Deferens
 A long, narrow tube that connects the epididymis to the seminal
vesicles during ejaculation.
34
Emission
 Sperm moves from the epididymis to the ejaculatory ducts and
combines with various ejaculatory fluids to form semen.
Semen
 Fluid containing sperm that is ejaculated upon orgasm.
 Composed of fluids from the seminal vesicles and prostate and
sperm from the testes.
 Contains mucus, protein, and sugars for energy.
Seminal Vesicles
 Two glands beneath the bladder and adjacent to the vas deferens.
 Produce seminal fluid.
Prostate Gland
 Located below the bladder.
 Produces a fluid that helps sperm move.
 Very sensitive to touch–also known as the “Male G-Spot” or “PSpot.” Typically stimulated through the anus.
Cowper’s Glands, AKA Bulbourethral Glands
 Responsible for the alkaline pre-ejaculatory fluid that is released
from the urethra during sexual arousal.
 The purpose of this is to neutralize and reduce friction in the
urethra to facilitate impending ejaculation.
Ejaculation
 Follows emission and forces the semen out of the penis by wavelike
contractions of the muscles at the base of the penis surrounding the
urethra.
 The rigidity of the penis allows these contractions to force the
semen through the urethra and out of the body
35
Sexual Health Maintenance
Sexual health is just as important as general health, and good health
maintenance is necessary to maintaining overall health.
Female Sexual Health Maintenance
Scarleteen: Sexual Health 101- Hers
http://www.scarleteen.com/article/body/sexual_health_101_hers
Daily
Diet: Yeast infections, Vaginosis, and Urinary Tract Infections can often be
prevented by simple dietary measures.
 Drink lots of water.
 Avoid refined sugars, processed and fried foods, alcohol, caffeine,
citrus fruits, and foods that may have been contaminated with
pesticides.
 A daily, organic, multivitamin supplement made especially for woman
can help with sexual and reproductive health function.
 Other vitamins, minerals, and herbs that can help with female sexual
and reproductive health:
o Undiluted, unsweetened cranberry juice: helps to keep the
bladder and urinary tract free of unwanted bacteria.
o Fresh organic yogurt with live cultures: restores friendly bacteria
and helps to fight unfriendly bacteria.
o Garlic: natural antibiotic and immune system-enhancer.
o Calcium: reduces bladder irritability and reduces menstrual
cramps.
o Vitamin E: fights infectious bacteria.
o Zinc (plus copper, to balance): aids in tissue repair, acne, and is an
immune-system booster. DO not take more than 50 mg. daily.
o Kelp/Iodine: Supports healthy development of reproductive
organs.
o Essential fatty acids: aids in brain function, menstrual complaints,
and can help alleviate depression.
Genital care
36
 When washing the genitals, use only a gentle, unfragranced soap.
 Fragranced soaps, vaginal "cleansers" or douches are not advised, as
they can upset the pH balance of the vagina, creating infection.
Vaginal mucus and discharge
 Normal vaginal discharge and cervical mucus are yellowish, whitish,
clear, or -- around your period -- slightly brown or pink.
 Normal vaginal mucus or discharge does not itch or smell foul, and
while it can be everything from thin to pasty, it should not have
"chunks" or curdles in it.
 Consult a clincian if vaginal discharge is itchy, has a strong scent, has
curdles in it, or is greenish or very pink (when you are not
approaching or finishing your period.
Monthly
Breast Self-exam
Genital Check
 Look for open, raw or red sores, hard lumps inside the outer labia or
on the mons, or small white cauliflower-like growths or warts.
 If any of these symptoms, itching, burning, or unusual discharge
appear, see a clinician.
Menstrual Care
 It is ideal to use organic, 100% cotton and unbleached menstrual pads
or tampons at the lowest absorbency needed.
 High-absorbency pads or tampons with rayon fibers, which use
bleaches (most commercial brands use both) are not advised, as they
can contribute to Toxic Shock Syndrome, and can also upset the acid
and bacterial balance of the vagina, or irritate the tissue.
 Washable cotton pads or The Keeper or Divacup are also healthy and
ecologically-happy methods of managing menstrual flow.
Biannually
Full STI screen
 Necessary if a woman is sexually active, has engaged previously or
37
presently in manual, oral, vaginal, or anal sex.
 If a couple is together for longer than six months, this can be done
once yearly.
Annually
Female Sexual Health Exam
As Needed




Safer Sex Practices
Birth Control
Pregnancy Testing
Emergency Contraception
Male Sexual Health Maintenance
Scarleteen: Sexual Health 101- His
http://www.scarleteen.com/article/body/sexual_health_101_his
Daily
Diet: Yeast infections, jock itch, and Urinary Tract Infections can often be
prevented by simple dietary measures.
 Drink lots of water.
 Avoid refined sugars, processed and fried foods, alcohol, caffeine,
citrus fruits, and foods that may have been contaminated with
pesticides.
 Vitamins, minerals, and herbs that can help with male sexual and
reproductive health:
o Selenium: aids in prostate function.
o Undiluted, unsweetened cranberry juice: helps to keep the
bladder and urinary tract free of unwanted bacteria.
o Fresh organic yogurt with live cultures: restores friendly bacteria
and helps to fight unfriendly bacteria.
o Garlic: natural antibiotic and immune system-enhancer.
o Zinc (plus copper, to balance): aids in tissue repair, acne, and is an
immune-system booster. DO not take more than 50 mg. daily.
38
o Kelp/Iodine: Supports healthy development of reproductive
organs.
o Essential fatty acids: aids in brain function, and can help alleviate
depression. Aids in the production of sperm and seminal fluids.
Monthly
Testicular Self-exam
Genital Check
 Look for open, raw or red sores, hard lumps, or small white
cauliflower-like growths or warts.
 If you have any of these symptoms or itching, burning, or unusual
discharge from the urethra, see your clinician.
 Consult a clinician if symptoms such as itching, burning, or unusual
discharge from the urethra appear.
Biannually
Full STI screen
 Necessary if you are sexually active, have engaged previously or
presently in manual, oral, vaginal, or anal sex.
 If you and your partner are together for longer than six months, this
can be done once yearly.
Annually
Male Sexual Health Exam
As Needed
 Safer Sex Practices
39
Sexual Health Exams
Sexual health exams can be very intimidating. When having an exam, people
should try to relax and remember that the clinician is there to help them to
maximize their health. To do this she or he needs to know about concerns
and factors or situations that may impact a person’s health. If people do not
feel comfortable revealing these things to their clinician, they may not be
able to help them as fully. They should find a clinician they trust and feel
comfortable talking to them. If they don't feel right with a certain clinician,
it’s important to find another.
An understanding clinician should:
 Be attentive, open, and willing to listen, and should take their time
during each visit.
 Use gender-neutral language instead of assuming patients are
heterosexual.
 Show respect for the individual patient and use gentleness during the
physical exam.
 Be willing to include your partner in health care visits and discussions
if that is your wish.
If a person has specific health considerations, he or she should make sure
his or her clinician will properly address these issues.
Remember:
 It is important to give a clinician a complete medical history.
 It is not sexual identity that puts a person at risk; it is specific
behaviors. For example, gay men are not inherently at higher risk for
infections, but some activities that some gay men participate in put
them at higher risk. Heterosexual people who perform the same
activities are at similar risks.
 Sexual identity is also not the same thing as practice. A clinician may
ask if a person has sex with "men, women or both." Someone may be a
male who is straight but has had sex with men: it is important to be
honest with the clinician about specific sexual activities.
40
Female Sexual Health Exam
Vaden Health Center: Women's Health
http://vaden.stanford.edu/medical/womens.html
Beginning at age 21, women should have a full gynecological, Pap and pelvic
exam once a year. If a woman is under 21 years old and has been sexually
active for three years or more, she should also have a yearly Pap and pelvic
exam.
For women, cervical cancer is linked to Human Papilloma Virus (HPV) and is
easily screened for by a Papanicolaou test (also known as a Pap test, Pap
smear, cervical smear, or smear test). The breasts, ovaries, and uterus are
also examined during the annual exam to help detect any problems. If a
woman has become sexually active, other screening tests for gonorrhea,
Chlamydia, HIV, syphilis, and herpes are done if appropriate.
Female Stanford students can get free annual Well Woman exams at
Vaden, or schedule an appointment with any gynecologist.
A woman should schedule a visit with her gynecologist if she:






Needs her annual Pap test.
Wants to discuss contraception options.
Needs Emergency Contraception.
Wants to have an IUD inserted.
Needs to be fitted for a diaphragm or cervical cap.
Wants to know specifically about his status with respect to sexually
transmitted infections.
 Experiences unusual symptoms (including sores, unusual discharge, or
pain during urination).
 Wants to learn how to give herself a breast self-exam.
To prepare for an exam a woman should:
 Make an appointment with someone she’s comfortable with.
 Schedule the appointment for the middle of her menstrual cycle, when
41





she is not having her period.
Know her health history, her family's health history, her current (if
any) symptoms, and any questions she would like to ask. (Sometimes
writing these things down helps.)
Avoid sexual intercourse, douches, tampons or anything in the vagina
(including medications, spermicides, and lubricants) for 48 hours
prior to her exam.
Bring medications she is taking, including birth control pills.
Urinate before the examination (a full bladder makes the bimanual
exam uncomfortable).
If her period begins within 48 hours of your appointment, she should
call to reschedule for another time.
What to expect:
1. Family and medical history.
2. Discussion: The health care provider will ask questions about sexual
activity, current methods of contraception, and current symptoms (if
any).
3. General physical exam: Blood pressure, weight, abdominal exam.
4. Breast Examination: The practitioner will palpate the woman's
breasts, looking for abnormalities and teaching the patient how to
examine her own breasts.
5. External Examination: The practitioner will look at the external
structures of the vulval area. If you are having any unusual symptoms,
this is a good time to bring them up.
6. Speculum Examination: A plastic or metal speculum is inserted into
the vagina, and it is opened. The vaginal walls and the cervix (opening
to the uterus) are examined. If a Pap test is planned, the examiner
uses a small spatula-like instrument to gently scrape the cervix. This
test microscopically examines cervical cells in order to detect
abnormalities, including pre-cancerous changes.
7. Bi-manual Examination: The practitioner inserts one or two fingers
into the vagina, and using the other hand on the abdomen, palpates
the uterus and ovaries.
8. Testing: Pregnancy testing and tests for sexually transmitted
infections and HIV are also available at this time.
42
Bi-manual
Examination
Speculum
Examination
43
Male Sexual Health Exam
Needed routinely once every few years, or more frequently if there are
symptoms or concerns.
A sexually transmitted infection check is recommended for men once they
become sexually active. In addition, having a testicular exam performed and
being instructed in the technique of self testicular examination is of great
benefit to ensuring early detection of this treatable cancer.
Male Stanford students can get free sexual health exams at Vaden, or
schedule an appointment with any urologist.
A man should schedule a sexual health exam if he:
 Is sexually active or about to become so.
 Wants to know specifically about his status with respect to sexually
transmitted infections.
 Experiences unusual symptoms (including sores, discharge, or pain
during urination).
 Wants to have a testicular exam, or to learn more about performing
self-exams.
To prepare for an exam a man should:
 Make an appointment with someone he is comfortable with.
 Know his own health history, his family's health history, his current (if
any) symptoms, and any questions he would like to ask (writing these
down helps).
What happens during an exam:
1. Family and medical history.
2. Discussion: The health care provider will ask questions about sexual
activity, current methods of contraception, and current symptoms (if
44
3.
4.
5.
6.
7.
any).
General physical exam: Blood pressure, weight, abdominal exam.
External Examination: The practitioner will look at the external
structures of the penis and testicles, looking for abnormalities.
External Manual Exam: The practitioner will palpate the penis and
testicles, feeling for lumps and tenderness. Includes testicular exam.
Rectal Exam (sometimes): Practitioner puts one finger in rectum,
feeling for swelling, tenderness.
Testing: Possible tests include a urine test for Chlamydia and
gonorrhea and a blood test for HIV. Additionally, sometimes a swab of
the throat or a rectal culture is also necessary.
Rectal
Exam
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45
Cancer Self-Exams
Breast and testicular cancer are much more curable if caught early on.
College-aged students should get in the habit of giving themselves cancer
self-exams so that any problems can be caught early.
Breast Cancer
American Cancer Society
Both men and women are at risk for breast cancer, but 99 out of 100 cases
occur in women. Breast cancer is the second leading cause of cancer death
among American women, after lung cancer. One out of eight American
women who live to the age of 85 will develop breast cancer at some point in
her life.
The American Cancer Society recommends that all women in their 20s be
taught about the benefits and limitations of a monthly breast self-exam.
Breast cancer is not very common in young women, but getting in the
routine of self-examination and learning about the normal features of the
breasts is best started early. Performing regular breast self-exams can help
to detect any abnormalities early, which is the best way of fighting cancer.
Breast Self Exam
American Cancer Society: How to Perform a Breast Self-Exam
http://www.cancer.org/docroot/CRI/content/CRI_2_6x_How_to_perform_a_breast_self_exam_5.asp
When: Breast self-exams should be performed once a month, when
breasts are least tender, about seven days after you start your period.
It is important for women of all ages to examine their breasts so they
know what is normal.
What to look for: Normal breasts are made up of fatty tissue, milk ducts,
and glands. They may feel lumpy, which is why it's important to learn
what your breasts feel like so you recognize any changes. Look for firm
46
fixed lumps, hard lumps, or lumps with irregular borders, redness,
lumps under arm, or nipple discharge. If you notice anything unusual,
see your clinician.
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How it works:
1. Lie down and put a pillow under your right shoulder. Place your right
arm behind your head.
2. Use the pads of your three middle fingers on your left hand to feel for
any lumps or thickening. Your finger pads are the top third of each
finger. Use overlapping dime-sized circular motions to feel the breast
tissue.
3. Press down using a light, a medium and a firm pressure. If you're not
sure how hard to press, ask your health care provider. Learn what
your breast feels like most of the time. A firm ridge in the lower curve
of each breast is normal.
4. Check your breast in the same way each time, using a vertical up and
down or circular movement.
5. Make sure to feel from your collarbone down to under your breast and
47
back up into your armpit area. This will help you to make sure you
have gone over the entire breast area.
6. Examine the left breast in the same way.
7. Stand in front of a mirror with your hands at your sides. Check for any
puckering or dimpling in the skin or nipple discharge. Put your hands
over your head to check for symmetry, nipple direction and general
appearance. Report any changes to your health care provider.
Testicular Cancer
American Cancer Society: Do I Have Testicular Cancer?
http://www.cancer.org/docroot/PED/content/PED_2_3X_Do_I_Have_Testicular_Cancer.asp
Testicular cancer is the most common
form of cancer found in men age 15-34
(National Cancer Institute). For this
reason, it is especially important for men
of college age and younger to examine
their testicles monthly. Although breast
self-exams are more widely publicized and
encouraged, in a college age population,
testicular self-exams are more likely to
detect a life threatening cancer.
Testicular Self-Exam
When: The best time to do a self-exam is during or after a bath or shower,
when the scrotum is relaxed.
What to look for:
Normal testicles are somewhat lumpy, so you should get to know what
yours are like. Look for changes in consistency, hard lumps, or
unexplained pain in your testicles. If you notice anything unusual, see
your clinician.
48
How it works:
1. Hold the penis out of the way and check one testicle at a time.
2. Hold the testicle between your thumbs and fingers of both hands and
roll it gently between your fingers.
3. Look and feel for any hard lumps or smooth rounded bumps (nodules)
or any change in the size, shape, or consistency of the testes.
Remember that each normal testis has an epididymis, which feels like
a small "bump" on the upper or middle outer side of the testis. Normal
testicles also contain blood vessels, supporting tissues, and tubes that
conduct sperm.
4. Look for visible puckering of the skin or unusual lumps that stand out
from the rest of the scrotum.
Testicular cancer has a 97% cure rate if it is caught in the early stages. It
should be one of the easiest cancers to treat, but many men ignore the
symptoms until the disease has progressed. A simple exam once a month is
worth it to keep your testicles in good shape.
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Section Review Questions
1. If someone came in and asked where the clitoris is, how would you
explain it to him/her?
2. A student comes in, anxious about his or her upcoming reproductive
health exam. How can you reassure him or her about the exam?
3. You're tabling at Stanford's American Cancer Society Fair. What sort of
information can you give a student who comes up to your table?
50
SEXUAL EXPRESSION, PLEASURE, &
THEIR MANY FORMS
SEXUAL EXPRESSION
Safer Sex Choices
SEXUAL RESPONSE CYCLE
Linear Model
Circular Model
Non-Linear Model
SELF-PLEASURE
Self-pleasure Tips
Orgasm (or not)
Taking Care of Oneself
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Sexual Expression
Every human being has a sexual identity and is a sexual being. This fact may
seem obvious, but is often unclear. Some people feel very comfortable
displaying their sexual identities; others do their best to deny that they are
sexual in any way. However obvious these sexual identities may or may not
be, there are as many of them as there are people. Along these lines, there is
a vast spectrum of sexual expression.
A few behaviors within the spectrum:
Holding hands
Self-pleasure
Massage
Oral-genital sex
Oral-anal sex
Fantasy
Watching porn or erotic movies
Reading erotic novels, stories
Penile-vaginal intercourse
Anal intercourse
Mutual masturbation
Kissing
The range of sexual expression is limited only by the extent of human
creativity. Some of these behaviors carry with them a level of risk, and so
warrant a discussion of appropriate protective and contraceptive
strategies. It is important to understand that individual behaviors can be
risky, but no sexual identity is inherently more risky than another.
Becoming comfortable with sexual identity is challenging for some
people. Keep in mind that SHPRC peer counselors are not trained
therapists, and are not there to spruce up anyone’s love life or offer
professional counseling. However, they are happy to refer students to
other more appropriate resources, like Counseling and Psychological
Services (CAPS) or any of the books in the lending library.
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Safer Sex Choices
The SHPRC advises and suggests ways of limiting risk, but does not endorse
or discourage particular behaviors. An SHPRC counselor should always be
non-judgmental with regard to personal sexual decisions. It is our goal to
give realistic advice on risk prevention, but never to be prescriptive.
Making educated evaluations of risk for particular activities is difficult. The
SHPRC offers specific information on preventing pregnancy and on
prevention of sexually transmitted infections. In terms of preventing
sexually transmitted infections, there are three general principles referred to
as Safer Choices to help guide people who wish to be safe and responsible in
their sexual expression. Abstinence is also included as a safer choice because
the ambiguous nature of the term can include some sexual contact.
Safer Choices:
1. Monogamy: Have only one sexual partner.
2. Testing: Get tested for sexually transmitted infections before engaging
in sexual activity.
3. Barrier Methods: Use condoms and dental dams to prevent fluids
(semen, vaginal fluid, blood) from contacting each other.
4. (Abstinence): Don't engage in sexual activity with anyone except
yourself. Employing this strategy alone carries the least risk, but is
impractical for many people.
These strategies can be used together for even greater levels of protection,
or employed individually depending on the situation. These are "safer"
choices because they aren't risk free. HPV, herpes, and other STIs can be
transmitted from skin-to-skin contact, at times even when they are
asymptomatic. For more information, please review the STI section.
53
Sexual Response Cycle
Association of Reproductive Health Professionals: What You Need to Know About Female Sexual Response
http://www.arhp.org/uploadDocs/FSRfactsheet.pdf
The sexual response cycle is the physiological changes in our bodies’ arousal
and orgasm. The first mode is a linear (meaning one follows the next in a
forward-only fashion) four-stage cycle of sexual response: excitement,
plateau, orgasm and resolution.
Linear Model
Excitement Phase: Increase in
heart rate, muscle tension and
blood flow, engorgement of the
genitals, lips and breasts;
general body warmth and
flushed skin.
 Women: vaginal lubrication,
swelling of the clitoris and
vaginal lips, nipple erection
 Men: erection, contraction of
the scrotum and elevation of
the testicles, nipple erection
Plateau Phase: a continuation and heightening of the excitement phase.
 Women: clitoris retracts under the clitoral hood; the outer third of the
vagina becomes even more congested with blood
 Men: secretion of a clear fluid, a.k.a. "pre-cum," from the urethra. If the
man has not urinated since his last ejaculation, pre-cum can contain
some sperm.
Orgasm: the discharge of sexual tension through involuntary muscular
contractions, which releases the blood from engorged genital tissue.
Resolution: the body returns to an unaroused state. (Takes longer without
orgasm.)
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Modern Models
As time progressed, sexologists began to notice that many people's sexual
response was not linear. Several new models were proposed., which better
reflect sexual response. The two models that best reflect female sexual
response are the Circular and Non-linear Models (though keep in mind that
no one fits a model exactly.)
Circular model (Whipple and Brash-McGreer)
This model has a different four
stages than the linear model:
Seduction (desire)
Sensations (arousal and
plateau)
Surrender (orgasm)
Reflection (resolution).
In this model, positive and
satisfying sexual experiences
can have a reinforcing effect on
the next sexual experience. If a
person reflects that the sexual
experience was positive, the
seduction stage of the next
sexual experience can be
reinforced and heightened and
vice versa. All of the physical
changes in a person’s body are
the same as the first model describes.
Non-linear Model (Basson)
The non-linear model emphasizes the effect of emotional intimacy, sexual
stimuli, and relationship satisfaction on a sexual encounter. This model
55
acknowledges that sexual
functioning is by numerous
psychosocial issues (e.g.,
satisfaction with the
relationship, self-image,
previous negative sexual
experiences).
Although some people may
experience spontaneous desire
and interest, many others do not. Rather, the motivator is a desire for
increased emotional closeness and intimacy. The desire for intimacy
prompts people to seek ways to become sexually aroused via conversation,
music, reading or viewing erotic materials, or direct stimulation. The goal of
sexual activity for women is not necessarily orgasm but rather personal
satisfaction, which can manifest as physical satisfaction (orgasm) and/or
emotional satisfaction (a feeling of intimacy and connection with a partner).
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Self-Pleasure (Masturbation)
Scarleteen: Sexual Response & Orgasm: A Users Guide
http://www.scarleteen.com/article/sexuality/sexual_response_orgasm_a_users_guide
Note: the derivation of the word masturbation (from the Latin manus ["hand"]
and turbare ["to disturb"]) has negative connotations inconsistent with a sexpositive philosophy. That said, whenever possible we will try to the term selfpleasure in lieu of masturbation.
Although self-pleasure is one of the safest alternatives to sexual intercourse,
it is hardly ever talked about. However, it has been determined that there
are tangible benefits from self-pleasure, such as a decrease in depression
and stress, and an increased sense of self-worth. It has also been found to
decrease insomnia and lower one's blood pressure that carries through to
other stressful situations in one's life.
Even the most knowledgeable people can have problems with enjoying sex
and achieving orgasm. Sometimes, it’s about how their feelings come into
play during sex. They may feel that sexuality is wrong, or they are doing
something that doesn't feel right to them. Self-pleasuring can be a no-risk
way to figure out how someone feels most comfortable and healthy. . The
best way – as well as the safest both physically and emotionally – to start
exploring and understanding one’s sexuality is with his or her own two
hands.
Self-pleasure tips
Preparation: Get comfortable. Find out what relaxes the mind and body.
The space should BE comfortable, without fear of someone walking in.
Release Inhibitions: Any and all sexual fantasies are allowed. With selfpleasure, one doesn’t need to worry about hurting anyone's feelings: it's all
in the head and no one else knows.
Techniques: People often ask what the "right" way is to self-pleasure, but
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the truth is that the only "right" things to do are the things that feel good to
each person.
Many men enjoy stimulating their penis and testicles with their hands by
rubbing or stroking them. Most women enjoy rubbing or stroking the clitoris
and other areas of the vulva with the hands and fingers, with running water
from a water source like the shower or faucet, or with a vibrator.
Remember, someone can have plenty of sexual pleasure and even orgasm
without necessarily stimulating the genitals.
Orgasm (or Not):
Orgasm is achieved by doing what feels good. Follow what feels better than
other things, and just keep doing what works. More self-pleasuring means
more awareness about what is arousing to and what triggers orgasm for
each person.
Self-pleasure may or may not bring cause orgasm, and it may not be
necessary. Sometimes, it feels good just to get aroused and then stop.
(Sometimes an uncomfortable pressure in the body occurs without orgasm,
but that can be relieved by some simple exercise or rest, or even with a
couple of aspirin or ibuprofen.)
Understand that orgasm isn’t a guarantee. The body is a complex system:
sickness, stress, fatigue, preoccupation, or guilt makes it difficult to feel
sexual pleasure, let alone orgasm. If this happens, the person should do
something else that is enjoyable and listen to what his or her body is saying.
Taking Care of Oneself
Self-pleasure can help us in that way to be in charge of one’s own sexuality,
without pressuring others to get involved. Sometimes people say that they
“need to get laid,” but self-pleasure can alleviate such needs. No one should
depend upon someone else to make them feel sexually satisfied -- no one is
responsible for our sexual pleasure but the person him- or herself.
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Section Review Questions
1. List three methods of sexual expression not mentioned in the course
reader. Do some research on the expression (nothing too hard, can be
found on Wikipedia): how is it done, what does it involve?
2. What are the four safer sex choices? Why are they safer?
59
GENITAL HEALTH ISSUES
GENERAL MENSTRUAL ISSUES
Menstrual Cramps
Premenstrual Syndrome
Irregular Periods
Missed Periods
Toxic Shock Syndrome
ERECTILE AND EJACULATORY ISSUES
Premature Ejaculation
Erectile Dysfunction
SEXUALLY-RELATED ISSUES
Mono
Urinary Tract Infections
Pelvic Inflammatory Disease
60
General Menstrual Issues
During their reproductive lives, most women experience menstrual
problems to some degree. Fortunately, they are usually not serious and are
almost always temporary. Because they are so common, most women may
have their own methods of addressing and dealing with the respective
problems, but it is still important to understand the nature of menstrual
problems. Many treatments exist for each problem, from prescribed
medications to over-the-counter painkillers, to natural, at-home remedies.
Menstrual Cramps (Dysmenorrhea):
Mayo Clinic: Menstrual Cramps
http://www.mayoclinic.com/health/menstrual-cramps/DS00506
Menstrual cramps are dull, throbbing, or cramping pains in the lower
abdomen, which occur just prior to and during menstrual bleeding. Most
women have experienced cramps, which tend to be worse during the first
years of menstruation. Multiple causes have been attributed, including high
levels of prostaglandin hormones, a narrow opening of the cervix, and a
relative lack of blood supply to the muscles of the uterus during cramping.
Risk factors:
 Age younger than 20.
 Early onset puberty (younger than 11).
 Heavy bleeding during periods.
 Never having delivered a baby.
Symptoms:
Typical symptoms:
 Dull, throbbing, or cramping pain the lower abdomen.
 Pain that radiates to the lower back and thighs.
Severe symptoms:
 Nausea and vomiting.
61
 Loose stools.
 Sweating.
 Dizziness.
When to see a clinician: If menstrual cramps disrupt a woman's life for
several days a month or if a woman is older and has just begun to
experience severe menstrual cramps. These may be indications of a more
serious disorder, such as endometriosis, uterine fibroids, adenomyosis,
pelvic inflammatory disease, or cervical stenosis.
Treatment:
 Ibuprofen (Advil and Motrin) and Naproxen (Aleve) both have antiprostaglandin effects and are especially useful if taken before
cramping begins. (Note: Tylenol does not have this effect.)
 Hormonal birth control reduces the severity of menstrual cramps.
 Resting in a comfortable position, stretching, or yoga.
 Warm baths or the application of heat to the lower abdomen.
 Orgasm reduces the congestion of blood and fluid in the pelvic area.
 Vitamin E, thiamin, and omega-3 supplements may help reduce
menstrual cramps.
Premenstrual Syndrome (PMS):
Mayo Clinic: Premenstrual Syndrome (PMS)
http://www.mayoclinic.com/health/premenstrual-syndrome/DS00134
PMS is the name given to the set of symptoms that begin a short time before
menstruation occurs. An estimated 75% of women experience some form of
PMS. Hormonal and chemical changes play a large role in monthly PMS
symptoms. Insufficient levels of the neurotransmitter seratonin can
contribute to premenstrual depression, fatigue, food cravings, and sleep
problems. Preexisting stress and depression can aggravate many PMS
symptoms. Fluid retention, caffeine, alcohol consumption may be other
causes of many other PMS symptoms. Symptoms usually disappear once
actual menstrual bleeding occurs.
Symptoms: Most women with PMS symptoms experience only a few of
62
these problems.
Emotional and behavioral:
 Tension or anxiety.
 Depressed mood.
 Crying spells.
 Mood swings and irritability or anger.
 Appetite changes and food cravings.
 Insomnia.
 Social withdrawal.
 Poor concentration.
Physical:
 Joint or muscle pain.
 Headache.
 Fatigue.
 Weight gain from fluid retention.
 Abdominal bloating.
 Breast tenderness.
 Acne flare-ups.
 Constipation or diarrhea.
Treatment: (In addition to those listed above for menstrual cramps.)
 Antidepressants can be successful in reducing symptoms of fatigue,
food cravings, and sleep problems.
 Ibuprofin or naproxen can alleviate symptoms of breast tenderness
and cramping.
 Diuretics can treat fluid retention by shedding excess water through
the kidneys.
 Oral contraceptives can help stabilize the physical and emotional
symptoms of PMS.
 Relaxation and stress reduction techniques (plenty of sleep, muscle
relaxation, yoga, and massage).
 Avoiding salt and salty foods, as well as caffeine and alcohol up to a
week prior to menstruation help reduce bloating and fluid retention.
 Eating calcium-, magnesium-, and potassium-rich foods.
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 Drinking at least 6-8 glasses of water per day.
 Taking a daily multivitamin supplement.
 Exercising at least 30 minutes a day, three times a week.
Irregular Periods (Oligomenorrhea):
Women's menstrual cycles vary widely and are considered regular if they
can be predicted within a few days, do not last more than seven days, and do
not cause the loss of more than four tablespoons of blood. When a woman's
menstrual cycle is unpredictable, it may be the result of a hormone
imbalance or a lack of ovulation. These imbalances are very common during
the first few years of menstruation, just prior to menopause, and during
stressful times in a woman's life.
Possible causes:
 Pregnancy.
 Stress.
 Poor diet
 Extreme weight loss or gain.
 Intense exercise.
 Menopause.
 Hormonal birth control.
Treatment: Unless there is a medical condition causing irregular cycles,
treatment is not usually necessary. Most women's cycles will eventually
settle into a regular pattern. However, a clinician should be consulted for
all persistent irregular bleeding patterns because there may be
underlying causes such as infections, hormonal imbalances, or pregnancy.
Missed Periods (Amenorrhea):
Mayo Clinic: Amenorrhea
http://www.mayoclinic.com/health/amenorrhea/DS00581
Primary amenorrhea refers to not having menstrual periods by the age of 16.
Secondary amenorrhea describes when a women previously had menstrual
periods, but has stopped menstruating. While occasional missed periods are
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frequent among all women, a woman should see her clinician if she has not
begun menstruating by age 16, or if she has previously menstruated, but has
missed three or more periods in a row. Pregnancy is the most common
reason for amenorrhea, but there are other causes as well. If there is any
possibility of pregnancy, it should be investigated as soon as possible.
Possible causes of primary amenorrhea:
 Chromosomal abnormalities.
 Hypothalamus problems.
 Pituitary disease.
 Lack of reproductive organs.
 Structural abnormality of the vagina.
Possible causes of secondary amenorrhea:
 Pregnancy.
 Contraceptives.
 Breastfeeding.
 Stress.
 Medication.
 Hormonal imbalance.
 Low body weight.
 Thyroid malfunction.
 Pituitary tumor.
 Uterine scarring.
 Premature menopause.
 Illness.
 Depression.
 Strenuous exercise.
 Travel.
 Change in sleep patterns.
 Excessive weight gain or loss.
Treatment: Treatment depends on the cause of the amenorrhea. Often
simply removing the cause of stress or reducing exercise will bring back
normal periods. It is common for college students, for example, to miss
periods while at school, only to resume them once they return home. If
eliminating causative factors fails, different hormone treatments may be
65
used to bring on bleeding and ovulation.
Toxic Shock Syndrome (TSS)
Mayo Clinic: Toxic Shock Syndrome
http://www.mayoclinic.com/health/toxic-shock-syndrome/DS00221
What it is: Toxic shock syndrome is a rare but serious illness most often
caused by toxins released from the Staphylococcus aureus (also known as
staph) bacteria, though sometimes caused by toxins produced from group
A streptococcus (strep) bacteria. This potentially serious problem is most
often associated with menstruating women who are using a tampon or
contraceptive sponge during their periods, but about half of current cases
occur in non-menstruating women, men, and children. In menstruating
women, it is believed that the bacteria grow in the blood trapped in the
vagina by the tampon or sponge. In others, the bacteria grow in a cut or in
an open sore.
Symptoms: The symptoms develop rapidly, and almost always during
menstruation. A woman who develops any of these symptoms while
menstruating should get medical help immediately.
 A sunburn-like rash, particularly on the palms or soles.
 Fever (101 degrees or more).
 Low blood pressure.
 Diarrhea.
 Vomiting.
 Muscle aches.
 Confusion.
 Redness of the eyes, mouth, and throat.
 Seizures.
 Headaches.
Testing and Diagnosis: The infection is diagnosed based on symptoms,
blood and urine samples, and a culture of vaginal secretions.
Treatment: Antibiotics are used to treat the illness. Because this serious
66
disease develops very quickly, it is important to get immediate medical
help if symptoms develop.
Complications: This is a very serious illness because 10% of patients who
are hospitalized for TSS die. The infection is extremely rare, though, and
affects only 3 out of every 100,000 menstruating women.
Prevention:
 Avoid super-absorbent tampons. Use "regular", rather than "super"
tampons.
 Change tampons frequently, at least every four to eight hours.
 Avoid scratching or irritating the lining of the vagina when the vagina
is dry or if there is little bleeding (if the tampon sticks to the walls of
the vagina).
 Don't use tampons 24 hours a day. Alternate with pads (maybe wear
pads at night).
 Wash hands before inserting tampons. Be sure that tampons and
applicators are clean and contamination free.
 Don't use tampons if you have had TSS, if you believe you have had
mild TSS symptoms, or if staph bacteria have been found in your
vagina.
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Erection and Ejaculatory Issues
Nearly all men have experienced erection or ejaculation issues at some point
in their lives, but the frequency of these problems do not make them any less
distressing. Both of these issues usually disappear with relaxation and
exercises.
Premature Ejaculation
Mayo Clinic: Premature Ejaculation
http://www.mayoclinic.com/health/premature-ejaculation/DS00578
Whether a man is ejaculating "prematurely" or not is subjective. There are
no absolutes when it comes to how long intercourse "should" take place
before a man ejaculates. Whether the time involved is a minute or an hour,
ejaculation is only premature if either partner wishes it had been delayed.
Still, premature ejaculation is a very common sexual complaint among men:
as many as one of three men may have been affected by this "issue" at some
time. Premature ejaculation can be classified to either primary (lifetime) or
secondary (acquired).
Risk Factors:
 Erectile dysfunction.
 Health problems.
 Stress.
 Certain medications.
Possible Causes:
Psychological:
 Negative feelings about sex.
 Erectile dysfunction.
 Anxiety.
 Relationship problems.
Biological:
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Abnormal hormone levels.
Abnormal levels of neurotransmitters.
Abnormal reflex activity of the ejaculatory system.
Thyroid problems.
Inflammation and infection of the prostate or urethra.
Inherited traits.
Nervous system damage.
Withdrawal from narcotics.
Symptoms:
Primary (International Society for Sexual Medicine):
 Ejaculation that always or almost always occurs within a minute of
less of sexual activity.
 The inability to delay ejaculation on all or nearly all sexual activities.
 Negative personal consequences due to the situation, such as distress,
frustration, or the avoidance of sexual intimacy.
Secondary (Diagnostic and Statistical Manual of Mental Disorders [DSM]):
 Develops after a man has had satisfying sexual relationships without
ejaculatory problems.
 Persistent or recurrent ejaculation with minimal stimulation before,
on, or shortly after sexual activity.
 Personal distress and relationship problems.
Treatment:
Exercises: The best way to gain control over one's physical responses is to
increase rather than decrease awareness of sensation. Learn to identify
the moment of "ejaculatory inevitability" right before orgasm. Start by
masturbating. Pay attention to your level of arousal, and when you feel
you're about to reach orgasm, stop moving, stop touching yourself for a
moment and let the arousal ebb slightly before starting up again. Repeat
this a few times and see how long you can stimulate yourself each time
before you have to back off again. It's usually recommended that a man
learning to control ejaculation progress from masturbating with no
lubricant, to masturbating with lubricant, to intercourse with his partner
on top of him while he lies still, to intercourse with him moving.
69
The "squeeze technique": With this method, you forestall an imminent
orgasm by grasping the area right below your glans (with your four
fingers lined along the bottom of the penis while the thumb squeezes the
top of the tip) between your thumb and forefingers, and squeezing. After
the urge to ejaculate has passed, wait 30 seconds, then resume
stimulation and build yourself up to the point of ejaculatory inevitability
again. Doing this helps teach you how to delay ejaculation, with the end
goal being able to delay ejaculation during sexual activity.
Kegal exercises: These also
control one's control over
ejaculation. Though Kegal
exercises are associated with
women and childbirth, they
have benefits for men as well.
These exercises strengthen the
pelvic floor muscles, allowing
one to willfully stop orgasm.
To find the pelvic floor
muscles, try to stop the flow of
urine next time you use the
rest room. Squeezing these
muscles as one would conduct other exercises strengthens the pelvic
floor muscles.
Other treatment options:
 Masturbating an hour or two before intercourse.
 Avoiding sexual intercourse for a period of time to decrease the
pressure surrounding intercourse.
 Taking antidepressants.
 Topical anesthetic creams. (Some condoms come with this for
"prolonged pleasure.")
 Psychotherapy.
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Erectile Dysfunction
Mayo Clinic: Erectile Dysfunction
http://www.mayoclinic.com/health/erectile-dysfunction/DS00162
Previously referred to by the loaded term “impotence”, erectile dysfunction
(ED) is defined as the inability to sustain an erection sufficient for sexual
intercourse at least twenty five percent of the time. Most men experience ED
at one point or another in their lives, and the occasional inability to maintain
an erection is perfectly normal. However, ongoing erection problems can be
the result of more serious physical or psychological problems. If ED is more
than a temporary problem, it's important to see a clinician. For more
information about the physical process of erection, review the "Male
Anatomy and Physiology of Reproduction" section.
Risk factors:
 Aging.
 Having a chronic health condition.
 Taking certain medications (antidepressants, antihistamines, etc.)
 Certain surgeries or injuries that damage the nerves that control
erection.
 Substance abuse.
 Stress, anxiety, or depression.
 Smoking.
 Obesity.
 Prolonged bicycle riding.
Possible causes: Remember that erection is a physical process and
problems can occur at any stage in this process. Your brain must send a
signal pumping blood into the penis, the tissues in the penis must fill with
enough blood to create an erection, and the erectile tissues must expand
against their surrounding membrane with enough force to squeeze shut
the veins that would normally carry the blood back out of the penis.
Physical:
 Heart disease.
 Clogged blood vessels.
 High blood pressure.
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Diabetes.
Obesity.
Metabolic syndrome.
Certain prescription medicines.
Tobacco use.
Alcoholism and other forms of drug abuse.
Treatment for prostate cancer.
Parkinson's disease.
Multiple Sclerosis.
Hormonal disorders such as low testosterone.
Peyronie's disease.
Surgeries or injuries that affect the pelvic area or spinal cord.
Psychological:
 Depression.
 Anxiety.
 Stress.
 Fatigue.
 Poor communication or conflict with your partner.
Testing and diagnosis: Your clinician will ask questions about how and
when your symptoms developed, what medications you take and any
other physical conditions you might have. Your clinician will also want to
discuss recent physical or emotional changes.
In order to determine whether the symptoms are physical or
psychological, a clinician can fit a special perforated tape around your
penis. If the tape is separated in the morning, then you are having
erections when you sleep, and presumably your difficulties with erection
during waking hours are psychological, not physiological in origin.
If your clinician suspects that physical causes are part of the problem,
there are several things he or she may do:
 Blood tests to check hormone levels.
 Eliminate or replace certain drugs you're taking to try to eliminate
possible causes.
 Perform an ultrasound to check blood low to the penis.
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 Assess possible nerve damage.
 Injecting dye into the penis to view any possible abnormalities in
blood pressure and flow into and out of the penis.
Treatment:
 Medications that relax the muscles in the penis and increase blood
flow.
 Hormone replacement therapy to treat testosterone deficiency.
 Penis pumps can be placed over the penis, creating a vacuum, which
pulls blood into the penis. Once erection is achieved, the pump is
removed and a tension ring is placed at the base of the penis to
maintain the erection.
 Vascular surgery can treat vascular blockages.
 Penile implants are inflatable devices that allow you to control when
and for how long you have an erection.
 Psychological counseling or sex therapy.
Prevention:
 Work to manage conditions that can lead to ED, such as diabetes and
heart disease.
 Limit or avoid the use of alcohol.
 Avoid illegal drugs such as marijuana.
 Stop smoking.
 Exercise regularly.
 Reduce stress.
 Get plenty of sleep.
 Manage anxiety and depression.
It is important to remember that there are a number of other sexual
activities a man can perform on or with his partner without an
erection.
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SEXUALLY-RELATED ISSUES
Urinary Tract Infections
Pelvic Inflammatory Disease
Mono
These issues are referred to as “sexually-related” because while they are
often a result of varying degrees of sexual activity, they do not have to be. It
is important to understand that these do not qualify as sexually transmitted
infections (STIs), but can sometimes be just as serious.
Urinary Tract Infection
Mayo Clinic: Urinary Tract Infection
http://www.mayoclinic.com/health/urinary-tract-infection/DS00286
Urinary tract infections (UTIs) are bacterial infections of the urinary system,
often developing after irritation of the urethra. They are usually caused by
gastrointestinal bacteria (E. coli) or STIs such as herpes simplex, Chlamydia,
and gonorrhea. UTIs are more common in women than in men because of
the short length of women's urethras. Organs that may be affected include
the urethra (urethritis), bladder (cystitis) and/or the kidneys
(pyelonephritis). Because kidney infections are a serious medical problem, it
is important to receive treatment as soon as possible in order to avoid
spread of the infection.
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Risk factors:
 Being female. Females have
much shorter urethras than






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

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The female urethra is much shorter
than the male, making UTIs much
more common in women.
males, which reduces the
distance that bacteria have to
travel to reach the bladder.
Sexual activity. Intercourse can
irritate the urethra, allowing
bacteria to travel from the
urethra to the bladder.
Frequent and vigorous sexual
activity after a period of little
sexual activity ("honeymoon
cystitis").
Failure to urinate frequently
enough.
Failure to drink enough water.
Poor hygiene, such as wiping
back to front towards the
vagina.
Using feminine hygiene sprays,
douches, bubble baths, and
vaginal deodorants. These
contain chemicals that irritate
the urethra and can cause a UTI.
Using a diaphragm or cervical cap. These can put pressure on the
urethra, causing a UTI.
Using spermicides, which can irritate the urethra.
Immunosuppression.
Elderly individuals are more likely to have more bacteria in their
reproductive/urinary systems at any point and are therefore more
likely to develop an infection.
Symptoms:
 Burning during urination.
 A strong urge to urinate frequently, often accompanied by an inability
to void any urine at all.
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 Visible blood and/or cloudiness may be present in the urine.
 Aching or cramping in the lower abdomen.
 If the infection has progressed to the kidneys, fever and general flulike symptoms may be present, along with flank and upper back pain.
Testing and Diagnosis: Symptoms are fairly diagnostic of a UTI.
Microscopic examination of the urine can also be used to detect the
presence of bacteria, pus, and red blood cells. The presence of fever and
flank pain indicates that the infection has moved to the kidneys.
Treatment:
 A practitioner will prescribe antibiotics to eliminate the infection. He
or she may also prescribe a pain medication that numbs the bladder
and urethra to relieve pain upon urination. Symptoms usually start to
clear in a few days, but it is important to finish this medication so that
the infection does not return.
 Several over the counter medications can be taken to reduce pain,
burning, but these do not cure a UTI (Azo-Standard® and Prodium ®)
 Drinking copious amounts of fluids will help discomfort by keeping the
walls of the bladder from touching each other, which can be
uncomfortable. This also dilutes the urine so that the bacteria have
less of a chance to cause irritation.
 Avoid caffeine, alcohol, and soft drinks containing citrus juices until
the infection has cleared. These can irritate the bladder and aggravate
the frequent urge to urinate.
Complications: Kidney infections resulting from untreated UTIs can cause
permanent kidney damage.
Prevention:
 Drink plenty of water each day (6-8 glasses) and do not put off
urinating.
 Avoid irritating the urethra. Use extra lubricant during intercourse if
needed.
 Urinate immediately following intercourse.
 Avoid the diaphragm and the cervical cap.
 Always wipe from front to back after using the bathroom, especially
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after having a bowel movement.
 Avoid douches, deodorants, sprays, powders, and other potentially
irritating feminine products.
 Avoid caffeine, alcohol, and strong spices, all of which are irritating to
the urethra.
 Drink pure cranberry juice or take cranberry capsules. These
prevent E. coli from attaching to the walls of the bladder.
Pelvic Inflammatory Disease
Mayo Clinic: Pelvic Infammatory Disease
http://www.mayoclinic.com/health/pelvic-inflammatory-disease/DS00402
Pelvic inflammatory disease (PID) is an infection of the upper reproductive
tract in women (cervix, uterus, fallopian tubes, and ovaries). It is caused by a
wide variety of sexually transmitted organisms, especially gonorrhea and
Chlamydia, and if left untreated can have serious or fatal complications.
Bacteria move upward from a woman’s vagina or cervix into the internal
reproductive organs. PID affects more than 1 million women each year, of
which about 10% become infertile (Center for Disease Control).
Risk factors:
 Previous episode of PID. The body's defenses are often damaged
during the initial bout of infection.
 Sexually active women under the age of 25: the cervixes of these
women are not yet fully matured, which increases their susceptibility
to the STIs that are linked to PID.
 Having STIs, especially gonorrhea and Chlamydia.
 Multiple sex partners and/or partner(s) with multiple partners.
 Douching.
 Having an IUD inserted while infected with an STI.
Symptoms: Often asymptomatic; PID goes unrecognized 2/3 of the time.
 Abdominal, cervical, and/or uterine pain.
 Fever.
 Unusual vaginal discharge that may have a foul odor.
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 Painful intercourse and urination.
 Irregular menstrual bleeding.
Testing and Diagnosis: PID is difficult to diagnose because the symptoms
are often mild and subtle. Many episodes are undetected because there
are no precise tests for PID.
 Initial diagnoses can often be made based on a history of symptoms
and on a pelvic exam, which shows evidence of PID.
 Cultures of cervical secretions will confirm an infection of the genital
tract.
 An ultrasound can view enlarged fallopian tubes or an abscess.
 A laparoscopy (a minor surgical procedure in which a thin, flexible
tube with a lightened end is inserted through a small incision in the
lower abdomen, allowing the clinician to view the internal pelvic
organs and take specimens for laboratory studies) may be necessary
to confirm the diagnosis.
Treatment:
 PID can be cured with antibiotics, and prompt treatment can prevent
severe damage to pelvic organs. Treatment does not reverse any
damage already done.
 PID is usually treated with multiple antibiotics because more than one
organism may be responsible.
 A woman's partner should also be treated to decrease the risk of reinfection, even if the partner shows no symptoms.
 All medication must be taken to prevent re-infection, even if no
symptoms are present.
 Hospitalization or surgical intervention may be required in more
serious cases.
Complications:
 Infection-causing bacteria can cause normal tissue in the fallopian
tubes to turn into scar tissue, which blocks or interrupts the normal
movement of eggs into the uterus.
 About one in five women with PID become infertile, with increased
chances of infertility after multiple episodes.
 A partially blocked or slightly damaged fallopian tube may cause a
fertilized egg to get stuck in the tube, resulting in an ectopic pregnancy
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if the egg begins to grow into a fetus inside the fallopian tube. Ectopic
pregnancy can rupture the fallopian tube, cause severe pain, internal
bleeding, and even death. Scarring in pelvic structures can also lead to
chronic pelvic pain.
Prevention: PID can be prevented by adhering to safer sex practices to
avoid initial STI infection.
Mononucleosis
Mayo Clinic: Mononucleosis
http://www.mayoclinic.com/health/mononucleosis/DS00352
More commonly known as mono or “the kissing disease,” infectious
mononucleosis is caused by the Epstein-Barr virus. The virus lives in saliva,
so it can be transmitted through kissing, coughing, sneezing, or sharing
infected utensils, cups, etc. The disease most commonly affects children and
young adults. The symptoms of mono will only occur once, but the disease
will remain in the body and can flare up and become infectious at any time.
Risk factors:
 Being a child or a young adult.
 Kissing. The disease is transmitted through saliva.
 Sharing utensils, cups, etc. with an infected person.
Symptoms:
 Fatigue and/or weakness.
 Sore throat.
 Fever.
 Swollen neck and armpit lymph nodes and/or tonsils.
 Headache.
 Skin rash.
 Loss of appetite.
 Night sweats.
 Swollen, soft spleen.
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Testing and Diagnosis: A clinician will look for the above-mentioned
symptoms. Subsequently, antibody tests will reveal the presence of the
Epstein-Barr virus, though such tests may not be accurate within the first
week of the illness.
Treatment:
 Treatment for mono is mostly self-care. There are no specific
treatments.
 Drink plenty of water and gargle with salt water several times a day.
 Get plenty of rest: wait to return to strenuous activities such as sports.
 Sometimes a secondary infection (such as strep throat) will occur,
which will require antibiotics.
 Some antibiotics may cause a rash when someone is infected with
mono. In such cases, the person may switch to different antibiotics.
 Corticosteroids may be used to reduce severe swelling of the throat or
tonsils.
Complications: Enlargement of the spleen can cause it to rupture, which
may require surgery. Problems may also develop with the liver, including
inflammation and jaundice of the skin. Less common complications
include: anemia, low count of platelets, inflammation of the heart,
complications with the nervous system, and swollen tonsils, which may
affect breathing.
Prevention:
 Do not kiss or share utensils, cups, etc. with those who have mono. A
brief kiss is unlikely to spread the virus: saliva much be transmitted.
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Section Review Questions
1. A student comes in who is worried that she is pregnant because she
has not had her period. While acknowledging that possibility, explore
other causes of this situation. Try to formulate it as if you were
actually in a counsel.
2. During your next shower, perform a testicular or breast selfexamination. If you have never done one before or can remember
when you started, make notes of things you would tell people about
what to expect.
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SEXUALLY TRANSMITTED INFECTIONS
STIs: EDUCATION & PREVENTION
TESTING AT AND AROUND STANFORD
Vaden
HIV*PACT
Planned Parenthood
PARASITIC
Crabs
Scabies
BACTERIAL
Chlamydia
Gonorrhea
Syphilis
VIRAL
Human Papilloma Virus (HPV)
The HPV Vaccine
Herpes Simplex Virus I & II
HIV/AIDS
VAGINITIS
Trichomoniasis
Bacteria Vaginosis
Yeast Infections
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Education and Prevention
“STI” is written as it is because of a controversy over the fact that some
sexually transmitted diseases are actually infections (and thus curable), not
chronic conditions as implied by the older term "sexually transmitted
disease." Also, a disease is a manifestation of symptoms and, as you will
learn, maybe STIs can be asymptomatic.
Safer Choices
Employing these strategies does not guarantee protection from all STIs,
but it does significantly decrease your chances of contacting and
spreading STIs. These strategies can be used together for even greater
levels of protection, or employed individually depending on the situation.
 Don’t engage in sexual activity with anyone except yourself. Employing
this strategy along carries the least risk, but is impractical for many
people.
 Have only one sexual partner.
 Get tested for sexually transmitted infections before engaging in
sexual activity with a new partner. Insist that your partner gets tested
as well.
 Use barrier methods (condoms, dental dams) to prevent fluids (semen,
vaginal fluid, blood) from contacting each other.
What does it mean for a sexual activity to be “risky”?
If an activity exposes a mucus membrane, preexisting wound, cut, or sore,
or can cause a wound, cut, or sore, the activity is considered "risky" in
regards to the transmission of STIs.
STIs on Campus
FACT: The three most common STIs on Stanford’s campus are HPV,
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herpes, and Chlamydia (Stanford University Hospital Laboratories). An
estimated 20-25% of college students has or has had a sexually
transmitted disease or infection. (Health Services at Columbia University)
This high rate of STIs highlights the fact that there is a continuing need
for STI education and STI prevention resources on campus. The SHPRC
aims to give students both the knowledge and the motivation to make
safer sex choices.
Further, the prevalence of STIs on college campuses should also serve as
a reminder that many of the people that we reach had, have, or will have
an STI at some point in their lives. Therefore it is important to spread
awareness without spreading stigma about STIs. Remember, except for
viral infections (there is no cure for a virus, only ways to manage them),
all STIs can be treated and cured. We should never attempt to scare
someone into safer sex practices at the expense of alienating someone
else. In fact, our goal is not to scare anyone, but rather to encourage
people to practice safer choices through a realistic picture of risk.
Oral Sex: How Risky?
Many people are unclear on the risks associated with oral sex. Questions
about oral sex and the risk of contracting an STI are very common in
outreaches and at the SHPRC. Many people engage in unprotected oral
sex, and are particularly concerned with the risks associated with not
using protection.
The risks:
 Herpes is generally the biggest STI risk during oral sex. Both strains of
herpes can live in the mouth or the genitals, and particularly during
outbreaks (cold sores, herpes lesions) can be passed from one place to
the other. In general, it is not a good idea to have unprotected oral sex
while any lesions are present, though herpes may be transmitted even
when no outbreak of lesions is present.
 Chlamydia and gonorrhea can infect the throat and eyes, since they are
mucus membranes. Symptoms of a throat infection of this sort
characterized by an acute sore throat about a week after initial
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infection.
 Syphilis can also affect the throat, manifesting itself as sores similar to
those of a genital infection.
 HIV can rarely be transmitted through unprotected oral sex. The HIVinfected semen/pre-cum or vaginal fluid must enter the body through
a cut or sore in the mouth or esophagus. The virus is very unlikely to
be passed from a person's mouth to another person's genitals.
 HPV can be passed during oral sex, but it is rare. HPV has been found
on vocal chords.
Reducing Risks:
 To reduce the risk of infection during unprotected oral sex, limit
exposure to sexual fluids and ensure that no cuts or lesions are
present in the mouth or on the genitals.
 Use barrier methods - though many people feel that barrier methods
detract from oral sex, they are very effective at preventing STI
transmission:
o Oral-penile sex: Male condoms, flavored condoms, and lube are
available.
o Oral-vaginal sex: Dental dams - can buy them, or you can use
non-microwaveable saran wrap (the microwaveable kind has
tiny holes through which viruses and bacteria can pass!), or cut
up a latex glove or a condom.
o Oral-anal sex: Dental dams, non-microwaveable saran wrap, cut
up latex glove or condom.
 Spit or swallow? Limiting exposure to semen reduces risk of infection,
so ejaculation away from partner's body is the safest. That said, the
mouth is the place most likely to contract something like HIV, so the
conventional wisdom is, "swallow or spit, just don't let it sit."
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Testing At and Around Stanford
The Difference between Confidential and Anonymous Testing
Confidential Testing: Appointments through Vaden Medical Services and
Planned Parenthood are confidential, but not anonymous. This means that
your name will appear on the lab requisition, and the lab results are filed in
your medical records. Special precautions are taken to safeguard the
confidentiality of these results. However, the law enacted in April, 2006
mandates that we report individuals with positive test results for
Chlamydia, hepatitis B, gonorrhea, syphilis, HIV and hepatitis C must be
reported, by law, to the County Department of Public Health. If you need
documentation of your results, this is the type of testing you need.
Anonymous HIV Testing: If you do not need documentation of your test
results, you might consider anonymous screening conducted by HIV*PACT
at Wellness and Health Promotion Services. When scheduling your
appointments, please use an anonymous name. Positive test results must
be reported, by law, to the County Department of Public Health.
Vaden
Vaden Health Center: STI Screening Information for Students
http://vaden.stanford.edu/medical/sti_considerations.html
Free, confidential STI testing.
Blood tests: HIV, Hepatitis B, and Syphilis. Blood tests may not become
positive up to three months after the exposure.
Urine tests: Gonorrhea and Chlamydia.
Controversial tests: Herpes Simplex Virus (HSV), types 1 and 2. Genital
Herpes belongs to a larger virus family including strains, so many people
without the genital form will test positive in a blood test. Therefore,
Vaden does not test for herpes unless specifically requested to. Diagnosis
is usually performed after a visual inspection and a culture of actual
symptoms such as a herpes sore.
Tests not usually performed: HPV and Hepatitis C. No blood test is
available for HPV. A Pap test is the best screening in asymptomatic
women. You are at risk for Hepatitis C if you have ever used drugs by
injection, even if only once, even if a long time ago. You may also be at
risk if you are a frequent sexual partner, using no protection, of someone
who has used drugs in this way. Most people with Hepatitis C have no
symptoms.
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HIV*PACT
Vaden Health Center: HIV*PACT
http://vaden.stanford.edu/wellness/hiv_pact.html
Anonymous HIV testing.
Wellness and Health Promotion Services and highly trained students offer
you free, anonymous HIV testing, counseling and education through
HIV*PACT (HIV Peer Anonymous Counseling and Testing). This screening
through HIV*PACT is free to registered students. Highly trained Stanford
undergraduate and graduate students offer individual appointments. A
limited number of appointments are also available with health educators.
Procedure: Every student has two appointments: one to take the test and
one to get the results. The second appointment is always exactly one
week after the first, at the same time and with the same counselor. Don't
schedule an appointment until you know you can make both
appointments.
For appointments: call (650) 498-2336, extension 1 or DROP IN to the East
Clinic or West Clinic at Vaden (First Floor) and request an anonymous
HIV test appointment. When scheduling your appointments, please use an
anonymous name.
What are the new laws about HIV test results?
Senate Bill 699 was passed in April, 2006. It affects reporting of positive
HIV test results to local health officials and the California Department of
Health Services. Since April, health care providers and labs are required
to report confidential, positive HIV test results by patient name.
Because HIV*PACT is an anonymous service, they do not keep or report
test results. If a student would like his results or needs documentation, he
needs to see a Vaden medical clinician for testing.
Who does the HIV counseling and testing?
Our HIV counselors are a paraprofessional team of highly trained
graduate and undergraduate Stanford students. The team is closely
supervised by Vaden Health Center professional staff. The counselors
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offer you an anonymous, nonjudgmental, peer-to-peer free service. You
may use an assumed name and can have an appointment with a
professional health education counselor at your request.
Can I choose either a needle-free saliva test or a blood test?
Yes. HIV*PACT offers both tests. There are no needles involved in the
Orasure saliva test and the results are extremely accurate.
Can I have a copy of my results or request documentation?
No. Privacy in regards to an HIV test is one of the highest priorities at
HIV*PACT. It is our policy to shred results after the final appointment. If
you want a copy of your results or need documentation, please have
testing done with a Vaden medical clinician (see below).
Can my partner(s) come with me?
Although anyone can escort you to your appointment, our policy does not
permit another person to come into the room with you. This applies to
both the testing appointment and the results appointment. Giving another
person permission to be in the room does not change the policy.
Can my Vaden medical practitioner test me?
Yes, Vaden medical clinicians can do confidential HIV tests as well as
comprehensive testing for other STIs. HIV*PACT offers both blood and
oral tests. Medical Services offers only blood tests.
How can I become a peer HIV counselor?
During Fall Quarter, applications for peer counselor volunteers are
welcomed. To become a test counselor, enroll in the
prerequisite/corequisite course, Education 193A: Peer Counseling. You
will attend an all-day mandatory training during a weekend in November
and participate in two follow-up evening sessions. For more information,
contact health@stanford.edu.
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Planned Parenthood
Planned Parenthood Mountain View Health Center: STD Testing and Treatment
http://www.plannedparenthood.org/health-center/centerDetails.asp?f=2310&a=90130&v=details
Confidential STI testing.
The closest location is in Mountain View, but there are locations all over the
Bay Area.
Services offered:
STD testing, diagnosis and treatment, including:
 Bacterial vaginosis (BV)
 Chlamydia
 Genital warts
 Gonorrhea
 Herpes
 HIV
 Syphilis
 Trichomoniasis (trich)
 Other STD testing, diagnosis and treatment services are also available.
Please ask our staff for more information.
STD prevention, including:
 Condoms
 Female condoms
 Dental dams
 Hepatitis B vaccine
 HPV vaccine
STD/safer sex education
STD testing and treatment services are available:
 During all business hours on a walk-in basis
 During all business hours by appointment
Test results can be obtained in 1-2 weeks, and the HIV testing can be done
confidentially.
What to know about STI testing at Planned Parenthood:
 Gonorrhea and Chlamydia are tested for using a urine sample. If this




test shows an infection, then we will provide you with treatment and
explain how your partner(s) can be treated.
For testing involving urine samples, including Chlamydia and
gonorrhea, do not urinate or engage in sexual intercourse for one
hour before testing.
Rapid HIV testing can be done with a blood sample taken from a
finger stick. The results are available in 20-40 minutes.
Counseling and confidential (private) testing for STDs are provided
by trained staff who are sensitive to your needs and concerns.
Many STD tests require a genital exam when displaying symptoms.
Students can sign up for a state-funded program at Planned Parenthood,
called Family PACT, so that the testing is free.
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Parasitic
Parasitic STIs are caused by small, but not microscopic, organisms that live
on and receive nutrients from the human body.
Scabies
Scabies are tiny parasitic mites that
burrow under the superficial layers of
the skin, depositing eggs and feces, which
cause intense irritation. Scabies is highly
contagious and is most often spread
through sexual contact, but it can also be
transmitted by contact with skin,
infected sheets, towels, or even furniture.
Scabies is not usually known to cause
anything more than discomfort and
inconvenience.
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Risk factors: Close contact with an infected person.
Transmission:
 Sexual contact, which gives the mites lots of time to move from one
person to another.
 Holding hands.
 Touching infested towels or sheets (mites can live up to two days on
linens).
 Sharing a bed with someone who is infected.
Symptoms:
 Intense itching that often becomes worse at night.
 Small red bumps or lines where the mites have burrowed. Common
locations include warmer sites on the skin or under tight clothing
(genitals, lower abdomen, elbows, wrists, and webs between fingers).
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Testing and Diagnosis: Microscopic examination of scrapings from
suspicious lesions is performed to identify the presence of mites.
Treatment: People with scabies are considered infectious as long as they
have not been treated. Infested articles of clothing and bedding are
considered infectious until washed.
 The recommended drug used to treat scabies is Permethrin cream
(5%), which is applied to all areas of the body from the neck down
and washed off after 8-14 hours.
 Linens and clothing should be cleaned in hot water.
 Family members and close contacts should be treated concurrently to
avoid re-infestation.
 Secondary bacterial infections are possible from excessive scratching.
 Antihistamines can treat itching.
Prevention: Avoid contact with anyone who you know to have scabies.
Crabs
Pubic lice (commonly known as crabs) are members
of the head lice family, but are not the same thing as
head lice. They attach to capillaries in the skin and
suck blood for nutrients, usually in the pubic area
(though armpit, eyelash, beard, and moustache
infection is possible). The body responds with an
immune response that causes itching.
Nits are about this size
Adult lice are about
this size
Transmission:
 Most often spread through sexual contact.
 Occasionally transmitted through sleeping in
infested bedding and wearing infested clothing
(crabs can live for up to 24 hours off a human
body).
 It is unlikely that they can be transmitted through toilet seats.
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Symptoms:
 Itching in pubic area
 Blue spots where the crabs have been feeding.
 Small crab-like parasites around genitals (may be whitish-grey or rust
colored)
 Crab nits (eggs) are small and often attached to the base of pubic
hairs
 Dark spots in underwear.
Testing and Diagnosis: Inspection of pubic hair for nits attached to the
base of the pubic hair or adult lice.
Treatment: Over-the-counter lotion treatments are available (RID is most
common): consult pharmacist for more information. More effective
prescription medications are also available. One treatment is usually
sufficient. Wash clothes, linen, sleeping bags, etc. in hot water and then
dry on a hot cycle in the dryer. Non-use of these items for two weeks will
also ensure decontamination. Secondary bacterial infections are possible
from excessive scratching. Some prescription medications should not be
used during pregnancy.
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Bacterial
Single-celled “living” microorganisms that reproduce by dividing cause
bacterial STIs. Certain bacteria, like the ones in the digestive system, are
essential to healthy body function, but other can cause infection. Like other
bacterial infections, such as strep throat, antibiotics can quickly and easily
treat the infection. However, because many bacterial STIs are
asymptomatic, many people go for a long time without getting treated.
Extended infection can lead to PID in women, and can increase the chance of
spreading the infection to other people. It is for this reason that frequent
STI testing is very important.
Chlamydia
Chlamydia ("cla-mid-ee-ah") is a bacterial infection that can have very
serious complications if left untreated, such as pelvic inflammatory disease
and infertility in women. It can infect all mucus membranes, including a
woman’s reproductive organs, the penis, the anus, throat, and eyes. Bacteria
initially infect the cervix and urethra in women, and urethra in men. If left
untreated, it can progress to infect the upper reproductive tract in women.
It is the most frequently reported bacterial sexually transmitted disease in
the United States; under-reporting is substantial because most people with
Chlamydia are not aware of their infection and do not seek
testing/treatment. An estimated 2.8 million Americans are infected with
Chlamydia each year, and women are frequently re-infected if their sex
partners are not treated. (Center for Disease Control)
Risk Factors:
 Sexual activity.
 Multiple partners.
 A new partner.
 Because the cervices of teenage girls and young women are not fully
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mature, they are at particularly high risk for infection if sexually
active.
 Men who have sex with men are also at high risk for Chlamydia
infection.
 Any sexually active person can be infected with Chlamydia, but in the
United States, the highest reported rates of infection are among
sexually active teenagers, young adults, and African-Americans.
Transmission:
 Chlamydia can be transmitted during vaginal, anal and oral sex, and it
can be passed from an infected mother to her baby during vaginal
childbirth.
Symptoms: About 75% of infected women and 50% of infected men are
asymptomatic. If symptoms do occur, they usually appear within 1 to 3
weeks after exposure:
 Abnormal vaginal or penile discharge.
 Burning sensation when urinating.
 Burning and itching around the opening of the penis.
 Bleeding between menstrual periods.
 Pain and swelling in the testicles (uncommon).
 Pain during intercourse.
 Lower abdominal pain.
 Lower back pain.
 Nausea.
 Fever.
Complications:
 Pelvic inflammatory disease (PID) occurs in up to 40% of women with
untreated Chlamydia.
 Women infected with Chlamydia are up to five times more likely to
become infected with HIV, if exposed.
 Complications in men are rare – very infrequently, infection spreads
to the epididymis, causing pain, fever and sometimes sterility.
Diagnosis: There are laboratory tests to diagnose Chlamydia. Some can be
performed on urine; other tests require that a specimen be collected
96
from a site such as the penis, rectum, or cervix.
Treatment:
 Chlamydia can be easily treated and cured with antibiotics.
 All sex partners should be evaluated, tested and treated.
 Women whose sex partners have not been appropriately treated are
at high risk for re-infection.
 Because many people with gonorrhea also have Chlamydia, another
STD, antibiotics for both infections are usually given together.
Prevention:
 Safer Sex Choices.
 Screening at least annually for Chlamydia is recommended for all
sexually active women 25 years and younger, and an annual
screening test also is recommended for older women with risk factors
for Chlamydia.
 Report any genital symptoms such as an unusual sore, discharge with
odor, burning during urination, or bleeding between menstrual cycles
to a clinician and stop having sex immediately.
Gonorrhea
Gonorrhea ("gone-or-ee-ah"), also known as "the clap," is a bacterial
infection that can have very serious complications if left untreated, such as
Pelvic Inflammatory Disease and infertility. Gonorrhea is caused by a
bacterium that can grow and multiply easily in the warm, moist areas of the
reproductive tract, including the cervix, uterus, and fallopian tubes in
women, and in the urethra. The bacterium can also grow in the mouth,
throat, eyes and anus.
Risk Factors:
 Sexual activity.
 Multiple partners.
 A new partner.
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Transmission:
 Gonorrhea is spread through contact with the penis, vagina, mouth or
rectum. Ejaculation does not have to occur for gonorrhea to be
transmitted or acquired.
 Gonorrhea can also be spread from mother to baby during vaginal
delivery.
 People who have had gonorrhea and received treatment may get
infected again if they have sexual contact with a person infected with
gonorrhea.
Symptoms: Most infected people are asymptomatic. For those who are not,
symptoms can include:
 Burning when urinating.
 Unusual vaginal or penile discharge.
 Painful or swollen testicles.
 Vaginal bleeding between periods.
 Rectal discharge, soreness, bleeding, itching, and painful bowel
movements.
Complications: Untreated gonorrhea can cause serious and permanent
health problems in both women and men.
 Pelvic Inflammatory Disease (PID).
 Epididymitis: a painful condition of the testicles that can lead to
infertility if left untreated.
 Gonorrhea can spread to the blood or joints. This condition can be life
threatening.
 People with gonorrhea can more easily contract HIV, the virus that
causes AIDS. HIV-infected people with gonorrhea can transmit HIV
more easily to someone else than if they did not have gonorrhea.
Diagnosis: Gonorrhea can quickly be diagnosed through a lab test, usually
through a urine test. A sample can also be taken from the urethra,
rectum, or cervix, which can allow the clinician to see the gonorrhea
bacterium under a microscope.
Treatment:
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 Several antibiotics can successfully cure gonorrhea in adolescents and
adults. However, drug-resistant strains of gonorrhea are increasing in
many areas of the world, including the United States, and successful
treatment of gonorrhea is becoming more difficult.
 Because many people with gonorrhea also have Chlamydia, another
STI, antibiotics for both infections are usually given together.
Prevention:
 Safer Sex Choices.
 Report any genital symptoms such as an unusual sore, discharge with
odor, burning during urination, or bleeding between menstrual cycles
to a clinician and stop having sex immediately.
Syphilis
Syphilis is a sexually transmitted disease caused
by a bacterium. It has often been called the
“great imitator” because so many of the signs
and symptoms are indistinguishable from those
of other diseases. It is very uncommon around
the Bay Area and the prevalence in the US is
around 0.03%. (Center for Disease Control)
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Transmission:
 Syphilis is passed from person to person through direct contact with a
syphilis sore.
 Transmission of the organism occurs during vaginal, anal or oral sex.
 Syphilis cannot be spread through contact with toilet seats,
doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or
eating utensils.
Symptoms: Many people infected with syphilis are asymptomatic for years,
yet remain at risk for late complications if they are not treated. Although
transmission appears to occur from persons with sores who are in the
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primary or secondary stage, many of these sores are unrecognized. Thus,
most transmission is from persons who are unaware of their infection.
Primary Stage:
 The time between infection with syphilis and the start of the first
symptom can range from 10 to 90 days (average 21 days).
 The primary stage of syphilis is usually marked by the appearance of
a single sore (called a chancre ["shang-ker"]), but there may be
multiple sores. The chancre is usually firm, round, small, and painless.
It appears at the spot where syphilis entered the body.
 Chancres occur mainly on the external genitals, vagina, anus, or in the
rectum. Sores also can occur on the lips and in the mouth.
 The chancre lasts 3 to 6 weeks, and it heals without treatment.
Secondary Stage:
 Skin rash and mucous membrane lesions characterize the secondary
stage. This stage typically starts with the development of a rash on
one or more areas of the body. The rash usually does not cause
itching. Rashes associated with secondary syphilis can appear as the
chancre is healing or several weeks after the chancre has healed.
 The characteristic rash of secondary syphilis may appear as rough,
red, or reddish brown spots both on the palms of the hands and the
bottoms of the feet. However, rashes with a different appearance may
occur on other parts of the body, sometimes resembling rashes
caused by other diseases. Sometimes rashes associated with
secondary syphilis are so faint that they are not noticed.
 In addition to rashes, symptoms of secondary syphilis may include
fever, swollen lymph glands, sore throat, patchy hair loss, headaches,
weight loss, muscle aches, and fatigue.
 The signs and symptoms of secondary syphilis will resolve with or
without treatment, but without treatment, the infection will progress
to the latent and late stages of disease.
Late and Latent Stage:
 The latent (hidden) stage of syphilis begins when secondary
symptoms disappear. Without treatment, the infected person will
continue to have syphilis even though there are no signs or
symptoms; infection remains in the body.
100
 In the late stages of syphilis, it may subsequently damage the internal
organs, including the brain, nerves, eyes, heart, blood vessels, liver,
bones, and joints. This internal damage may show up many years
later.
 Signs and symptoms of the late stage of syphilis include difficulty
coordinating muscle movements, paralysis, numbness, gradual
blindness, and dementia.
 This damage may be serious enough to cause death.
Complications:
 Chancres (sores) caused by syphilis make it easier to transmit and
acquire HIV infection sexually. There is an estimated 2- to 5-fold
increased risk of acquiring HIV infection when syphilis is present.
 Damage to internal organs.
 Poor muscle coordination.
 Paralysis.
 Numbness.
 Gradual blindness.
 Dementia.
 Death.
Diagnosis:
 Health care providers can diagnose syphilis by examining material
from a chancre (infectious sore) using a dark-field microscope.
 A blood test is another way to determine whether someone has
syphilis. Shortly after infection occurs, the body produces syphilis
antibodies that can be detected by an accurate, safe and inexpensive
blood test.
Treatment:
 Syphilis is easy to cure in its early stages.
 A one-dose antibiotic injection will cure a person who has had
syphilis for less than a year; additional doses may be necessary for
someone who has had syphilis for longer than a year.
 Persons who receive syphilis treatment must abstain from sexual
contact with new partners until the syphilis sores are completely
healed.
 Persons with syphilis must notify their sex partners so that they also
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can be tested and receive treatment if necessary.
Prevention:

Safer Sex Choices.
Viral
Viruses are not alive, but rather capsules of genetic material. They require
living hosts, such as people, plants, and animals, to multiply and survive.
Just like the common cold and influenza cannot be cured by anything but
time, neither can viral STIs. Once a person contracts a viral STI, he or she
always has it. Though they can’t be cured, safer sex practices can help to
ensure that viral STIs cannot be spread to anyone else.
Human Papilloma Virus (HPV)
HPV is the most common sexually transmitted disease in the United States.
HPV may also be harder to understand than other STIs. HPV is actually a
group of common viruses that cause warts on different parts of the body.
There are over 100 strains of HPV, and there are more than 40 HPV types
that can infect the genital areas of men and women, including the skin of the
penis, vulva, anus, lining of the vagina, cervix, and rectum. Some of these
strains cause genital warts while others cause cervical cancer or other
forms of genital cancer.
HPV types are often referred to as “low-risk” (wart-causing) or “high-risk”
(cancer-causing). In 90% of both high-risk and low-risk cases, the body’s
immune system clears the HPV infection naturally within two years.
Transmission:
 Genital to genital contact, most often during vaginal and anal sex, but
skin-to-skin contact is all that necessary.
 Infection after oral sex is rare but has been reported (in some cases
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lesions were found on vocal cords).
Symptoms: Most often asymptomatic, especially in women. The incubation
period is one month to many years.
Genital warts:
 Small bumps or groups of bumps, usually in the genital area.
 They can be raised or flat, single or multiple, small or large, and
sometimes cauliflower shaped.
 They can appear on the vulva, in or around the vagina or anus, on the
cervix, and on the penis,
scrotum, groin, or thigh.
 Warts may appear within
weeks or months after sexual
contact with an infected
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 If left untreated, genital warts
may go away, remain
unchanged, or increase in size
or number.
 They will not turn into cancer.
Cervical Cancer:
 Asymptomatic until it is quite
advanced. For this reason, it is
important for women to get
screened regularly for cervical
cancer.
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Other less common HPV-related cancers,
(cancer of the vulva, vagina, anus, and
penis):
 Often asymptomatic until they are
advanced.
Complications: HPV can cause genital warts, cervical cancer, and other
forms of cancer (see above).
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Diagnosis: There is no general test for men or women to check one’s
overall “HPV status.” HPV usually goes away on its own, without causing
health problems. For this reason, there is no need to be tested just to find
out if you have HPV now. However, you should get tested for signs of
disease that HPV can cause, such as cervical cancer.
 Genital warts on the penis and the vulva are usually diagnosed by
visual inspection. HPV is harder to diagnose on the vagina and cervix.
Biopsies (tissue samples) and/or magnification with a special
instrument called a colposcope are sometimes used.
 For women, HPV can be detected with a Pap smear, which examines
cervical cells for abnormalities, and can also find HPV DNA within the
cell. Additional HPV tests can be used to determine which strains of
HPV a woman has. Often a Pap smear is the only way to detect HPV
related changes on the cervix. There is no HPV test for men.
 Often people wonder why there is no blood test for HPV. A blood test
looking for HPV antibodies is available, but it is expensive and the
information it provides is not particularly useful. HPV is so common
that many people will have the antibodies, and then it would be back
to a visual exam to decide the next course of action. Regular Pap
smears would be important, but they are already recommended once
a year for all women regardless of HPV diagnosis.
Treatment: There is no “cure” for HPV infection, although in most women
the infection goes away on its own. The treatments provided are directed
to the changes in the skin or mucous membrane caused by HPV infection,
such as warts and pre-cancerous changes in the cervix.
Prevention:
 HPV vaccine.
 Routine Pap tests.
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Gardasil: The HPV Vaccine
Who should get the HPV Vaccine? The HPV vaccine is recommended for
11-12 year-old girls, and can be given to girls as young as 9. The vaccine
is also recommended for 13-26 year-old girls/women who have not yet
received or completed the vaccine series. These recommendations have
been proposed by the ACIP—a national group of experts that advises the
Centers for Disease Control and Prevention (CDC) on vaccine issues.
These recommendations are now being considered by CDC.
Why is the HPV vaccine recommended for such young girls? Ideally,
females should get the vaccine before they are sexually active. This is
because the vaccine is most effective in girls/women who have not yet
acquired any of the four HPV types covered by the vaccine. Girls/women
who have not been infected with any of those four HPV types will get the
full benefits of the vaccine.
Will sexually active females benefit from the vaccine? Females who are
sexually active may also benefit from the vaccine. But they may get less
benefit from the vaccine since they may have already acquired one or
more HPV type(s) covered by the vaccine. Few young women are
infected with all four of these HPV types. So they would still get
protection from those types they have not acquired. Currently, there is
no test available to tell if a girl/woman has had any or all of these four
HPV types.
Why is the HPV vaccine only recommended for girls/women ages 9 to
26? The vaccine has been widely tested in 9-to-26 year-old girls/women.
But research on the vaccine’s safety and efficacy has only recently begun
with women older than 26 years of age. The FDA will consider licensing
the vaccine for these women when there is research to show that it is
safe and effective for them.
What about vaccinating boys? A recent study shows that it is 90%
effective in protecting against the virus in boys (Merck). It is possible
that vaccinating males will have health benefits for them by preventing
genital warts and rare cancers, such as penile and anal cancer. It is also
105
possible that vaccinating boys/men will have indirect health benefits for
girls/women. The vaccine is not yet approved by the FDA as being
effective for males, though males may request it.
Should pregnant women get the vaccine? The vaccine is not
recommended for pregnant women. There has been limited research
looking at vaccine safety for pregnant women and their unborn babies.
So far, studies suggest that the vaccine has not caused health problems
during pregnancy, nor has it caused health problems for the infant-- but
more research is still needed. For now, pregnant women should
complete their pregnancy before getting the vaccine. If a woman finds
out she is pregnant after she has started getting the vaccine series, she
should complete her pregnancy before finishing the three-dose series.
Efficacy of the HPV Vaccine: Studies have found the vaccine to be almost
100% effective in preventing diseases caused by the four HPV types
covered by the vaccine– including pre-cancers of the cervix, vulva and
vagina, and genital warts. The vaccine has mainly been studied in young
women who had not been exposed to any of the four HPV types in the
vaccine.
The vaccine was less effective in young women who had already been
exposed to one of the HPV types covered by the vaccine. This vaccine
does not treat existing HPV infections, genital warts, pre-cancers or
cancers.
How long does vaccine protection last? Will a booster shot be needed?
The length of vaccine protection (immunity) is usually not known when
a vaccine is first introduced. So far, studies have followed women for five
years and found that women are still protected. More research is being
done to find out how long protection will last, and if a booster vaccine is
needed years later.
What does the vaccine not protect against? Because the vaccine does not
protect against all types of HPV, it will not prevent all cases of cervical
cancer or genital warts. About 30% of cervical cancers will not be
prevented by the vaccine, so it will be important for women to continue
getting screened for cervical cancer (regular Pap tests). Also, the vaccine
106
does not prevent about 10% of genital warts—nor will it prevent other
sexually transmitted infections (STIs). So it will still be important for
sexually active adults to reduce exposure to HPV and other STIs.
Will girls/women be protected against HPV and related diseases, even
if they don’t get all three doses? It is not yet known how much
protection girls/women would get from receiving only one or two doses
of the vaccine. For this reason, it is very important that girls/women get
all three doses of the vaccine.
How much does the vaccine cost? The vaccine is currently on the market for
$120 per single dose. Three doses are required over a 6-month period,
making the total cost for the HPV vaccine $360. Students can get the
vaccine at Vaden or any other health care practitioner.
Genital Herpes
Herpes is a viral infection,
caused by the herpes simplex
viruses type 1 (HSV-1) or type
2 (HSV-2), traditionally called
oral and genital herpes,
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respectively. Though most
genital herpes is caused by
HSV-2, both strains of the virus
commonly affect the genital
area, and can be passed on
through genital-genital sex and
through oral-genital sex. This means that a cold sore on someone's lip can
transmit the herpes virus to someone else's genitals.
In the United States, 45 million people ages 12 and older (1 out of 5 of the
total adolescent and adult population) are infected with HSV-2 (CDC 2009).
An even larger number of people, estimated around 70%, have HSV-1.
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Transmission:
 HSV-1 and HSV-2 can be found in and released from the sores that the
viruses cause, but they also are released between outbreaks from skin
that does not appear to have a sore.
 Generally, a person can only get HSV-2 infection during sexual contact
with someone who has a genital HSV-2 infection.
 Herpes enters the body through the skin and mucous membranes of
the mouth and genitals. Once inside the body, the herpes virus travels
through the nerves to the deep nerve centers (ganglia) where it
remains in a latent state after the initial infection. It may cause a
recurrence of herpes symptoms at any time and cannot be
permanently cured.
 The outbreaks most commonly occur at times when the immune
system is compromised, such as during an infection, hence the name
cold sores for oral herpes.
Symptoms: The first outbreak, typically the most severe, usually occurs
within two weeks after the virus is transmitted, and the sores typically
heal within two to four weeks. Subsequent outbreaks can have the same
symptoms, but are usually milder.
 Mild tingling and burning. This often precedes the appearance of
lesions and blisters. It may occur several hours or several days before
blisters begin to develop. It is during this time that "asymptomatic
shedding" occurs when cells around the future blister begin to slough
off. Although developing blisters may not be detected at this time, it is
possible to spread the virus during this period.
 Watery blisters. (May occur on both external and internal genitalia.)
 Low-grade fever. (Especially with the first outbreak.)
 Headache.
 Generalized muscle aches.
 Tender, swollen lymph nodes in the groin or throat.
 The blisters break down 24-72 hours after their appearance and leave
raw, red, ulcer-like sores. These sores crust over and heal without
treatment.
 The entire course of the initial infection may last from two to six
weeks, with the recurrent infections lasting three days to three
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weeks.
 Recurrence is common, and is often triggered by several factors
including fever, menstruation, sexual intercourse, environmental
heat, trauma, sunlight, fatigue, and emotional stress.

Complications:
 Recurrent painful genital sores.
 Severe infection in people with suppressed immune systems.
 Meningitis (infection surrounding the spinal cord) has been reported
in as many as 36% of patients experiencing their first outbreak of
herpes, but usually resolves without treatment.
 Throat infections.
 Infection of the urethra.
 Psychological distress.
 Fatal infections in babies.
 Higher susceptibility to HIV infection because of open sores.
Testing and Diagnosis:
 Health care providers can diagnose an outbreak by visual inspection,
and can take smears of the lesions can be used to detect presence of
the virus.
 Blood tests can determine whether an individual has been exposed to
the herpes virus, but cannot determine whether the disease is
currently active.
Treatment: At present, there is no cure for herpes. There are, however,
several treatments that may be effective in relieving symptoms.
 Pain relievers, such as aspirin, can be used to alleviate discomfort.
 Wearing loose, dry clothing helps the lesions to heal.
 Acyclovir, a drug to treat herpes, is available in three forms:
o Ointment. Reduces pain and the period of asymptomatic shedding.
o Intravenous. Administered in hospitals, for very severe cases only.
o Oral. May lessen the severity of the symptoms when taken during
outbreaks, and reduce the frequency of outbreaks when taken on a
regular basis.
 Valtrex, another herpes drug, is usually prescribed in two ways:
109
o Outbreak therapy. Take pills to treat each outbreak.
o Suppressive therapy. Take pills on a regular basis to suppress
possible outbreaks.
Prevention:
 Safer sex practices.
 If active lesions are present, avoid sexual contact.
 When no active lesions are present, barrier methods
(condoms/dental dams) should be used to reduce likelihood of
transmission.
 If you have herpes, be aware of your body and communicate with
your partner about prevention. Couples have gone years without
transmitting the virus from one partner to the other.
HIV/AIDS
Mayo Clinic: HIV/AIDS
http://www.mayoclinic.com/health/hiv-aids/DS00005
HIV (Human Immunodeficiency Virus) is the virus that causes AIDS
(Acquired Immunodeficiency Syndrome). HIV is a sexually transmitted
infection, and the American College Health Association estimates that one in
every 500 college students (0.2 percent) is HIV positive.
HIV is especially deadly because it attacks components of the body’s
immune system, particularly the helper-T cells. Once enough of these
helper-T cells have been killed, the body can’t defend itself against
infections. AIDS, the final stage of HIV infection, occurs when the HIV has
demolished the immune system to the point that it can no longer fight
infections. A patient is determined to have AIDS once he or she has one or
more of these infections, as well as a low number of T cells. Infections that
aren’t harmful to people with normally functioning immune systems can be
deadly to AIDS patients, because their immune systems are compromised.
These infections, such as the common cold or pneumonia, are called
opportunistic infections and are usually what causes death in an AIDS
patient.
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Transmission:
 HIV can be transmitted through these four bodily fluids: blood,
semen, vaginal and cervical fluids, and breast milk.
 During oral, anal, and vaginal sex with a person who is infected with
HIV.
 When sharing needle equipment with someone infected with HIV
during use of IV drugs
 From a pregnant woman to her child before birth, during birth, or
after birth through breast milk
 Through a transfusion of infected blood or blood products.
 The risk of passing and contracting HIV is much higher when open
wounds or sores are present.
Symptoms:
Early HIV infection
 Often asymptomatic in early stages.
 Flu-like symptoms.
Later HIV infection
 Swollen lymph nodes.
 Diarrhea.
 Weight loss.
 Fever.
 Cough and shortness of breath.
Latest phase of HIV infection
 Development of opportunistic infections.
 A CD4 lymphocyte count of 200 or less (normal ranges are 8001,200).
AIDS





Development of opportunistic infections.
Soaking night sweats.
Shaking chills or high fever.
Dry cough and shortness of breath.
Chronic diarrhea.
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



Persistent white spots or lesions on the tongue or mouth.
Headaches.
Blurred and distorted vision.
Weight loss.
Complications:
 Opportunistic infections (bacterial, viral, fungal, parasitic).
 Increased risk of certain kinds of cancer.
 Death.
Testing and Diagnosis:
When to be tested for HIV: If you are currently or have in the past engaged in
any activities that may put you at risk for HIV infection, if you and your
partner have chosen to engage in unprotected sex, if you are considering
pregnancy or if there is a chance you may become pregnant, or if you
have had unplanned or forced unprotected sex, then an HIV test is a good
idea. It can take up to six months for HIV antibodies to appear in an
infected person’s blood; therefore a negative test result means only that
the patient was not infected with HIV BEFORE six months prior to when
the test was taken. However, tests as soon as 3 months after possible
exposure are generally 95% accurate. A positive result means that HIV
antibodies are present in the patient’s blood, indicating HIV infection.
HIV Antibody Testing: The only way to detect HIV is through a test
performed in a clinic or laboratory. There are several different kinds of
tests available, but the most common is the ELISA (enzyme-linked
immunosorbent assay), which is a test for the presence of HIV antibodies
in the blood. The presence of specific antibodies, manufactured by the
body in defense, is a positive indication that the patient is infected with
HIV. Rapid HIV tests, which also test the presence of HIV antibodies, are
available at greater cost (and in fewer locations). These tests show
results within 20 minutes and are most commonly used to test people
who encounter needle sticks or other occupational hazards. The HIV
antibody test can be performed either by drawing blood through a
needle or through OraSure, a needle-free method in which a swab of the
patient’s cheek is taken.
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HIV Testing at/around Stanford:
 HIV*PACT.
 Vaden.
 Planned Parenthood.
Treatment: HIV can only be managed with anti-retroviral drugs, but cannot
be treated. The virus eventually results in death.
Prevention:
 Safer Sex Practices.
 Abstaining from IV drug use.
 Cleaning injection works before sharing them.
 Non-porous plastic wrap, cut-up condoms, dental dams, and latex
gloves can also provide protection when performing oral sex on a
vagina or an anus.
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Vaginitis
Vaginitis refers to an infection or inflammation of the vagina, which may
have several causes. The three most common types have three different
causes: bacteria, trichomoniasis (a one-celled organism), and yeast (a
fungus). Vaginitis is only occasionally sexually transmitted, more commonly
these infections develop spontaneously. Symptoms of vaginitis can include
itching, pain, abnormal discharge, and an unpleasant odor. Each organism
causes slightly different symptoms and requires different treatments; reinfection is common for all three.
Yeast Infections (Candidiasis)
Yeast infections are the most
common type of vaginitis. Infection
occurs when the conditions in the
vagina cause an overgrowth of the
fungus Candida Albicans, a type of
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low amounts in the vagina. Yeast
infections are more common in
women who are in poor health, are
diabetic, are pregnant, are using
birth control pills, or are taking
antibiotics. Men can develop yeast
infections in their penises as well and pass them on to their partners. They
should be treated if they exhibit redness and/or itching of the genital area.
Risk factors:
 Unbalanced diet.
 Diabetes or immunosuppression as the result of a disease like AIDS or
the HIV virus.
 Preexisting STI.
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




Birth control pills.
Prolonged use of antibiotics.
Pregnancy.
Douching.
Wearing pantyhose and synthetic or wet undergarments without
breathability.
Symptoms:
 Thick, white "cottage cheese" discharge.
 Vaginal and labial itching, burning, and soreness.
 Redness and swelling of the labia, vagina, and/or upper thighs (penis,
scrotum, and/or upper thighs in men).
 Pain with intercourse and urination.
Testing and Diagnosis:
 These infections are easy to diagnose from a microscopic examination
of the discharge for evidence of yeast overgrowth.
 If this is the first time you suspect a yeast infection, see your clinician
to make sure that you actually have one.
 If you get another yeast infection, you can get a prescription over the
phone or use your regular over-the-counter or natural remedy.
Treatment: Various anti-fungal vaginal medications are available.
 Common medications for both men and women include Monistat,
Femstat, and Terazol. These are used with an application tube that
inserts the treatment cream or ovule into the vagina or can be applied
topically to the penis.
 Your clinician may also prescribe a soothing cream for the labia and
vulva.
 While many medications are available over the counter, it is
necessary to visit a medical practitioner to receive an accurate
diagnosis.
 Undiluted cranberry juice or cranberry tablets can help soothe the
discomfort that comes with a yeast infection. The ascorbic acid in
cranberry juice acts as a natural disinfectant and helps restore the
vagina to its naturally acidic state.
 Plain, organic yogurt can also help to relieve symptoms. Eating
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natural yogurt with live cultures helps protect and restore healthy
bacteria in the body. It can also be applied directly to the vulva and
vagina with a finger.
Prevention:
 Avoid douching.
 Avoid pantyhose or other tight, synthetic undergarments.
 Maintain a balanced diet.
 Keep genitals clean, but don't over-wash.
 Eat lots of organic, plain yogurt, especially if also taking antibiotics.
 Don't do anything that irritates your genitals.
Bacterial Vaginosis:
Bacterial Vaginosis (BV) is caused by an imbalance in the vagina that causes
certain types of bacteria to outnumber normal, healthy bacteria. It is not
necessarily sexually transmitted, but certain sexual activities do increase its
likelihood. It has not been shown to be beneficial to treat male partners.
Risk factors:
 Sexual activity.
 Multiple partners.
 A new partner.
 Douching.
 Antibiotics.
 Improper wiping (i.e., back-to-front instead of the "proper" front-toback).
 Sharing sex toys.
 Having vaginal intercourse after anal intercourse without using a
condom or without changing the condom.
Symptoms: Most infected women are asymptomatic.
 Creamy, grayish-white discharge with a fishy odor.
 Pain upon urination.
 Vaginal itching.
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Complications:
 Increases susceptibility to other STIs.
 Preterm delivery.
 Pelvic inflammatory disease.
Testing and Diagnosis: These infections can be diagnosed based on a
microscopic examination of a vaginal smear.
Treatment: Treatment can be achieved with the prescribed antibiotics.
Male partners do not usually need to be treated, but BV can pass
between female sex partners.
Prevention:
 Safer Sex Practices.
 Avoiding douching.
 Using fresh condoms between anal and vaginal sex/use of sex toy.
 Practicing proper hygiene.
Trichomoniasis Infections
Trichomoniasis ("trick-oh-moe-nye-uh-sis"), or "trich," infections are
caused by a one-celled parasitic organism, called Trichomonas, and are
usually sexually transmitted. The organism can live for a few hours outside
the body, and can also be transmitted through shared towels, bathing suits,
etc.
Risk factors:
 Sexual activity.
Symptoms:
Almost half of women and most men with trichomoniasis are
asymptomatic.
 Frothy, yellow-green vaginal discharge with an unpleasant fishy
odor.
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



Itching and redness in the vaginal area.
Discomfort during intercourse, urination, and/or ejaculation.
Temporary irritation inside the penis.
Mild penile discharge.
 Symptoms usually appear within 5-28 days of exposure.
Complications:
 The genital inflammation caused by the infection increases the
chances of contracting and transmitting HIV.
 Adverse pregnancy outcomes should trichomoniasis go untreated.
Testing and Diagnosis:
 Trichomoniasis infections can be easily diagnosed based on
symptoms and a microscopic examination of a vaginal smear. It is
harder to detect in men than in women.
Treatment: Treatment is usually accomplished by both partners taking a
prescribed dose of an antibiotic. It’s important that both partners
continue treatment even if symptoms disappear.
Prevention:
 Safer sex practices.
 Stopping sexual activity as soon as any unusual genital symptoms are
recognized.
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Section Review Questions
1. Name the most common signs of an infection.
2. Identify and research one condition that results from sexual contact
but might not be classified as an STI.
3. Who can get the HPV vaccine and how do they go about receiving it?
119
PREGNANCY
GENERAL PREGNANCY INFORMATION
POSSIBLE PREGNANCY COMPLICATIONS
Ectopic Pregnancy
Miscarriage
FROM FERTILIZATION TO IMPLANTATION
TESTING AT AND AROUND STANFORD
SHPRC: First Response®
Vaden
Planned Parenthood
Home Pregnancy Tests
INFERTILITY
MENOPAUSE
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General Pregnancy Information
One of the risks commonly associated with college students and vaginalpenile sex is pregnancy. 85% of couples that do not use any type of
contraception will get pregnant within a year of sexual intercourse. This is a
huge number! The next few pages will address pregnancy, pregnancy
testing, potential complications, and infertility as they relate to both college
students and couples in general.
What is pregnancy?
This may seem like a silly question, but the answer is important.
Pregnancy is defined as the condition of gestation, being “with child,” or
carrying young. Pregnancy occurs following the fertilization of an egg by
a sperm and the implantation of the developing embryo in the woman’s
uterus. This process does not occur in the space of an hour, or even a
day. It is impossible to detect human chorionic gonadotropin (hCG), the
hormone released by the embryo, until at least ten days after
conception, and most tests won’t detect HCG for up to two weeks.
Symptoms of Pregnancy: Any or none of the following:
 Missed or scant menstrual periods. (It’s important to note that some
pregnant women experience a small amount of vaginal bleeding
around the time of an expected period and mistake this for a regular
period.)
 Breast tenderness
 Fatigue
 Nausea and vomiting (often referred to as “morning sickness”)
 Frequent urination, irregular bowel movements, constipation
 Mood swings
 Bloating and weight gain
 “Mask of pregnancy” (the slight darkening of the skin on the face)
 Softening of the cervix and enlarged uterus after one month
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Importance of Early Pregnancy Diagnosis
Early diagnosis enables a woman to begin prenatal precautions (such as
cessation of alcohol, tobacco and drug consumption) AS SOON AS
POSSIBLE. It also provides early detection of possible pregnancy
complications, such as ectopic pregnancy. Finally, it allows a woman
who may be considering abortion as an option the time for adequate
counseling and decision-making, as well as undergoing the abortion
when it is safest for her – within the first 10-14 weeks of pregnancy.
Danger Signs during Pregnancy:
If there is any possibility a woman is pregnant and any of the following
occur, notify a health practitioner immediately.
 Intense abdominal pain.
 Irregular bleeding or spotting paired with abdominal pain when your
period is late, or an abnormally light period.
 Fainting or dizziness that lasts more than a few seconds.
 Following a late last period, heavy bleeding that possibly contains
blood clots, with cramping more severe than usual.
 A period that is unusually prolonged AND heavy (6-7 days of heavy
bleeding).
 Fever.
Advice for Pregnant Women:
No matter what decision is made regarding pregnancy (abortion,
adoption, or continued pregnancy and parenting), it is important to
practice prenatal precautions. First, a woman should schedule an
appointment with a practitioner to discuss her pregnancy. In the
meantime, however, these guidelines should be followed:
 Nutrition: maintain a balanced diet. Avoid dieting, raw meat, and
unpasteurized dairy products.
 Avoid alcohol and exposure to illegal drugs.
 Stop smoking
 Do not take any medications (prescription or non-prescription)
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without first consulting your clinician.
 Exercise moderately, but avoid extremely strenuous activities that
could raise the body’s temperature.
 Avoid hot tubs and saunas.
 Use condoms and other barrier methods if there is any chance the
woman could be exposed to sexually transmitted diseases.
Possible Pregnancy Complications:
Ectopic Pregnancy
Definition: The fertilized egg
implants somewhere other
than in the uterine lining.
(Usually in a fallopian tube, and
rarely in the abdomen, ovary,
or cervix.)
Causes: Scarred tubes,
inflammation of the uterine
lining. Sometimes the cause is never known.
Risks: Previous ectopic pregnancy, previous tubal surgery, previous
pelvic inflammatory disease (PID), inflammation or infection, taking
fertility drugs.
Symptoms: Initially all the same as a normal pregnancy. Later, stabbing
pain, cramps, neck, or shoulder pain may develop.
Treatment: Must be immediate because of the risk of tubal rupture. An
injection of the drug methotrexate may be used to stop cell growth
and dissolve existing cells. If methotrexate does not work, surgery
may be required.
Miscarriage
Definition: A spontaneous loss of a pregnancy before the 20th week.
Reasons: Genetic abnormalities, structural problems of the uterus,
infection, weak cervical muscles, hormonal imbalances, toxins, blood
incompatibility.
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Note: 1/6 of all pregnancies end in miscarriage, and 75% of these
miscarriages occur before 12 weeks.
From Fertilization to Implantation
Wikipedia: Prenatal Development
http://en.wikipedia.org/wiki/Prenatal_development
Fertilization is an important term to know when discussing pregnancy,
contraception, and female sexual health in general. Fertilization is
essentially the first step on the path to pregnancy, and refers to the actual
act of the male sperm penetrating the female ovum (or egg) and then
beginning a zygote. For information about how to learn when a woman is
fertile, see Natural Family Planning section.
What is the sequence of events involved in fertilization?
 Sperm secrete enzymes to digest the membrane surrounding the egg.
 A hole forms so that sperm can penetrate the cell membrane of the
egg.
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 The sperm and ovum combine and form a zygote (fertilized egg), with
half of its genes from the egg and half from the sperm.
 A very hard fertilization membrane forms around the egg. It prevents
other sperm from penetrating the egg.
Where in the female reproductive system does fertilization usually
occur?
 In the first 1/3 of the fallopian tube. See picture.
 As the soon as the egg is fertilized it is referred to as a zygote.
What happens after the egg is fertilized?
 Once the egg is
fertilized it becomes a
group of cells called a
blastocyst and begins
moving to the uterus,
which takes about 3
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 Once it reaches the
uterus, it moves very
close to the
endometrium and
begins to implant itself.
 Implantation usually
happens on day 20 to
24 of the menstrual cycle (about 7 days after ovulation) and the ball
of cells is now referred to as an embryo.
 Once the embryo implants it begins releasing human Chorionic
Gonadotropin (hCG), the pregnancy hormones that pregnancy tests
detect. It is only once the embryo has implanted that pregnancy tests
are accurate.
When during a woman’s menstrual cycle is she fertile? For how many
days (approximately) is she fertile?
 Usually fertilization occurs 12-24 hours after ovulation, in the middle
of a woman's cycle. An egg lives for 24 hours after release; sperm can
live for at least 3 days in a woman's body.
 A woman is fertile for approximately four days, but it is very difficult
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to tell when those days are. Ovulation and menstrual cycles change
with stress, travel, sickness, and many other factors. She should still
protect herself ever time she has sex.
Pregnancy Testing
As mentioned before, pregnancy tests work by detecting human Chorionic
Gonadotropin (hCG), a hormone released by the developing embryo, in the
blood or urine of a woman. This hormone causes the levels of progesterone
in a woman’s body to remain elevated, which allows the fetus to develop
normally.
Different types of tests have different sensitivities; in other words, they can
accurately detect pregnancy at different stages of gestation. Some tests are
accurate as soon as 10 days after conception, while others may be negative
for up to several weeks after conception. It is important to understand the
sensitivity of the test performed, and to return for a retest if a normal
period does not occur within two weeks.
If the woman has had unprotected intercourse in the last five days, one
option still available to her is Emergency Contraception (also known as Plan
B and the Morning After Pill). This can be accessed at the pharmacy
downstairs in Vaden, another pharmacy like Walgreens or Longs, or at
Planned Parenthood. No prescription is needed.
If the woman has a negative pregnancy test and is still going to have
intercourse, she should use contraception. Even if she believes she is
pregnant (i.e. she doesn’t believe the test results), she should continue to
use or start to use birth control if she does not wish to become pregnant.
Although pregnancy tests are quite accurate, false positives and false
negatives may occur for several reasons:
 False Positives: human error, LH cross reaction, drug interference.
 False Negatives: human error, test performed too early in pregnancy,
urine too dilute to detect HCG, drug interference.
For these reasons, careful follow up with a health care provider is an
126
important part of any pregnancy test.
127
SHPRC: First Response® Pregnancy Test
This test is only accurate two weeks after intercourse.
How to use the Pregnancy Test:
 Hold it facing downward, with the result window facing away from
the person, and keep it in the stream of urine for FIVE seconds.
 (Alternatively, a woman can collect your urine in a cup and hold the
pregnancy test in the cup for 20 seconds).
 The result will show in the result window between 1-5 minutes
afterwards:
o One line means that the test is negative.
o Two lines mean that the test is positive (if positive, PLEASE visit a
practitioner at Vaden to take a second verification test)
o If there is no line, then the test didn’t work – come back to the
SHPRC and get another one!
o DO NOT wait longer than 10 minutes to look at the reading in the
window, because there is a much higher chance of a false positive.
Additional Information if Your Test Result is Positive:
Most importantly – visit a clinician to verify result, and get health
information.
 Continuing the Pregnancy:
o Parenting
o Adoption
o Be sure to get prenatal care
o Do not drink, smoke, or get X-rays
 Abortion
o Aspiration Abortion
o Medication Abortion
o If you want more detailed information about abortion, ask an
SHPRC counselor or a clinician
Important Notes if a woman IS pregnant:
 It is crucial that she visit a health practitioner immediately.
 If she experiences slight bleeding, this is normal.
 If she experiences intense lower abdominal pain, this could indicate
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an ectopic pregnancy. Visit a clinician immediately, as this is a serious
health risk.
We strongly recommend that the student visits a clinician downstairs
about resources available to her, regardless of whether the test is
negative or positive.
Pregnancy Counseling Tips:
 Talk with the student about why she thinks she may be pregnant,
specifically what activities she has engaged in that may have led to a
possible pregnancy, etc. Even if she says she hasn’t had sex, a little
probing can reveal that she is at risk for pregnancy.
 Make sure that unprotected sex has occurred at least 2 weeks ago, or
else the test may not be accurate.
 If negative, you should go through information on risky behavior that
can cause pregnancy (unprotected intercourse), and how/where a
student can find out about different forms of contraception.
 There is a very small chance of false positive, so if the test comes out
positive the person is most likely pregnant. If the test is positive, go
through the counseling on options: abortion, adoption, or continuing
the pregnancy and parenting.
 Along with information about pregnancy, make sure to go over her
risk for STIs.
Vaden
 All testing at Vaden is free and confidential for Stanford students.
 Urine testing is available every day (even weekends and holidays
through same day emergency care), as often as the patient desires.
 Following each test, a brief consultation with a clinician¸
 Urine tests at Vaden are accurate 14 days after intercourse.
 Blood tests can be accurate 10 days after intercourse, but may only be
ordered by a clinician in the case of special circumstances (such as
potential ectopic pregnancies). Blood tests are not used for ordinary
early diagnosis tests.
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 The first urine specimen of the morning is best for the test (urine is
more concentrated after sleep), so a sample should be collected as
early in the day as possible in a small, clean container (provided by
the nurses).
Planned Parenthood
 Confidential pregnancy testing.
 hCG urine test can be given after a missed period, or 14 days after
intercourse.
 Urine tests range in price from $10-$20; no appointment is necessary.
 Blood tests can be given 10 days after intercourse, however they are
more expensive and some Planned Parenthood offices do not have
adequate blood testing facilities and thus will have to send blood
samples away to an outside lab (thus results will take at least 24
hours).
Home Pregnancy Tests
 These are urine tests that look for the same hCG hormone that clinical
tests do.
 These tests can be purchased at any grocery or drug store.
 Advantages include privacy, convenience, easy instructions, and
anonymity.
 Test typically cost around $15.
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Infertility
Infertility is defined as the inability to conceive after a year or more of
sexual relations without the use of contraception. While infertility is not a
common problem for students at Stanford (or for most college students), it
is an important aspect of sexual health.
Infertility can be the result of reproductive problems in males and females,
and while its causes are sometimes fairly elusive, there is a lot of
information on both sides of the issue.
There are two types of infertility:
1. Primary Infertility: never had a full-term delivery because of
miscarriage or because the woman has never been pregnant before
2. Secondary Infertility: infertility subsequent to previous pregnancy
which includes people who have either given birth or had an abortion
Possible causes of infertility
 Low sperm count.
 Poor sperm mobility.
 Damage to reproductive organs.
 Untreated STIs.
 Old eggs (especially when a woman is over 35).
 Scar tissue in fallopian tubes or ovaries.
 Untreated STIs.
 PID.
 Bad abortions or IUDs.
 Temporary infertility due to hormonal birth control.
 Slanted uterus (tilted away from the stream of ejaculation).
 Endometriosis (uterine lining grows into the fallopian tubes).
 Retrograde emissions (semen goes into the bladder).
 Amenorrhea.
Suggestions for Treatment of Infertility
131
 In males:
o No briefs (“tighty whities”), hot baths, or saunas.
o Possibly taking androgens if testosterone is low.
 In females:
o Basal body temperature method.
o Use a pillow to prop uterus and make cervix closer to ejaculate.
o Gain weight.
o Avoid hormonal methods of birth control.
Menopause
After about 450 menstrual cycles, human females undergo menopause, the
cessation of ovulation and menstruation. Menopause usually occurs
between the ages of 46 and 54. Apparently, during these years the ovaries
lose their responsiveness to certain hormones and menopause results from
a decline in estrogen production by the ovary.
Menopause is an unusual phenomenon; in most species, females as well as
males retain their reproductive capacity throughout life. Is there an
evolutionary explanation for menopause? Why might natural selection have
favored females who had stopped reproducing? One intriguing hypothesis
proposes that during early human evolution, undergoing menopause after
having some children actually increased a woman’s fitness; losing the
ability to reproduce allowed her to provide better care for her children and
grandchildren, thereby increasing the survival of individuals bearing her
genes.
132
Section Review Questions
1. A student comes in and tells you that she unprotected sex with her
boyfriend a few days ago. Outline what you would say and what
questions you would ask.
2. You have just sold a pregnancy test. What are three things you should
make sure the student knows before he or she leaves?
3. How can a person better prevent false positives or false negatives?
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CONTRACEPTION
FUNDAMENTALS
Choosing a Method
ABSTINENCE
METHODS THAT PROVIDE NO PROTECTION AGAINST
PREGNANCY
NON-METHODS
Withdrawal
Douching
BARRIER METHODS
Male Condom
Female Condom
Dental Dam
Spermicide
HORMONAL METHODS
General
Oral Contraceptive Pill
COMBINATION
METHODS
Diaphragm
Cervical Cap
Contraceptive Shield
Contraceptive Sponge
INTRAUTERINE DEVICE
(“The Pill”)
Mirena®
ParaGard®
(Ortho Evra®; “The Patch”)
PERMANENT METHODS
Contraceptive Patch
Vaginal Ring
(NuvaRing®; “The Ring”)
Contraceptive Injection
(Depo-Provera; “The Shot”)
Contraceptive Implant
(Implanon®)
Continuous Hormonal
Contraception
Tubal Ligation
Vasectomy
NATURAL FAMILY
PLANNING
Calendar Method
Standard Days Method
Cervical Mucus
Rhythm Method
EMERGENCY CONTRACEPTION
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Fundamentals
Contraception is the general term used for anything that works to prevent
pregnancy from occurring, and many counsels at the SHPRC relate to
contraception and birth control. To reiterate the importance of
contraception in the arena of sexual health, it seems appropriate to repeat
the statistic that the percentage of women who become pregnant after one
year of unprotected intercourse is 85%. Understanding contraception is an
important part of protecting a student’s body and learning about sexual
health.
Definitions
Contraindication: any condition that would make a particular method
inadvisable
Failure Rate: the percentage of couples that will become pregnant after a
year of using a particular method
Choosing a Method
Choosing a method of contraception is a personal and individual decision for
both females and couples in general. Because there are so many methods
and types of contraception available today, ideally there will be one or more
that meets the needs of every person and every situation that exists.
The important thing to remember when choosing a method of contraception
or when counseling someone else through their decision-making process is
that communication, between the sexual partners and their respective
health care providers, is absolutely essential. Men should not feel that they
are without responsibility for preventing pregnancy. While the woman is the
one who becomes pregnant, all partners should take an active role in
preventing unwanted pregnancy. This means that women should feel
comfortable carrying around condoms, and men should feel comfortable
135
asking if the woman is on birth control, and/or helping to choose a method
that works well for them.
Basic considerations and questions to address:
Failure rate: How well does this method work?
STI protection: Does this method protect against pregnancy and STIs, or
just pregnancy? Is STI protection needed?
Health risks or family history: Some methods of contraception require
information about blood clots or heart problems, as well as family
histories of cancers such as breast cancer, ovarian cancer, and colon
cancer.
Allergies: Many people have either drug allergies or allergies to latex and
other materials used in contraception.
Health considerations and affect on lifestyle: Many methods of
contraception may have adverse effects when paired with smoking; in
addition some methods that do not protect against STIs should not be
used if a woman has multiple partners and is at risk for STI
transmission.
Side effects: Issues such as weight gain, weight loss, acne increase or
decrease, and nausea are common with many types of contraception
Cost: As students, this is always an issue and it definitely varies from
method to method.
Responsibility: Who is "in charge" of making sure contraceptives are
taken or used correctly? If the outcome is possibly pregnancy, the
woman may want to have greater control because a pregnancy would
more directly affect her.
Ease of use: Is forgetfulness a problem? Can the student remember to
take a pill every day or have a shot once every three months?
136
Prescription versus non-prescription: How accessible is this method?
Does a woman need a pelvic examination to get her prescription? Can
one just walk up in a grocery store and buy what one needs?
Timing: How long is this method effective for? Does it need to be
employed before intercourse or foreplay?
Does it affect spontaneity? Some couples complain about having to
interrupt foreplay to insert or put on various methods of
contraception.
Will it affect your future fertility? Any type of contraception that
involves hormones or invasion into the cervix or uterus has a small
potential of effecting fertility down the road.
Does it contradict any beliefs or values? Many people have religious or
moral beliefs that may dictate what is appropriate for methods of
contraception.
Would it be embarrassing to use? Do sex feel awkward or
uncomfortable with this method?
What type of sexual relationship is it? Monogamous? Open?
Communicative?
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Abstinence
Abstaining from intercourse is the only 100% effective method of
contraception. Nothing else guarantees complete protection from pregnancy
or from sexually transmitted diseases.
While there are many methods of contraception that will be discussed later
on, abstinence is important to begin with because it brings up the fact that
having sexual intercourse is a choice, and a very personal one at that. There
is no reason that anyone should ever feel pressured to have a sexual
relationship that they are uncomfortable with or not ready for. Choosing not
to have sex is as viable a contraception option as is choosing condoms or
pills or an IUD. This is a choice that many college students grapple with and
it is important to know that there are as many reasons that people choose
not to have sex as there are reasons that people choose to have sex.
Common Questions
What is abstinence?
Abstinence is more than the clichés of "Just say no," "Wait until marriage," or
"You're too young to have sex." While those are all very valid reasons, most
decisions about abstinence go deeper than that. Abstinence essentially
means waiting to choose the right person, the right time, and the right
place to have sex. A person can choose to abstain for an evening, for a
month, or for years, as well as for any time in between. People may choose
not to have sex with a particular person, or at a certain time, or in different
circumstances.
Isn't abstinence boring?
No! Sexual behavior isn't just an all or nothing thing. Abstinence can be
defined however you choose it to be. It can include hugging and kissing. It
can include intimacy. It can allow for everything except sexual intercourse.
Abstinence is whatever you make of it. There are plenty of other forms of
sexual expression that allow affection, intimacy, and love to be
138
demonstrated.
When is abstinence right for someone?
Just like other forms of contraception and other decisions regarding sexual
health, abstinence requires communication and an understanding of one's
self and one's goals and values. It is important to ask questions about values
and morals, future plans and expectations, and about the relationship in
question. As with everything, communication is extremely important.
Is it too late to abstain if sex has already occurred?
Just because a previous relationship may have been sexual doesn't mean that
every new relationship had between two people has to become sexual. Nor
does it mean that a current relationship has to remain sexual or intimate if
you have changed your mind. It is totally normal to reevaluate choices and
comfort levels, and communication about these thoughts is an important
aspect of any relationship.
After deciding to abstain, how can someone avoid pressure to
have sex?
Be clear about the decision. Make sure words and actions express the
limits clearly and consistently.
Plan ahead. Intimate circumstances often lead to intimate behaviors, so a
person should be prepared for this to occur.
Speak up. If feeling pressured, a person should make his or her feelings
known. Make sure the decision is respected.
Listen to partners. Respect partners’ views and acknowledge their opinions
and limits, too.
Stay in control of the situation. Remember that impaired judgment may
have a negative affect on your ability to control actions and assure that
one is comfortable with the situation.
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Methods That Provide NO Protection
from Pregnancy
"Doing everything but"
Pregnancies have been reported (even in virgins, although not often) when
ejaculation occurred near the vaginal opening.
"But we only did it once"
Many women have become pregnant after having sex only once. Women can
and do become pregnant the first time they have sex.
Special Positions
Sperm can swim against gravity. Having sex standing up or in other positions
will not prevent pregnancy.
Avoiding "the one" dangerous day per month
See fertility charting. This doesn't work because it is nearly impossible to
predict which days a woman will be fertile.
Urinating after intercourse
This helps avoid UTIs, definitely, but it does not have any effect whatsoever
on preventing pregnancy. Wrong orifice!
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Non-Methods of Contraception
We call the following methods of contraception “non-methods,” because they
are either legends about sex that are completely outdated, or just because
they don’t work very well.
While most of these methods have a higher effectiveness than, say, nothing
or no protection, they are far inferior to the rest of the methods covered in
this course reader because of their failure rates. We will treat them as
comparable methods of contraception for the sole purpose of demonstrating
that they are both unpredictable and unsafe, and that other methods of
contraception should definitely be considered before resorting to these.
Withdrawal
Also known as “coitus interruptus” and “pulling out”
The penis is withdrawn before ejaculation occurs, thus limiting the number of
sperm that enter the vagina.
Failure rate: 4%-18%. It was previously thought that pre-ejaculate contains
sperm, but a recent study found this to be untrue. Stray sperm can remain
in the urethra after ejaculation, but are flushed out once a male urinates.
If the male does not urinate between ejaculations, there is a possibility of
sperm from the previous ejaculation being released with the preejaculatory fluid. However, if he has urinated, the pre-ejaculate will
contain no sperm. When done correctly (consistently withdrawing before
ejaculation), the withdrawal method is nearly as effective as condoms.
Contraindications:
 Lack of self-control.
 Lack of ejaculatory control.
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 It is not an appropriate method for couples that wish to have repeated
acts of intercourse because sperm may be retained in the urethra
following ejaculation.
Possible side effects, risks, and considerations:
 Diminished pleasure, frustration, anxiety.
 Provides NO protection from STIs.
 Requires high level of self-control.
Benefits:
 Requires no devices or chemicals.
 Available in any situation.
 Free.
Why is the withdrawal method considered a non-method
when it has such a low failure rate?
As previously mentioned, the withdrawal method required a great deal of
self-control and understanding of one’s own sexual response. Many college
students have not had the experience necessary to gain these skills, and thus
cannot consistently withdraw before ejaculation. While we do not
recommend this method as a standalone contraceptive method for college
students, it is always better at preventing pregnancy than not using any
contraception.
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Douching:
Douching washes some sperm out of the vagina by flushing it out with
scented liquid.
Failure rate: 40% It has actually been argued that douching may increase
the risk of pregnancy by flushing sperm up against the cervix and into the
uterus. In addition, douching makes the pH in the vagina become
imbalanced, thus increasing the risk of vaginal infections and possible STI
transmission. For this reason, the SHPRC strongly discourages the
practice of douching. In addition to being ineffective, it perpetuates a
negative image of female sexuality and sexual health (i.e. that the vagina
is dirty and must be washed with perfume).
Contraindications:
 Allergy to douche.
Side effects:
 pH imbalance.
 Possible allergies.
 Vaginal infections.
 Does not protect against
STIs.
Benefits:
 Does not require a
prescription.
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Barrier Methods
Barrier methods are methods of contraception that work by preventing
contact between male sperm and female vaginal secretions (or any sexual
fluids). Using some form of plastic, usually latex or polyurethane, fluids are
blocked, thus preventing transmission of STIs as well as pregnancy. The
main types of barrier methods are the male condom, the female condom, and
dental dams. Spermicide is also included in this section, but note that it uses
a chemical barrier rather than a physical barrier. There are also combination
methods, which combine barrier methods with chemical methods, but these
will be discussed later on.
Male Condom
A condom is a sheath made of latex, polyurethane, or animal tissue that fits
over the penis. Polyurethane and animal tissue condoms are available for
those allergic to latex. However, animal tissue condoms are not
recommended for protection against STIs. The condom acts as a physical
barrier by preventing sperm from entering a woman's vagina. Some
condoms are lubricated, some also come with spermicide (but the SHPRC
does not carry condoms with spermicide any more, see below for more
information).
Failure rate: 3%-14%. The large difference between these two failure rates
is due to incorrect and inconsistent use of the condom. Therefore it is
crucial that a condom is used every time one has intercourse, and is used
correctly. Condoms are not more effective when used with spermicide.
Contraindications:
 Allergy to latex (polyurethane condoms are an alternative)
Possible side effects, risks, and considerations:
 May allow for less sensation. (Lubrication may lessen this effect.)
 Approximately 1 in 165 condoms tear during vaginal intercourse.
 Using a condom may be considered an interruption, but partner
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participation can make condom usage more pleasurable.
 Animal tissue condoms have been shown to be permeable to the AIDS
virus and therefore should not be considered protection against HIV.
Advantages:
 Does not require a prescription.
 Protection against most STIs, except those that can be transmitted via
skin-to-skin contact.
 Few potential side effects.
 Inexpensive.
 Can be used while breastfeeding.
How to use it:
1. Some packaging is difficult to open. Practice this so that the condom
doesn’t tear. In addition, be sure to check the packaging for damage
and look for the expiration date. (Do not use teeth to open the
package!)
2. Put a few more drops of water-based lube inside the tip of the
condom: that helps with getting it on and makes condoms feel better
during use.
3. Wait until the penis is erect before putting on the condom. Put the
condom on before any genital contact occurs.
4. If uncircumcised, pull the foreskin back before putting on the condom.
5. Place the rolled condom over the tip of the hard penis
6. Leave a half-inch space at the tip to collect semen
7. Pinch the air out of the tip with one hand; unroll the condom over the
penis with the other hand. Roll it all the way down to the base of penis.
8. Put some more latex-safe lube of the outside of the condom.
9. Immediately after intercourse, hold the bottom of the condom against
the penis and pull out. This prevents the condom from slipping off as it
is pulled out.
10. Tie the end, and throw the condom away in a trashcan.
What NOT to do:
 Never use two condoms at once.
 Never re-use a condom.
 Keep condoms in a wallet.
 Use foods (whipped cream, chocolate sauce, etc.) with condoms. Many
145
foods contain oil, which will break the condom down.
 Be afraid of using lube.
How to use a condom
Bogart, Jane, M.A. Sexploration: The Ultimate Guide to Feeling Truly Great
in Bed
146
How to get it:
Condoms are available at heavily subsidized prices at the SHPRC, located on
the second floor of the Vaden Health Center. They can also be purchased
over the counter at a drug store, Tresidder Express, or at the student health
pharmacy.
Cost:
The cost is $2 for a dozen condoms at the SHPRC. At drugstores, the average
cost is $6 for a dozen. Prices range up to $25 for a dozen polyurethane
condoms.
Important notes:
 Oil-based products (Vaseline, lotion, Monistat, certain foods) cannot be
used with latex because they degrade it and make it more likely to
break. Using oil-based products with condoms can diminish the
strength of latex by 70% within the first thirty seconds. Water-based
and silicon-based lubes should be used instead.
 Spermicidal condoms do not have enough spermicide on them to make
them any more effective. Additionally, studies have shown that
spermicide may increase the transmission of some STIs because it
causes micro-abrasions in the vagina or the anus. Spermicide should
only be used to prevent pregnancy.
Different Kinds of Condoms We Carry:
Aloe: These green-colored condoms have a lubricant with natural aloe
extract. Aloe prevents irritation, pain, and itching, and even more,
these condoms have extra lubrication.
Ribbed and Studded: These condoms are textured on the inside for the
person wearing the condom, and on the outside for the partner. We
carry various styles of these.
Extra Sensitive: These condoms are made with extra thin latex, so that
the user can barely tell that he is using a condom.
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Performance Enhancing: The distinguishing thing about this condom is
that it contains a male genital desensitizer. It uses Benzocaine, a local
anesthetic that is typically used as a topical pain reliever, to help delay
ejaculation by dulling sensation. It is not for everyone, but is a great
option for those who ejaculate sooner than they would like during
sexual activity. This only affects the person wearing the condom, so
there is no concern for the partner since there is plain old lubricant on
the outside.
Colored and Flavored: We carry a wide variety of colored and flavored
of condoms, like strawberry, banana, orange, and mint. They are just
as effective at protecting against STIs and preventing pregnancy as
regular condoms. We also carry a variety of flavored lubes.
Her Sensation: These condoms are ribbed on the outside, berry-scented
and flavored, and pink.
Dual Pleasure: This condom features an oversized tip, designed to give
the head of the penis more freedom of movement. The penis head is
packed with nerve endings, so the extra movement can be extremely
pleasurable. There are also soft ribs on the outside for the pleasure of
the partner.
Different Sizes: We feature both “XL” and “Snugger Fit” condoms, so
you’re sure to find a good fit.
Natural Feeling: If all of these seem too fancy, don’t worry! We have both
lubricated and non-lubricated “Natural Feeling” condoms.
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Female Condom
The female condom is a polyurethane
pouch with a flexible ring at each end.
The ring at the closed end holds the
female condom in the vagina. The ring at
the open end stays outside the vaginal
opening. Female condoms prevent sperm
from entering the vagina by acting as a
physical barrier.
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Failure rate: 5%-21%.
Contraindications:
 Discomfort with touching genitals to insert condom.
Advantages:
 Women who use female condoms do not have to depend on their
partners to wear condoms.
 Female condoms can be inserted up to 8 hours before intercourse.
 Female condoms are suitable for those women with latex allergies
because they are made of polyurethane.
 Does not require a prescription.
 Protection against STIs. May offer even more protection than male
condoms because the condom covers more of the vulva.
Possible side effects, risks, and considerations:
 Female condoms are less effective at preventing pregnancy than male
condoms.
 Female condoms are more expensive and harder to find than male
condoms.
 The condom may squeak during intercourse; this can be remedied by
using more lube. (Generation 2 of the female condom is said to be
quieter.)
 Female condoms may cause vaginal irritation.
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How to use it:
1. Lubricate the closed end of the condom.
2. Squeeze together the sides of the inner ring at the closed end and
insert it into the vagina like a tampon. Push it in as far as the ring can
go, until it reaches the cervix.
3. When removing, pinch and twist the open end closed to hold the
semen inside the condom.
4. Pull out the female condom and discard, do not reuse.
5. Discard in trashcan (not toilet).
How to get it: Female condoms are available at some drugstores, and are
available at reduced cost at the SHPRC.
Cost: Typical cost is around $2.50 per condom
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Spermicide
NOT sold or supported by the SHPRC
Contraceptive foams, creams, jellies, and
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chemicals that immobilize sperm and prevent
them from joining with an egg. They are inserted
deep within the vagina shortly before intercourse.
They are used to increase the effectiveness of
other methods such as the condom to prevent
pregnancy. These products should not be relied on alone to prevent
pregnancy or to protect against STIs.
Failure rate: 6%-26%.
Contraindications:
 Allergic reaction to spermicidal products.
Advantages:
 Sold over the counter and does not require medical supervision.
 Inexpensive and easy to use.
 Does not affect a woman's hormonal balance.
 Immediately effective and non-permanent.
Possible side effects, risks, and considerations:
 Spermicides have high failure rates when used alone.
 Some women find them messy.
 Some women and men may develop allergic reactions to the products.
 People who enjoy oral sex may object to the taste of contraceptive
foam.
 Increased likelihood of contracting STIs.
Contraindications:
 Sensitivity to spermicide.
How to use it:
Teens Health: Spermicide
http://kidshealth.org/teen/sexual_health/contraception/contraception_spermicide.html
 Spermicide must be placed deep in the vagina, close to the cervix.
 Creams, gels, and foams are squirted into the vagina using an
applicator.
 Other types of spermicides include vaginal contraceptive film (VCF), a
thin sheet placed in the back of vagina by hand, and vaginal
suppositories.
How to get it: Spermicides are available over the counter at most drug
stores.
Costs: Single applicator of foams, creams, and jellies typically cost about $1
per application.
Why we don’t sell it at the SHPRC:
Many spermicides contain a chemical called nonoxynol-9, which is a
detergent that can cause rashes or sores on the vaginal wall. These rashes
increase the likelihood of contracting STIs. Nonoxynol-9 can also wash
away the natural mucus and bacterial layer in the vagina that protects
against germs, which can lead to yeast and bladder infections. Many
Trojan brand condoms contain spermicide with nonoxynol-9, which is
why the SHPRC does not carry Trojan brand condoms.
152
Hormonal Methods: Combination
General
Revolution Health: Advantages and Disadvantages of Hormonal Birth Control
http://www.revolutionhealth.com/articles/advantages-and-disadvantages-of-hormonal-birthcontrol/tw9513
Combination hormonal contraceptives contain estrogen and progestin.
Specific advantages and disadvantages vary depending on the method, but
there are some that are common across all methods. Combined hormonal
contraception and progestin-only contraception have different risks and
benefits because of the different hormones they contain. Please refer back to
this section when reading about specific contraceptives, because all of the
advantages and disadvantages listed are in addition to these.
Types of Contraception:
 Combined Oral Contraceptive Pills (various brands)
 Vaginal ring (NuvaRing®)
 Contraceptive patch (Ortho Evra®)
How it Works:
 Prevents ovulation.
 Thickens cervical mucus to make
sperm less able to get into the
cervix.
 Makes the lining of the uterus
thinner and thus, less hospitable
for a fertilized egg to implant in.
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Advantages:
 No interruption of foreplay during intercourse
 Reduced risk of bleeding and cramping with periods
 Fewer or no periods
 Reduced pain during ovulation
 Reduced fibrocystic breast changes
 Reduced risk of PID
 Reduced risk of ectopic pregnancy
 May reduce acne
 May reduce ovarian cysts.
 May reduce symptoms of endometriosis
 May reduce bone density loss
 May protect against ovarian and endometrial cancers for up to 30
years after stopping use of combination contraceptives.
 Can be used after an abortion
Possible side effects, risks, and considerations:
 Does not protect against STIs.
 May not be as effective when taken with certain kinds of medications
(St. John’s Wort, anticonvulsants, narcolepsy medications, and
antiretroviral protease inhibitors used to treat HIV).
 May delay return of normal cycles.
 Increased depression.
 Increased mood swings.
 Low libido.
 Headache.
 Nausea.
 Breast tenderness.
 Spotting between periods.
 Increased depression.
 Possible weight gain.
Contraindications:
 Known or suspected pregnancy.
 Women over 35 who smoke.
 Migraines.
154
 Diabetes with complications of the kidneys, eyes, nerves, or blood
vessels.
 Current or previous blood clots in the legs, lungs, or eyes.
 Family history of blood clots.
 Chest pain.
 High blood pressure.
 High cholesterol.
 Current or previous cancer of the breast, endometrium, cervix or
vagina.
 Jaundice during pregnancy or previous use of combined hormonal
contraceptives.
 Liver tumors or liver disease.
 Obesity.
Combination Oral Contraceptive Pill
Planned Parenthood: Birth Control Pills
http://www.plannedparenthood.org/health-topics/birth-control/birth-control-pill-4228.htm
Also known as birth control pills or “The Pill”
Many brand names available
The most popular reversible contraceptive method in the U.S. – the pill – was
developed under the guidance of the founder of Planned Parenthood,
Margaret Sanger, and her friend, Katharine Dexter McCormick, who was one
of the first women graduates of MIT. Sanger’s pill now ranks among the
safest and most carefully studied medications in U.S. history.
How it works:
Combination pills work like typical combination birth controls. Combination
pills prevent ovulation, thicken the cervical mucus, and thin the
endometrium.
Failure rate: <1% - 8%.
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Advantages:
 Taking the pill is simple, safe, and convenient.
Possible side effects, risks, and considerations:
 Have to be taken every day.
How to use it: Combination pills come in 28-day or 21-day packs. Both
types have 21 "active" pills — they contain hormones that prevent
pregnancy. The last seven pills in 28-day packs of combination pills are
called "reminder" pills. They do not contain hormones. They are taken
during the fourth week. In 21-day packs, the pills are taken for three
weeks. A new pack of pills is started eight days after the last pack is
completed. The hormones in the active pills prevent pregnancy
throughout the month — even during the fourth week when taking either
no pills or reminder pills.
How to Get it: The pill is only available through prescription. Students can
obtain a prescription by making an appointment to see a clinician at
Vaden, or at Planned Parenthood.
Cost: Each pack of pills costs between $20-$50. Most private insurances
cover this cost, and students can receive this for free by signing up for the
state-funded program Family PACT through Planned Parenthood. The
lowest priced generic oral contraceptive for students with Cardinal Care
at the Vaden pharmacy is $19.
Vaginal Ring
Birth Control Vaginal Ring
http://www.plannedparenthood.org/health-topics/birth-control/birth-control-pill-4228.htm
Also known as intravaginal rings, V-rings, or “The Ring”
Brand name: NuvaRing®
NuvaRing® is a reversible prescription method of birth control. It is a small,
flexible ring that is inserted into the vagina once a month. It is left in place
156
for three weeks and taken out for the remaining week. The ring releases
synthetic estrogen and progestin to protect against pregnancy for one
month. How it works:
NuvaRing® works like
typical combination
hormonal birth controls to
prevent pregnancy: by
preventing ovulation, by
thickening the cervical
mucus, and by thinning the
endometrium.
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NuvaRing® contains a lower dose of estrogen than both the patch and than
oral contraceptives: for those who want a hormonal method with estrogen,
but want as low a dose as possible, the ring may be a good choice. The
hormones are absorbed through the vaginal walls.
Failure rate: <1% - 8%. Pregnancy can happen if an error is made in using
the ring — especially if:
 The unopened package is exposed to very high temperatures or direct
sunlight.
 It slips out of the vagina and is not replaced within three hours.
 It does not stay in the vagina for three weeks in a row.
 It is left in the vagina for more than three weeks.
If any of these things happen, follow the directions in the package insert, and
call your clinician.
Advantages:
 Same health advantages as other combination hormonal methods.
 No medicine to take every day.
 Only needs to be changed once a month.
 Very low dose of hormone, so the health risks are lower as well as
other symptoms (nausea, etc).
157
Possible side effects, risks, and considerations:
 Same disadvantages as other combination hormonal methods, but
these disadvantages may be less severe/serious because it’s a lower
dose of hormone.
 It is expensive relative to other methods such as the pill.
 Vaginal irritation.
 Vaginal odor.
 Increased vaginal discharge.
 More frequent vaginal imbalances or infections.
How to use it:
 A vaginal ring is inserted into the vagina, about the same way a woman
would insert a tampon or menstrual cup, and left inside the vagina for
three weeks.
 At the end of that three-week cycle, it's removed and left out for seven
days, though the user remains protected from pregnancy in that week.
 Most users of the ring and their partners do not feel the ring during
intercourse, but if the couple prefers, the ring can be taken out for
sexual activities so long as it is out of the vagina for no longer than
three hours during the weeks it is supposed to be in.
How to get it: The NuvaRing® can be obtained through a prescription given
by a health care practitioner.
Cost: It can cost up to around $60/month. Most private insurances cover this
cost, and students can receive this for free by signing up for the statefunded program Family PACT through Planned Parenthood.
Transdermal Contraceptive Patch
Birth Control Patch
http://www.plannedparenthood.org/health-topics/birth-control/birth-control-patch-ortho-evra-4240.htm
Not recommended due to the high risk of blood clots.
158
Also known as “The Patch”
Brand name: Ortho Evra®
The patch — Ortho Evra® — is a reversible prescription method of birth
control. It is a thin, beige, plastic patch that sticks to the skin. A new patch is
placed on the skin of the buttocks, stomach, upper outer arm, or upper torso
once a week for three weeks in a row. No patch is used in the fourth week.
How it works:
The Shot works like typical progestin-only birth
controls to prevent pregnancy: by thickening
the cervical mucus and by thinning the
endometrium.
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The Patch releases about 60% more estrogen
than combination pills. The hormones are
absorbed through the skin under which the
patch is placed.
Failure rate: <1% - 8%.
The patch works best when it is changed on the same day of the week for
three weeks in a row. Pregnancy can happen if an error is made in using
the patch — especially if it becomes loose or falls off for more than 24
hours or the same patch is left on the skin for more than one week.
Advantages:
 No medicine to take every day.
 Ability to become pregnant should return quickly after discontinuation
of use.
Possible side effects, risks, and considerations:
 Exposes women to higher levels of estrogen than oral contraceptives,
which may lead to an increased risk of blood clots.
 Some women may forget to apply and remove it on schedule
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 Nausea, breast discomfort, skin irritation at patch site, headache.
 Much more expensive than pills or other methods.
How to use it:
Scarleteen.com: The Contraceptive Patch
http://www.scarleteen.com/birth_control_bingo_the_contraceptive_patch
 Open a new patch and put it, like a band-aid, on a clean part of the
body where it's most likely to stay (choose places that don't rub up
against the edges of clothing a lot, for instance), and where it feels
most comfortable having it.
 One place it should NOT ever be put is on the breasts: that could create
breast health problems.
 If the woman uses body lotions, be sure to put the patch on before she
puts on any lotion: lotions or oils can keep it from adhering properly.
 Every week, around the same time, she is going to take off your old
patch, and put on a new one in at least a slightly different spot.
 Do that for three weeks in a row, then have one week where she
doesn’t have a patch on, but you will still be protected against
pregnancy for that week.
 After that off-week, go back to putting a patch on once a week for three
weeks.
How to Get it: The Patch can be obtained through a prescription given by a
health care practitioner. Students can sign up for state-funded programs
at clinics such as Planned Parenthood, in order to receive the patch for
free. You can still obtain a prescription at Vaden, but it is not
recommended due to the high risk of blood clots.
Cost: The patch is more expensive than other methods, such as the pill. It can
cost up to $60 per month ($20 per patch, 3 per month). Most private
insurances cover this cost, and students can receive this for free by
signing up for the state-funded program Family PACT through Planned
Parenthood.
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Hormonal Methods: Progestin-Only
General
Revolution Health: Advantages and Disadvantages of Hormonal Birth Control
http://www.revolutionhealth.com/articles/advantages-and-disadvantages-of-hormonal-birthcontrol/tw9513
Progestin-only hormonal contraceptives contain only progestin.
Specific advantages and disadvantages vary depending on the method, but
there are some that are common across all methods. Please refer back to this
section when reading about specific contraceptives, because all of the
advantages and disadvantages listed are in addition to these.
Types of Contraception:
 Mirena® IUD.
 Contraceptive implant
(Implanon®).
 Depo-Provera Injection.
 Progestin-only Oral
Contraceptive Pills (minipills).
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How it Works:
 Thickens cervical mucus to
make sperm less able to get
into the cervix.
 Makes the lining of the uterus thinner and thus, less hospitable for a
fertilized egg to implant in.
Advantages: Because they do not contain estrogen, progestin-only
contraceptives have both fewer risks and benefits than combination
161
hormonal birth control. Some of the distinguishing risks and benefits are as
follows.
In subsequent sections, any advantages listed will be in addition to these.
 Do not contain estrogen, so does not carry estrogen-related health
risks.
 Can be taken while breastfeeding.
 Not affected by most medications.
Possible side effects, risks, and considerations: In subsequent sections,
any risks listed will be in addition to these.
 Do not protect against STIs.
 Have fewer advantages than combination hormonal birth control.
 May not be as effective as combination methods.
 More spotting and unpredictable periods.
 Can worsen depression.
Progestin-Only Oral Contraceptive Pill
Planned Parenthood: Birth Control Pill
http://www.plannedparenthood.org/health-topics/birth-control/birth-control-pill-4228.htm
Also known as birth control pills or “The Pill”
Progestin-only pills are known as “mini-pills”
Many brand names available
How it works:
Combination pills and progestin-only pills work like typical combination and
progestin-only birth controls. Combination pills prevent ovulation, thicken
the cervical mucus, and thin the endometrium, and progestin-only pills
thicken the cervical mucus and thin the endometrium.
Failure rate: <1% - 8%. Progestin-only pills are slightly less effective.
Advantages:
 Taking the pill is simple, safe, and convenient.
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Possible side effects, risks, and considerations:
 Have to be taken every day.
 Progestin-only pills must be taken at the same time every day.
How to use it: Progestin-only pills come only in 28-day packs. All progestinonly pills are "active." Pills must be taken at the same time each day.
Menstruation usually occurs during the fourth week, no matter what type
of pill is used — unless a woman decides to avoid menstruation by using
active combination pills during the fourth week, as well.
How to get it: The pill is only available through prescription. Students can
obtain a prescription by making an appointment to see a clinician at
Vaden, or at Planned Parenthood.
Cost: Each pack of pills costs between $30-$50. Most private insurances
cover this cost, and students can receive this for free by signing up
for the state-funded program Family PACT through Planned
Parenthood.
Contraceptive Implant
Planned Parenthood: Birth Control Implant
http://www.plannedparenthood.org/health-topics/birth-control/birth-control-implant-implanon-4243.htm
Brand name: Implanon®
Implanon® consists
of a flexible plastic
rod inserted just
under the skin of the
upper arm. It was
approved in July
2006 by the FDA,
and prevents
pregnancy in several
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ways using the hormone progestin.
How it works:
Implanon® works like typical progestin-only birth controls to prevent
pregnancy: by thickening the cervical mucus and by thinning the
endometrium.
It is effective for three years, after which it must be removed and replaced
with a new Implanon® rod.
Failure rate: <1%
Advantages:
 Discreet; most woman can’t see the rod after its insertion.
 No medicine to take every day.
 No chance of user error.
 Is reversible; once the rod is removed, a woman’s ability to get
pregnant should return quickly.
 Lasts for three years.
Possible side effects, risks, and considerations:
 Requires a clinician for insertion and removal.
 Still relatively new, so some clinicians may not provide it or may not
have completed their training on how to insert it.
How to use it:
 Insertion: The health care provider will numb a small area of your
arm with a painkiller. Implanon® is inserted under the skin. Insertion
takes only a few minutes.
 Removal: Implanon® can be removed at any time. The health care
provider will numb the area with a painkiller and will usually make
one small cut to remove the implant. Removal usually takes just a few
minutes, but it generally takes longer than insertion. A new implant
may be inserted at this time. Pregnancy can happen anytime after the
implant is removed.
How to get it: Implanon® is now offered at Vaden, or by prescription
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through another health care practitioner.
Cost: The cost of the exam, Implanon, and insertion ranges from $400–$800.
Removal costs between $75 and $150. Most private insurances cover this
cost, and students can receive this for free by signing up for the statefunded program Family PACT through Planned Parenthood.
Contraceptive Injection
Planned Parenthood: Birth Control Shot
http://www.plannedparenthood.org/health-topics/birth-control/birth-control-implant-implanon-4243.htm
Also known as DMPA, or “The Shot”
Brand name: Depo-Provera
Not recommended due to risk of significant loss in bone density.
"The shot" is an injectable progestin-only prescription method of reversible
birth control. The shot is also known as DMPA.
How it works:
The Shot works like typical progestin-only birth controls to prevent
pregnancy: by thickening the cervical mucus and by thinning the
endometrium.
A shot of DMPA can prevent pregnancy for 12 weeks.
Failure rate: .3% - 3%. Protection is immediate if you take the shot during
the first seven days of your period. Otherwise, use a backup method of
contraception for the first week. Protection lasts for 12 weeks.
Advantages:
 Effective for 12 weeks.
 No medicine to take every day.
 Very private method — no evidence of use that might embarrass some
users.
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Possible side effects, risks, and considerations:
 Must go to a clinician to receive the shot ever three months.
 Pregnancies, which very rarely occur, are more likely to be ectopic (in
a fallopian tube).
 Takes an average of nine to 10 months — or sometimes more than a
year — to get pregnant after getting the last shot.
 Depo-Provera is associated with bone loss.
 Most women who use Depo-Provera will gain weight.
How to use it: Get an injection into the arm or bottom every three months.
How to get it: Depo-Provera can be obtained through a prescription given
by a health care practitioner. Vaden does not prescribe it.
Cost: $35–$75 per injection, plus any exam fees. Most private insurances
cover this cost, and students can receive this for free by signing up for the
state-funded program Family PACT through Planned Parenthood.
Why Vaden does not prescribe Depo-Provera:
Studies have shown that after even one year of use, the Depo shot can
cause SIGNIFICANT loss in bone density and the minerals in bone, causing
very early-onset osteoporosis. Although this bone density loss may be
reversible, it is still very troubling that bone loss happens in the first
place, especially because peak bone mass is developed in a woman’s teens
and early twenties. Because of this reason, Vaden does not prescribe
DMPA, and counselors at the SHPRC do not recommend that students
obtain it elsewhere. It is still available at outside community clinics, such
as Planned Parenthood.
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Continuous Hormonal Contraception
Continuous hormonal birth control
http://www.birth-control-comparison.info/continual-hormones.htm
While most hormonal birth controls are taken for three weeks, with one
week for a period, NuvaRing® certain birth control pills can be taken
continuously for three months. Research to date has shown that this is safe
and effective so long as four placebo periods per year are still taken.
The “period” a woman has while she is on hormonal birth control is different
from one she would have when she is not on hormones. Normal periods are
caused by a sudden decrease in progesterone levels. Bleeding while on
hormonal birth control is similar, but is caused by temporarily discontinuing
the use of the hormones. By continuing to take the hormonal pills, a woman
can avoid bleeding for up to three months.
Birth control pills
Only monophasic birth control pills can be used.
Monophasic means that the same amount of
hormone is in each pill, as opposed to triphasic pills,
which have different amounts of hormones
depending on when during the cycle they are taken.
Do not take the placebo pills until the end of the
third month. Seasonique® is an extended-cycle
birth control pill that gives women four periods per
year instead of 12.
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NuvaRing®
Insert one NuvaRing® every three weeks without skipping any days. Never
go without a ring inserted.
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Combination Contraceptive Methods
These methods of contraception are physical barriers that are used with
spermicide cream or jelly to prevent pregnancy. Most women do not use
these methods anymore because of their relatively high failure rate and the
disadvantages associated with using spermicide.
Though the specific details of each device are different, most share the same
general advantages and disadvantages.
Advantages
 Cannot be felt by either partner during sex (Lea's Shield carries the
highest chance of being felt by a male partner)
 Can be inserted hours ahead of intercourse.
 Can be used while breastfeeding.
 Can be carried in a pocket or purse.
 Immediately effective and reversible.
 No hormones.
 Reusable.
Possible side effects, risks, and considerations:
 Do not protect against STIs.
 Need to be used with spermicide, which the SHPRC and Vaden do not
support.
 Increased risk of Toxic Shock Syndrome, UTIs, and PID.
 Can be difficult or uncomfortable for some women to insert.
 May be pushed out of place by some penis sizes, heavy thrusting, and
certain sexual positions.
 Must be in place every time a woman has sexual intercourse.
 Odor if left in too long.
 Possible allergic reaction to latex or spermicide.
Care for reusable devices:
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




After the device is removed, wash it with mild soap and water.
Allow it to air dry.
Do not use any powder on the device, as it can cause infections.
Examine the device regularly for small holes or weak spots.
Discard the device if it has a hole or weak spot.
Diaphragm
Planned Parenthood: Diaphragm
http://www.plannedparenthood.org/health-topics/birth-control/diaphragm-4244.htm
The diaphragm is a reusable wide,
shallow, dome shaped latex cup
with a flexible rim, which is held in
place by the pubic bone. It needs to
be fitted by a health care provider,
and fits securely in the vagina to
cover the cervix. It has recently also
been found that diaphragms may
reduce the risks of cervical
infections, including HPV. It is
washable and reusable, and lasts
about 2 years.
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Failure rate: 6-16%. Protection may be increased by making sure the
cervix is covered before each act of intercourse, making sure spermicide
is used as recommended, and using a latex condom.
Advantages:
 Reusable.
 Can be worn during menstruation to contain menstrual blood.
Possible side effects, risks, and considerations:
 Requires a visit to a clinician to be fitted.
 May need to be refitted.
 As with latex condoms, it cannot be used with oil-based lubricants.
169
Contraindications:
 Allergy to latex.
 Repeated UTIs.
 Inadequate vaginal muscle tone.
 Inability or discomfort with inserting the device.
 Sensitivity to spermicide.
 History of Toxic Shock Syndrome.
How to use it:
 First fill it with spermicidal jelly.
 Fold it like a taco and slide it into the vagina, being sure the rim is
behind the pubic bone.
 Leave in at least 6 hours after intercourse.
 Remove by hooking your finger under an edge of the rim and just
sliding it out.
How to get it: The diaphragm needs to be fitted by a health care
practitioner, and can be obtained after a pelvic exam. The fitting is free at
Vaden for students.
Cost: A pelvic examination for fitting costs from $50 to $200. Diaphragms
average from $15 to $75. Spermicide jelly or cream costs from about $8 to
$17 a kit. Most private insurances cover this cost, and students can
receive most of this for free by signing up for the state-funded program
Family PACT through Planned Parenthood.
Cervical Cap
Planned Parenthood: Cervical Cap
http://www.plannedparenthood.org/health-topics/birth-control/diaphragm-4244.htm
Brand name: FemCap
FemCap is a reusable small, silicone cup shaped like a sailor's hat that is held
in place through suction. It comes in three sizes, and needs to be fitted by a
health care provider. Once in place, it fits securely in the vagina to cover the
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cervix. It is washable and reusable and lasts about two years.
Failure rate: 14% for women who have never been pregnant or given birth
vaginally will become pregnant during the first year of typical use. 29%
for women who have given birth vaginally. Protection may be increased
by making sure the cervix is covered before each act of intercourse,
making sure spermicide is used as recommended, and using a latex
condom.
Advantages:
 Reusable.
Possible side effects, risks, and
considerations:
 Cannot be used during
menstruation.
 Require a visit to a clinician to
be fitted.
 May need to be replaced by a
slightly larger cap after
pregnancy.
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Contraindications:
 Inability or discomfort with inserting the device.
 Sensitivity to spermicide.
 Allergy to latex.
 PID.
How to use it:
 Can be left in for up to 48 hours.
 Fill it lightly with spermicide, being careful to keep the jelly off the
rim.
 Slide the device deep into the vagina, pushing it unto your cervix
 Give it a little tug once it's on to be sure it's secure.
 Leave the device in at least 8 hours after intercourse before removing
it,
 Remove by just breaking the suction and then pulling it out.
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How to get it: FemCaps first need to be fitted by a health care practitioner,
and can be obtained after a pelvic exam. The fitting is free at Vaden for
students.
Cost: A pelvic examination for fitting costs from $50 to $200. Cervical caps
average from $60 to $75. Spermicide jelly or cream costs about $8 to $17
a kit. Most private insurances cover this cost, and students can receive
most of this for free by signing up for the state-funded program Family
PACT through Planned Parenthood.
Cervical Shield
Brand name: Lea’s Shield®
Lea's Shield is a silicone cup
with an air valve and a loop to
aid in removal. It is held in
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vagina: the vaginal muscles are
both strong and the vagina
contracts to hold what is within
it easily. It is one size fits all and
fits snugly over the cervix. It is
washable and reusable and lasts about six months.
Failure rate: 4-15%. Protection may be increased by making sure the
cervix is covered before each act of intercourse, making sure spermicide is
used as recommended, and using a latex condom.
Advantages:
 Reusable.
 Can be used during menstruation to contain menstrual blood.
 Does not need to be fitted.
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Possible side effects, risks, and considerations:
 May be felt by male partner during intercourse.
Contraindications:
 Inability or discomfort with inserting the device.
 Sensitivity to spermicide.
 Allergy to latex.
 PID.
How to use it:
 Insert the device very similarly to how you insert a tampon.
 It can be left in place for up to 48 hours, but needs to be left in for at least
6 hours.
 Remove it by using the loop on the end to slide it out. The Shield also has
a valve as part of the device, which may help to prevent odor or vaginal
infections, related to cervical barrier use.
How to get it: Lea's Shield requires a prescription, although it does not need
to be fitted.
Cost: A pelvic examination for fitting costs from $50 to $200. Lea’s Shields
average about $65. Spermicide jelly or cream costs about $8 to $17 a kit.
Most private insurances cover this cost, and students can receive most of
this for free by signing up for the state-funded program Family PACT
through Planned Parenthood.
Contraceptive Sponge
Planned Parenthood: Birth Control Sponge
http://www.plannedparenthood.org/health-topics/birth-control/birth-control-sponge-today-sponge4224.htm
Brand name: Today Sponge
The Today Sponge is a one-time-use foam sponge that comes pre-treated
173
with spermicide. It is inserted deep into the vagina and covers the cervix. It
has a nylon loop attached to the bottom for removal.
Failure rate: 9-16% for women
who have never given birth. 2032% for women who have given
birth vaginally. Protection may be
increased by making sure the cervix
is covered before each act of
intercourse, making sure spermicide
is used as recommended, and using
a latex condom.
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Advantages:
 Does not require a prescription.
 Does not need to be fitted.
 Comes pre-treated with spermicide.
Possible side effects, risks, and considerations:
 Can make intercourse messy.
 Can soak up a woman’s natural lubrication.
 Not reusable.
Contraindications:
 Sensitivity to spermicide.
 Women who have previously given birth.
 Inability or discomfort with inserting the device.
How to get it: The Today Sponge is only available online.
Cost: A package of three sponges costs from $9 to $15.
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Intrauterine Device (IUD)
Planned Parenthood: IUD
http://www.plannedparenthood.org/health-topics/birth-control/iud-4245.htm
IUDs are small, T-shaped pieces of plastic that are placed in the uterus. There
are two kinds, and while they work differently, they both provide long-term,
highly effective protection against pregnancy.
Mirena
The Mirena IUD is a small, T-shaped
piece of plastic, containing small
amounts of progestin. It can remain in
the uterus for as long as five years, but
can be removed at any time.
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How it works:
 The Mirena IUD works like
typical progestin-only birth
controls to prevent pregnancy:
by thickening the cervical mucus
and by thinning the endometrium. The shape of the IUD impedes the
sperm's journey to the fallopian tubes, inhibiting fertilization.
 If fertilization occurs, the device prevents the embryo from attaching
to the uterine wall.
Failure rate: <1%
Advantages:
 Very effective reversible birth control.
 Good for five years.
 Can be used while breastfeeding.
 Works immediately upon insertion.
 Nothing to do right before sex to make it work.
175
 Ability to become pregnant should return quickly when removed.
 Fewer menstrual cramps.
 Lighter periods and less blood loss: often periods stop after a few
months.
 Less iron deficiency anemia.
Possible side effects, risks, and consideration:
 Does not protect against STIs.
 Some possible side-effects that usually clear up after a few
weeks/months include heavier periods, cramping or backache, and
spotting between periods
 It requires visits to a healthcare provider, (must be inserted and
removed by a clinic)
 Mild to moderate discomfort with insertion
 Can slip out of the uterus. It's important to periodically check the
string to make sure the IUD is still in place.
 Increased likelihood of infection for the first three weeks.
 Substantial up-front cost (but it’s more economical over the long run)
 Very rare risks include perforation of the uterine wall or expulsion of
the IUD.
Contraindications:
 Current or recurrent STI or PID.
 Known or suspected pregnancy.
 Allergy to the device.
How to use it:
 IUDs are inserted after a pelvic exam.
 Some clinicians may offer medicine to soften the cervix beforehand.
 The vagina is held open with a speculum, and the IUD will be inserted
through the opening on the cervix, into the uterus.
 A short length of plastic “string” will hang down into the vagina, which
can be used to check occasionally to make sure that the IUD is still in
place.
 Schedule a checkup after your first period.
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How to Get it: The IUD can be obtained through a consultation with a health
care provider.
Cost: It can cost up to $600, but Stanford students with Cardinal Care can
obtain the IUD for a heavily reduced price. Additionally, students can sign
up for a state-funded program at Planned Parenthood to obtain the IUD
for free.
ParaGard
The ParaGard IUD is a small, T-shaped piece of plastic that is wrapped with
copper. It can remain in the uterus for as long as twelve years, but can be
removed at any time. It can also be used as a backup birth control if inserted
within 120 hours (5 days) after unprotected intercourse. It is 99.9%
effective.
How it works:
 The copper in ParaGard is also believed to act as a sort of natural
spermicide.
 The shape of the IUD impedes the sperm's journey to the fallopian
tubes, inhibiting fertilization.
 If fertilization occurs, the device prevents the embryo from attaching
to the uterine wall.
Failure rate: <1%
Advantages:
 Good for twelve years.
 No hormones
 Can be used for emergency contraception
 Both can be used while breastfeeding.
 Works immediately upon insertion.
 Nothing to do right before sex to make it work.
 Ability to become pregnant should return quickly when removed.
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Possible side effects, risks, and consideration:
 Some possible side-effects that usually clear up after a few
weeks/months include heavier periods, cramping or backache, and
spotting between periods
 Does not protect against STIs.
 It requires visits to a healthcare provider, (must be inserted and
removed by a clinic)
 Mild to moderate discomfort with insertion
 Can slip out of the uterus. It's important to periodically check the
string to make sure the IUD is still in place.
 Increased likelihood of infection for the first three weeks.
 Substantial up-front cost (but it’s more economical over the long run)
 Using ParaGard can cause heavier periods and worse menstrual
cramps
 Very rare risks include perforation of the uterine wall or expulsion of
the IUD.
How to use it:
 IUDs are inserted after a pelvic exam.
 Some clinicians may offer medicine to soften the cervix beforehand.
 The vagina is held open with a speculum, and the IUD will be inserted
through the opening on the cervix, into the uterus.
 A short length of plastic “string” will hang down into the vagina, which
can be used to check occasionally to make sure that the IUD is still in
place.
 Schedule a checkup after your first period.
How to Get it: The IUD can be obtained through a consultation with a health
care provider.
Cost: It can cost up to $600, but Stanford students with Cardinal Care can
obtain the IUD for a heavily reduced price. Additionally, students can sign
up for a state-funded program at Planned Parenthood to obtain the IUD
for free.
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Permanent Methods
Tubal Ligation
Planned Parenthood: Sterilization for Women
http://www.plannedparenthood.org/health-topics/birth-control/sterilization-women-4248.htm
Tubal ligation, also known as
sterilization, is intended to be a
permanent method of birth
control for women. More and
more women today choose
sterilization. They know that
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provide highly effective
protection against pregnancy
for the remainder of their
reproductive years. They also
know that there is an increased
chance of failure with many
temporary methods, that some temporary methods have bothersome side
effects, and that some may be inconvenient.
Sterilization does not decrease a woman's sexual pleasure. It is often the
answer for women who have completed their families and for women who
do not want children.
How it works:
Tubal sterilization closes off the fallopian tubes, where a sperm fertilizes
an egg. When the tubes are closed, sperm cannot reach the egg, and
pregnancy cannot happen.
Sterilization does not affect femininity. It is very unlikely that sterilization will
affect your sex organs, or your sexuality. No glands or organs will be removed
or changed. All of your hormones will still be produced. Your ovaries will
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release eggs. Your menstrual cycles will most likely follow their regular
pattern.
Failure rate: <1% in the first year. In following years there is a limited
possibility that tubes may reconnect by themselves. About one out of
three of these pregnancies are ectopic (develop in a fallopian tube) and
may require emergency surgery.
Advantages:
 Safe.
 Simple and convenient.
 Very small risk of pregnancy.
 No change in hormones.
Possible side effects, risks, and consideration:
 Does not protect against STIs.
 Not easily reversible.
 Side effects associated with any surgery, including fatigue, abdominal
pain, dizziness, bleeding, etc.
How it's done:
 One or two small incisions are made near the navel and above the
pubic bone while under anesthesia.
 A laparoscope — a small, lighted magnifying device — is inserted
through the incision next to your navel.
 Using instruments passed through the laparoscope, your clinicain
cauterizes and seals the fallopian tubes or closes them with plastic
rings or clips.
 Tubal ligation can also be performed immediately after childbirth
through a small incision near the navel, during a Caesarean section or
through a small incision in the vagina.
Cost: The procedure costs between $2,500 and $4,000.
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Vasectomy
Planned Parenthood: Vasectomy
http://www.plannedparenthood.org/health-topics/birth-control/vasectomy-4249.htm
Vasectomy is permanent birth control
for men. About 500,000 men in the U.S.
choose vasectomy every year. It is
typically chosen by men who have
completed their families or by men
who do not want more children under
any circumstances. They prefer
vasectomy because most reversible
methods are less reliable, sometimes
inconvenient, and may have unpleasant
side effects for the women in their
lives. It has no effect on sexual pleasure.
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Vasectomy does not affect masculinity and will not affect the ability to get
hard and stay hard. It does not affect sex organs, sexuality, or sexual
pleasure. No glands or organs are removed or altered. The hormones and
sperm continue being produced. The ejaculate will look just like it always
did.
How it works: Vasectomy is a simple procedure. It makes men sterile by
keeping sperm out of semen. Vasectomy blocks each vas deferens and keeps
sperm out of the seminal fluid. The sperm are absorbed by the body instead of
being ejaculated.
Failure rate: <1%, but vasectomy is not immediately effective. Sperm
remains in the system beyond the blocked tubes. The couple must use
other birth control until the sperm are used up. It usually takes about
three months. A simple test — semen analysis — shows when there is no
more sperm in the seminal fluid. Very rarely, tubes grow back together
again and pregnancy may occur. This happens in about one out of 1,000
cases in the first year.
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Advantages:
 Very few side effects.
 Safe.
 Simple and convenient.
 Very effective.
Possible side effects, risks, and considerations:
 Does not protect against STIs.
 Not easily reversible.
 Swelling and bruising of the scrotum.
How it's done:
 A small incision is made in the upper part of the scrotum after you
receive a local anesthetic.
 The vas deferens may be tied off, cauterized or blocked with surgical
clips.
Cost: Between $250 and $1,000.
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Natural Family Planning
There are four types of natural family planning methods: basal body
temperature, mucus/ovulation, calendar/rhythm, and Standard Days
method. For each method, a woman or a couple identifies the woman's
fertile days and abstains from intercourse on those days.
Failure rate: 2%-25%: The methods are most effective when they are
combined. Of the three, the cervical mucus method is the most effective
on its own.
Contraindications:
 Inability to keep perfect records.
 Unwillingness to abstain from intercourse during fertile periods.
 Irregular menstrual cycles, temperature patterns, or vaginal discharge.
Benefits:
 Method is accepted by some religions.
 Methods can make women more in tune with their bodies.
 Instantly reversible; can actually help a woman conceive when she is
ready by her awareness of fertile times.
 Necessary supplies are inexpensive.
Possible side effects, risks, and considerations:
 Failure rates can be high.
 Abstinence from intercourse must be practiced during fertile periods.
 Provides no protection against STIs.
 Requires diligent record keeping in order for it to be effective.
How to get them: Information on natural family planning methods can be
obtained in All About Birth Control by Jon Knowles and Marcia Ringel.
Instruction given by a trained counselor is crucial to use any of the
natural methods effectively.
Costs: Costs can vary significantly. While materials necessary for these
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methods are inexpensive, training can be pricey.
Basal Body Temperature (BBT)
Planned Parenthood: Temperature Method
http://www.plannedparenthood.org/health-topics/birth-control/temperature-method-22143.htm
How it Works:
The woman's BBT, the
lowest body
temperature of a person
during waking hours, is
taken before she gets
out of bed in the
morning. This
temperature should be
recorded every morning
before getting up,
talking, eating, drinking,
smoking, having sex, etc.
The BBT of women
drops slightly immediately preceding ovulation. Before ovulation, 96 to 98°F
is normal for most women. After ovulation, 97 to 99°F is normal. From 24 to
72 hours after ovulation, the woman's BBT rises 0.4-0.8 degrees F, and
remains elevated until her next period.
The changes will be in fractions of a degree, so it's best to get a special, largescale thermometer that only registers 96 to 100°F. It will be much easier to
read. You can buy a basal thermometer for about $10 at most drugstores.
Some basal thermometers are to be used in the mouth and some are to be
used in the rectum. Rectal thermometers are generally more reliable.
Whatever you choose, be sure to take your temperature the same way every
day.
Charting your temperature: Must chart every reading. Soon a pattern will
emerge, and will look something like this:
Safe days:
 Safe days are safe for unprotected vaginal intercourse if the couple is
trying to prevent pregnancy.
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 They begin after the temperature rise has lasted for at least three days.
 They end when the temperature drops just before your next period
begins.
Because BBT identifies a woman's fertile period in retrospect, there is a high
risk of accidental pregnancy if this method is used incorrectly. To use this
method correctly, the couple should abstain from intercourse from the
beginning of a woman's menstrual cycle until her BBT has remained
elevated for three consecutive days.
Mucus/Ovulation Method
Planned Parenthood: Cervical Mucus Method
http://www.plannedparenthood.org/health-topics/birth-control/fam-cervical-mucus-method-22140.htm
The hormones that control the menstural cycle also make the cervix produce
mucus. It collects on the cervix and in the vagina. And it changes in quality
and quantity just before and during ovulation.
How it works:
 The woman checks her cervical secretions daily. Every time she goes
to the bathroom, she wipes her vagina and examines the mucus.
 After your period, there are usually a few days without mucus. These
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are called "dry days." These may be safe days if the cycle is long.
 While pre- and post-ovulation discharge is thick and cloudy, mucus at
the time of ovulation is clear, thin, slippery, and stretchy. Usually, the
woman will have the most mucus just before ovulation. When this type
of mucus appears, the couple should abstain from intercourse.
 After about four slippery days, you may suddenly have less mucus. It
will become cloudy and tacky again. And then the woman may have a
few more dry days before her period starts. These are also safe days.
 It is necessary to be aware that douching, semen, spermicides, some
medications, vaginal infections, and even sexual lubrication may
interfere with the ability to accurately chart the woman's mucus
pattern.
Safe days:
 The days of the woman period are not safe days, especially during
short cycles. The flow can cover the mucus signs.
 In a long cycle, the dry days after the woman’s period may be safe.
 Days that are not safe begin two or three days before the first sign of
slippery mucus. They last for about three days after slippery mucus
peaks. Safe days may begin after peak slippery mucus drops off and is
cloudy and tacky again. But the dry days that follow are even safer.
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Calendar/Rhythm Method
Planned Parenthood: Calendar Method
http://www.plannedparenthood.org/health-topics/birth-control/fam-calendar-method-22139.htm
This method is based on the lifespan of sperm (about 2 days) and the egg
(about 1 day), and the fact that 90% of women begin their periods 13-15
days after they ovulate. It is important to take into account that ovulation
may occur a day before or after expected. This method can only predict
which are most likely to be safe days, so it should always be combined with
another method. The calendar method is not accurate for women whose
cycles are shorter than 27 days.
How it works:
 Charts are kept of the woman's menstrual cycles for approximately
one year.
 To predict the first fertile day in the woman’s current cycle
o Find the shortest cycle in the record.
o Subtract 18 from the total number of days.
o Count that number of days from day one of the current cycle, and
mark that day with an X. Include day one in the count.
o The day marked X is the first fertile day.
 To predict the last fertile day in the current cycle
o Find the longest cycle in the record.
o Subtract 11 days from the total number of days.
o Count that number of days from day one of the current cycle, and
mark that day with an X. Include day one in the count.
o The day marked X is the last fertile day.
Safe days: Intercourse should be avoided during the fertile times.
187
Standard Days Method
Planned Parenthood: Standard Days Method
http://www.plannedparenthood.org/health-topics/birth-control/fam-calendar-method-22139.htm
The Standard Days Method is a kind of calendar method that uses a special
string of beads, called CycleBeads, to keep track of a woman’s cycle. There
are 33 colored beads and a moveable rubber ring on the string. The first
bead is black with a white arrow. The next one is red. The next six are
brown. The next 12 are white. And the last 13 are brown. Each one, except
the black one, represents a day.
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How it works:
 On the first day of the woman’s period, day one, put the ring on the red
bead.
 Move the ring from one bead to another each day — in the direction of
the arrow.
 Brown beads stand for safe days. You can have unprotected vaginal
intercourse when the ring is on one of them.
 White beads stand for unsafe days. Do not have vaginal intercourse
unless you use a cervical cap, condom, diaphragm, or female condom
when the ring is on one of them.
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Emergency Contraception (EC)
Planned Parenthood: Emergency Contraception
http://www.plannedparenthood.org/health-topics/emergency-contraception-morning-after-pill-4363.htm
EC helps prevent pregnancy after unprotected vaginal intercourse. It may be
that the condom broke, you didn’t use birth control, or you were forced to
have sex. Plan B is a form of EC that is now available to adults without a
prescription. EC is should be used as an emergency method, rather than
as a main method of birth control: this is because it contains a high
dose of hormone, and it is not as effective as other hormonal methods
of birth control.
Plan B
Also known as the Morning After Pill
How it works:
 Can keep the ovary from releasing an egg.
 Can thicken the cervical mucus to prevent sperm from reaching the
egg.
 In theory, it could prevent a fertilized egg from attaching to the lining
of the uterus, but this has not been proven.
 Emergency Contraception WILL NOT end a pregnancy. If you are
pregnant, or if you become pregnant after taking EC, there is no
evidence that it will harm the pregnancy.
Effectiveness: EC can reduce the risk of pregnancy by 75-89% if started
within the first 72 hours after intercourse. It reduces the risk of
pregnancy if taken up to 120 hours – five days – after unprotected
intercourse.
Advantages:
 Very effective if taken as soon as possible.
Possible side effects, risks, and considerations:
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





Nausea and vomiting.
Breast tenderness.
Dizziness.
Headaches.
Irregular period.
Taking EC can affect your next period. It could be early or late, lighter
or heavier, shorter or longer. You’re more likely to have problems with
your next period if you use EC more than once during your cycle.
 Even though EC is made of the same hormones as the birth control pill,
it does not have many of the same side effects because the hormones
are not in the body as long.
How to use it:
 It is recommended that the woman take Plan B as soon as possible
after unprotected intercourse. The sooner you take it, the more likely
that it will prevent pregnancy.
 Plan B can be taken in one dose or two doses. If taken in two doses,
take the second pill 12 hours after the first pill. Or simply take them
both at the same time.
How to get it:
 Available at drug stores and health centers for men and woman 17 and
older. Note: until recently, 18-year-olds were the youngest that could
get EC without a prescription, but the law has recently been changed.
 Available by prescription for those younger than 17.
Where it’s available:
At Vaden:
 A government issued ID (i.e. driver’s license) is required to verify
proof of age.
 Women under 17 can still receive Plan B by making an appointment
with a nurse.
 After hours, a prescription can be phoned in by the Doctor on Call, to
an outside pharmacy.
 The cost ranges from $30-$40.
At Planned Parenthood:
 Women and men (17 years or older) with valid ID can obtain EC at
190
Planned Parenthood for free if they sign up for a state-funded program
 Women and men (17 years or older) can also buy EC for $40 at
Planned Parenthood.
Outside Pharmacies:
 Different pharmacies have policies on EC that vary: Longs, Rite Aid,
CVS, and Walgreens all carry EC, and women who want to buy it may
or may not be required to speak to a pharmacist/clinician before
receiving it.
 It costs approximately $40 at outside pharmacies.
Cost: $10-$70. Students can sign up for a state-funded program at Planned
Parenthood to obtain the IUD for free.
ParaGard IUD
A ParaGard IUD can also be used as backup birth control if inserted within
120 hours — five days — after unprotected intercourse. It is 99.9 percent
effective. Talk with your health care provider if you're interested in getting
an IUD.
Birth Control Pills
The hormones in Plan B are the same as those found in ordinary birth
control pills, and women can take their normal birth control pills in different
dosages for emergency contraception. In contrast to Plan B pills, which may
either be taken together or 12 hours apart, birth control pills as emergency
contraception must be taken in two doses, 12 hours apart.
191
Brand
Plan B
Alesse
Aviane
Cryselle
Enpresse
Jolessa
Lessina
Levlen
Levlite
Levora
Lo/Ovral
Low-Ogestrel
Lutera
Lybrel
Nordette
Ogestrel
Ovral
Portia
Quasense
Seasonale
Seasonique
Tri-Levlen
Triphasil
Trivora
First Dose
(within 120 hours of
unprotected sex)
1 white pill
5 pink pills
5 orange pills
4 white pills
4 orange pills
4 pink pills
5 pink pills
4 light-orange pills
5 pink pills
4 white pills
4 white pills
4 white pills
5 white pills
6 yellow pills
4 light-orange pills
2 white pills
2 white pills
4 pink pills
4 white pills
4 pink pills
4 light-blue-green pills
4 yellow pills
4 yellow pills
4 pink pills
Second Dose
(12 hours later)
1 white pill
5 pink pills
5 orange pills
4 white pills
4 orange pills
4 pink pills
5 pink pills
4 light-orange pills
5 pink pills
4 white pills
4 white pills
4 white pills
5 white pills
6 yellow pills
4 light-orange pills
2 white pills
2 white pills
4 pink pills
4 white pills
4 pink pills
4 light-blue-green pills
4 yellow pills
4 yellow pills
4 pink pills
192
Section Review Questions
1. What are some non-methods of contraception you have heard of?
Think about why a student may choose to use these methods.
2. A student comes in and asks what sort of contraception is best for her.
Think of at least two questions you would ask her and give suggestions
based on some hypothetical answers. (Try to do 2 questions with 2
different answers for each, totaling in at least 4 suggestions.)
3. Why do you think Emergency Contraception is placed under
contraception and not abortion?
193
THE MORE SERIOUS SIDE OF SEXUAL
HEALTH
ABORTION
Aspiration
Medication
SEXUAL ASSAULT
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Abortion
Planned Parenthood: Abortion
http://www.plannedparenthood.org/health-topics/abortion-4260.htm
Abortion ends a pregnancy before birth. It occurs naturally in 15–40
percent of all established pregnancies — when an embryo or fetus stops
developing and the body expels it. This is called spontaneous abortion,
miscarriage, or early pregnancy loss. Women choose abortion in less than 25
percent of the 6,000,000 pregnancies that are diagnosed in the U.S. every
year, 50 percent of which are unintended. This is called induced abortion.
Induced abortion is not a new concept. In the U.S., induced abortion was
common among Native Americans, and it was legal from colonial times to
the middle of the 19th century. Unclean, primitive medical practices made
the procedure very dangerous. To protect women’s lives, laws against
abortion began to be passed during the mid-1800s. But by the middle of
the 20th century, cleaner, more advanced medical procedures made safe
abortion possible. All U.S. laws against abortion were overturned in 1973 by
the landmark U.S. Supreme Court decision in Roe v. Wade. Today, abortion is
legal nationwide and is one of the safest of all available medical procedures.
The chances are high that a woman will have more than one unplanned
pregnancy in the course of her lifetime. More than one-third of all U.S.
women will have an abortion by the time they are 45 years old. About six
million women in the U.S. become pregnant every year. Half of those
pregnancies are unintended. Nearly 1.3 million women choose abortion to
end their pregnancy each year.
The most common reasons a woman chooses abortion are:
 She is not ready to become a parent.
 She cannot afford a baby.
 She doesn't want to be a single parent.
 She doesn't want anyone to know she has had sex or is pregnant.
 She is too young or too immature to have a child.
 She has all the children she wants.
 Her husband, partner, or parent wants her to have an abortion.
 She or the fetus has a health problem.
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 She was a survivor of rape or incest.
Deciding If Abortion Is Right For You:
Most women look to their husbands, partners, families, health care
providers, clergy, or someone else they trust for support as they make
their decision about an unintended pregnancy. And many women go to
the clinic with their partner. But you don't have to tell anybody. Specially
trained educators at women's health clinics can talk with you in private.
You may bring someone with you. You will discuss your options —
adoption, parenting, and abortion. You may be asked if someone is
pressuring you to have an abortion.
Teens are encouraged to involve parents in their decision to have an
abortion, and most do have a parent involved. But telling a parent is only
required in states with mandatory parental involvement laws. Such laws
force a woman under 18 to tell a parent or get parental permission before
having an abortion. In most of these states, if she can't talk with her
parents — or chooses not to — she can appear before a judge. The judge
will consider whether she's mature enough to decide on her own. If not,
the judge will decide whether an abortion is in the teen's best interests. In
any case, if there are complications during the procedure, parents of
minors may be notified.
Abortion Options
Pregnancy is usually dated from the first day of the last menstrual cycle.
Early in pregnancy, you have two options for ending a pregnancy —
medication abortion or abortion by vacuum aspiration. After the first
trimester, dilation and evacuation (D&E) is the most common abortion
procedure.
Medical Abortion
Medication abortion is the use of medicine, mifepristone, to end a
pregnancy. You may choose it if you are early enough in pregnancy — this
may be defined as up to 49, 56, or 63 days, depending on how the
medicine is taken. When the pill is taken it blocks the hormone
196
progesterone, which breaks down the lining of the uterus and ends the
pregnancy. The patient then takes another pill that causes the uterus to
empty. It can be taken up to three days after the first pill, and the woman
and her health care practitioner carefully plan the time and place of this
second step. After two weeks, the woman follows up with her health care
practitioner.
Vacuum Aspiration
After 63 days, vacuum aspiration is the only abortion option during the
first trimester, which is calculated as the first 14 weeks after the first day
of a woman's last menstrual period. Vacuum aspiration is the use of
gentle suction to end pregnancy. The cervix is first slowly stretched open,
and a hand-held suction device gently empties the uterus. Pain
medication and antibiotics are given, and sedatives are offered to aid in
relaxation. The procedure takes 5 to 10 minutes, but the process of
stretching the cervix may take longer. The recovery period is about one
hour.
Dilation and Evacuation
Dilation and Evacuation (D&E) procedures happen in the second
trimester of pregnancy. D&E is similar to vacuum aspiration, but uses
different instruments. The cervix is slowly stretched open, and the
procedure is completed by emptying the uterus using a combination of
suction and medical instruments.
Abortion Contraindications
Medication Abortion
 Too far along in pregnancy.
 Unwilling to have a vacuum aspiration if needed.
 Cannot return for follow-up visits.
 Do not have access to a telephone, transportation, and back-up
medical care.
 Have a known or suspected molar pregnancy — one in which the
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



placenta develops abnormally.
Have severe adrenal gland, heart, kidney, or liver problems.
Take any medicine that should not be combined with the medications
used in medication abortion — methotrexate, mifepristone, or
misoprostol.
Take anti-clotting medication or have blood-clotting disorders.
Are unwilling to have your IUD (if you have one) removed before
taking the medicine.
Special considerations may be necessary if you:
 Are breastfeeding?
 Have chronic heart, liver, respiratory, or kidney disease.
 Have an infection or are sick.
 Have severe anemia.
 Have uncontrolled high blood pressure.
 Have any other serious health problem.
Vacuum Aspiration and D&E
Special considerations may be necessary if you:
 Are extremely overweight.
 Are running a fever.
 Have an infection in your uterus.
 Have certain kinds of sexually transmitted infections.
 Have certain serious health problems
 Have problems with anesthesia
 Have seizures more than once a week

Effectiveness
Medication Abortion
There are two types of medication abortion offered in the U.S. —
mifepristone medication abortion and methotrexate medication abortion.
Mifepristone and methotrexate affect the body differently. Mifepristone is
used more often than methotrexate because it is more effective and more
predictable. Mifepristone is 96-97 percent effective. Methotrexate is 9296 percent effective. Some of the medicines used in medication abortion
198
may cause serious birth defects if pregnancy continues, so if they don't
work, vacuum aspiration should be done.
Vacuum Aspiration and D&E
Vacuum aspiration and D&E abortion are more than 99 percent effective.
Failure to end a pregnancy can happen due to unusual conditions, such as
more than one chamber in the uterus or ectopic pregnancy. Repeated
aspiration or other treatment may be needed if the initial procedure does
not end the pregnancy.
Comparing Risks
If you choose abortion, you will want to compare the benefits, risks, and side
effects of each of your options. For example, both medication abortion and
early vacuum aspiration are extremely safe. But current data suggest that
medication abortion may carry a higher risk of death than early vacuum
aspiration abortion. Even so, both procedures are much safer than abortion
later in pregnancy or carrying a pregnancy to term.
Some women prefer medication abortion because they feel its benefits
outweigh its risks. Other women prefer vacuum aspiration abortion because
they feel its benefits outweigh its risks. Your clinician can help you decide,
but the choice is up to you.
Emergency Contraception vs. Medication Abortion
There is considerable public confusion about the difference between
emergency contraception and medication abortion because of
misinformation disseminated by anti-choice groups. Emergency
contraception helps prevent pregnancy; medication abortion terminates
pregnancy. According to general medical definitions of pregnancy that have
been endorsed by many organizations including the American College of
Obstetricians and Gynecologists and the United States Department of Health
and Human Services, pregnancy begins when a pre-embryo completes
implantation into the lining of the uterus (ACOG, 1998; DHHS, 1978; Hughes,
1972; "Make the Distinction..." 2001). Hormonal methods of contraception,
199
including emergency contraception, prevent pregnancy by inhibiting
ovulation and fertilization (ACOG, 1998). Medication abortion terminates a
pregnancy without surgery. By helping women to prevent unplanned
pregnancies after unprotected intercourse, emergency contraception has the
great potential to decrease the rate of abortion. By helping women terminate
unwanted pregnancies up to 56 days after their last menstruation,
medication abortion is a safe and effective option.
200
Sexual Assault
If someone you know has been sexually assaulted, call (650) 725-9955,
the YWCA Sexual Assault Center at Stanford.
Sexual Assault is the commission of an unwanted sexual act, whether by an
acquaintance or by a stranger, that occurs without indication of consent of
both individuals, or that occurs under threat or coercion. Sexual assault can
occur either forcibly and/or against a person's will, or when a person is
incapable of giving consent. A person is legally incapable of giving consent if
under 18 years of age; if intoxicated by drugs and/or alcohol; if
developmentally disabled; or if temporarily or permanently mentally or
physically unable to do so.
Under federal and state law, sexual assault includes, but is not limited to,
rape, forcible fondling (e.g., unwanted touching or kissing for purposes of
sexual gratification), forcible sodomy, forcible oral copulation, sexual assault
with an object, sexual battery, and threat of sexual assault.
Many misconceptions about sexual assault exist that make it more
difficult for someone to:
 Assess a potentially risky situation.
 Respond effectively when at risk or being assaulted.
 Seek help when they or someone else has been assaulted.
 Understand that they have been assaulted and are not to blame
(resulting in the high number of unreported rapes).
 Confide in someone when they've been sexually assaulted (because
they feel ashamed or are afraid of not being believed or understood).
 Understand and believe another person who confides that they've
been sexually assaulted (since many people have misconstrued ideas
of what constitutes as sexual assault).
Therefore it is important for everyone to become better informed of the
dangers and realities of sexual assault.
Not "understanding" sexual assault is no excuse for rape or other unwanted
sexual advances! Sexual assault is wrong in any language and in any culture
201
and will not be tolerated by Stanford University.
Defining Sexual Assault
Sexual Assault
Involves unwanted sexual behavior resulting from the use of physical force,
intimidation, or coercion, or when the person cannot give informed consent
because they're intoxicated. Perpetrators of sexual assault may face civil or
criminal charges and/or campus disciplinary actions.
Acquaintance/Date Rape
When someone you know or are dating forces you to have sexual intercourse
against your will. It is estimated that 80-85% of rapists are known to the
person they attack.
Consent
Consent is based on choice. Consent is active not passive. Consent is possible
only when there is equal power. Giving in because of fear is not consent.
Going along with something because of fear is not consent. Going along with
something because of wanting to fit in with the group, being deceived, or
feeling bad is not consent. Being verbally, emotionally, psychologically, or
physically pressured into any kind of sexual activity is not consent. If the
person cannot say "no" comfortably then "yes" has no meaning. If the person
is unwilling to accept a "no" then "yes" has no meaning.
There must always be active consent on both sides. Consent to one thing
does not imply another. If limits are made clear and consent is not given,
pressuring someone into changing their mind is not consent.
Seeking Help If You or Someone You Know Has Been Sexually
Assaulted
Please call (650) 725-9955 if you or someone you know has been sexually
assaulted.
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203
Section Review Questions
1. What are some important considerations when deciding which
method of induced abortion is most appropriate? Why?
2. In California, does a teenager have to notify her parents if she receives
an abortion?
3. A student comes in and admits that he or she was recently sexually
assaulted. Outline important questions, instructions, and thoughts you
should have or share.
204
SEXUAL EXPRESSION, PLEASURE, AND
THEIR MANY FORMS, PART 2
ACCESSORIES
Basic Types
Care and Maintenance
Where to Buy
MODES OF EXPRESSION
Bodily Fluids/Excretions
Bondage
Exhibitionism/Voyeurism
Fisting
Group sex
Non-penetrative Sex
Roleplay
S&M
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Accessories
Accessories, also known as sex toys, are a person to explore sexuality and
pleasure by themselves and/or with others. While the SHPRC is not a sex toy
shop, it has recently begun to carry productions outside of contraception,
from increasing the lending library to carrying Pearl Drop vibrators and cock
rings. Moreover, if done correctly, use of sex toys does not transfer bodily
fluids and can be considered a safer sex practice; however, if done
incorrectly, they can transmit certain STIs, so SHPRC counselors should
know the basics.
Note: Sex toys should not be shared between partners, as they are difficult, if
not impossible, to sterilize. To use a sex toy on more than one person, a new
condom must be replace over the toy.
Basic Types
Rings: Rings, also know as cock rings, are worn around the base of the penis
to trap blood flow and maintain an erection. They should not be worn for
more than twenty minutes at a time.
Dildo: Dildos are penetrative toys. They come in many different materials,
sizes, widths, colors, and shapes. They made be used on their own, with
strap on harnesses (to allow the user to penetrate others like an
anatomical male can), on oneself, or on others. They may or may not be
modeled after a penis.
Other penetrative: Other penetrative toys include:
 Butt plugs, which are inserted and remain stationary and in place in
the rectum;
 Anal beads, which is a string of beads inserted into the rectum and
pulled out slowly
 Ben Wa balls, which are hollow metal balls inserted into the vagina
Sleeve: Sleeves are self-pleasure toys that the user penetrates. Sleeves may
206
be designed to simulate the anus, the mouth, the vagina, or none of the
above.
Vibrator: Vibrators are toys that vibrate or pulsate. They can be used
externally or for penetration. They can be used in conjunction with other
toys – e.x., a small vibrator can be inserted into a dildo or a sleeve.
Care and Maintenance
Care for a sex toy will depend on the material it is made out of. (Remember,
though, that regardless of the material, it is almost always a good idea to use
a condom or another barrier method with the toy.)
Plastic: Hard plastic toys can be cleaned with soap and water. Soft plastic
toys are difficult to clean 100% and should be used with a condom.
Glass: Modern glass sex toys are generally very durable and are not prone to
chipping or breaking. However, they should be cleaned with soap and
water that is not too hot. (If it’s too hot for your skin, it’s too hot for the
toy!)
Silicone: Silicone toys are tearable and breakable if they get any sort of
initial tear or crack. Silicone toys should generally be used with waterbased lubes only. Silicone is non-porous and can be cleaned with soap
and water and can be disinfected in boiling water (~5 minutes).
Rubber: Rubber toys are porous. They can be cleaned with soap and water.
Metal: Similar to hard plastic and glass.
Where to Buy
The SHPRC sells a small vibrator and a package of rings, both of the Good
Vibrations brand. Students who wish to purchase from a larger selection
207
may do so at an adult novelty shop, an adult bookstore/video store, or a
specialty shop, such as Good Vibrations. Some exist in Redwood City, Santa
Clara, San Jose, and San Francisco. Toys can also be purchased online and
generally will come in discreet packaging. Prices will range depending on the
brand, material, and quality of the product
208
Modes of Expression
As stated in Sexual Expression, Pleasure, and Their Many Forms Pt.1, there is
a vast number of sexual expressions, each one as valid as the next, as long as
all parties are consenting. SHPRC counselors should at least be aware of
some of the many different modes of expression in order to know how to
present relevant information and react well to students who participate in
non-typical sexual acts. The following are just a few modes of sexual
expression:
Bondage
a.k.a. “BDSM”
What: Bondage is the use of restraints for sexual pleasure.
Additional Risks: Few in mild, practiced forms. In extreme and hasty forms:
loss of circulation and obstruction of airway.
Precautions: Partners should establish a “safety word” that means “stop.” All
restraints should be easily removed in an emergency. A bound person
should never be left alone. Airways should remain unobstructed.
Exhibitionism/Voyeurism
What: Exhibitions derive pleasure from exposing their bodies in sexual ways.
Voyeurs derive pleasure from watching someone expose his or her body.
Additional Risks: None, with consenting parties.
Precautions: None, with consenting parties.
Feces/Urine
a.k.a. “water sports,” “golden showers”
What: Some sexual practices involve fluids such as human urine or feces. Can
range from watching, having contact with, having a partner urinate or
defecate on another, or consumption of.
Additional Risks: Ingestion of urine or feces can pass toxic substances
and/or transmit infections. Contact with urine and feces is generally safe as
long as it doesn’t contact an orifice or an open wound.
Precautions: Barrier methods (such as dental dams, condoms, gloves, etc.)
can prevent transmission of bacteria and viruses.
(Goaskalice.com)
Fisting
What: Fisting is the insertion of a hand (or in some variations, foot) into the
rectum or vagina.
Additional Risks: The insertive partner (the one doing the fisting) can be
exposed to the blood of the receptive partner, as bleeding can occur during
fisting, and blood can transmit infections.
Precautions: Use of gloves and other barrier methods, especially in the
presence of sores or open wounds.
Group sex
a.k.a. “threesome,” “orgy”
What: Group sex is sexual activity that occurs with more than two partners
at the same time.
Additional Risks: Exposure to more partners can potentially mean exposure
to additional infections.
Precautions: Use of barrier methods (with a new barrier for each successive
partner) and limiting the number of sexual partners.
Non-penetrative Sex
a.k.a “dry humping,” “mutual masturbation”
What: Non-penetrative sex is sexual contact that does not require
penetration of an orifice. It can occur with clothes on or off, with or without
the use of hands.
Additional Risks: Skin-to-skin contact may pass infections such as herpes,
scabies, or crabs.
Precautions: Avoid contact when outbreaks are present.
Roleplay
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What: Roleplay is an act in which partners take part in a make-believe
scenario with sexual themes. This can involve assigning of roles, dialogue,
plot, and costumes.
Additional Risks: None
Precautions: None
Sadomasochism
a.k.a. “S&M”
What: A sadist derives pleasure from inflicting humiliation and/or pain on
another. A masochist derives pleasure from receiving. Note that sadists and
masochists do not necessarily derive pleasure in other scenarios, such as
medical procedures.
Additional Risks: None, with consenting parties.
Precautions: None, with consenting parties.
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Section Review Questions
1. What considerations might a student have in choosing a sex toy?
2. While we don’t want to scare you, the SHPRC does sometimes get
suspicious repeat callers. Describe how you would handle the
following: a caller has you on the phone for over 20 minutes, asking
unrelated, in-depth questions and you begin to feel uncomfortable.
3. Suggest at least one thing you would like added to this course reader
for future classes.
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Resources at Stanford
YWCA Sexual Assault Center at Stanford: (650)725-9955
http://www.stanford.edu/svab/ywca.shtml The YWCA offers immediate
individual counseling and referral to students who are affected by sexual assault,
sexual harassment, and violence in relationships.
Counseling and Psychological Services (CAPS): (650)723-3785 (24 hours)
http://caps.stanford.edu Student counseling for relationships, sexual assault,
work or academic related stress, and other psychological needs. Counseling can be
a good idea as it may stop the violence before it begins. Rape survivors group,
incest survivors group, child abuse survivor groups, and other specialized
counseling services are also available.
Stanford Faculty & Staff Help Center: (650)723-4577
http://www.stanford.edu/dept/helpcenter/ Faculty & Staff counseling for
relationships, sexual assault, work or academic related stress, and other
psychological needs. Other specialized counseling services are also available for
faculty, staff and their families.
Religious Life Office: (650)723-1762 http://religiouslife.stanford.edu Provides
spiritual guidance and religious counseling for all faiths.
Undergraduate Residence Deans: (650)725-2800 Residence Deans are available
for individual/confidential consultation and advising support. To find your local
RD call (650) 725-2800 or ask your RA or RF. Your RA or RF can page the RD 24hour pager in the event of an after hours crisis.\
Graduate Life Office: (650)723-9929 http://glo.stanford.edu The Graduate Life
deans are available in our offices for individual/confidential consultation and
advising support. In a crisis or emergency, a GLO dean is available via pager on a
24-hour basis at: (650)723-8222 ext. 25085
The Bridge: (650)723-3392 http://www.stanford.edu/group/bridge/ Peer
counseling and information for students by students.
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Bechtel International Center: (650)723-1834
http://www.stanford.edu/dept/icenter/ The Advisor to International Families
works with international students, their spouses or domestic partners and their
families. The Advisor has knowledge of, and sensitivity to, relationship issues that
may be of concern.
Stanford Community Centers Stanford has several community centers that offer
support and assistance to students. Specially trained staff regarding sexual
violence are available at the Women's Community Center (650)723-0545 and the
LGBT Community Center (650)725-4222.
Online Resources
Sexuality Information and Education Council of the United States
www.siecus.org
National clearinghouse and annotated bibliographies on many sex-related topics
and current issues.
Advocates for Youth
www.advocatesforyouth.org/youth/index.htm
This site includes information on a variety of health and well-being topics,
including safer sex, sexually transmitted diseases, healthy relationships, and body
image.
Go Ask Alice
www.goaskalice.columbia.edu
Nonjudgmental Q&A website on a wide variety of sexual health topics written
specifically for college students, produced by Columbia University Health Services.
Planned Parenthood
www.plannedparenthood.org/health
This site includes information on safer sex, sexually transmitted infections,
HIV/AIDS, contraceptives, pregnancy options, and more.
American Social Health Association (ASHA)
www.ashastd.org/stdfaqs/index.html
This site has facts and answers about STIs and a sexual health glossary.
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National Sexuality Resource Center
www.nsrc.sfsu.edu/index.cfm
Clearinghouse for current issues in sexuality, sexuality research, and social policy
(affiliated with San Francisco State University).
San Francisco Sex Information
www.sfsi.org
This site includes FAQs, weekly columns, and access to more information by phone
and email.
Good Vibrations
www.goodvibrations.com
Good Vibes is a Bay Area institution – a collective that sells sex toys and books. Its
website sells these items and also provides information on sex, sexuality, and
erotica.
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