Wedding Preps: Sex Talk (Part 1)

Wedding Preps: Sex Talk (Part 1)

GUYS. I’m launching a ‘wedding’ section on the blog today. However, this isn’t going to be about centerpieces or ghararas-worth-a-kidney. We’re going to have a more discussion based approach to this with stuff thrown in for pre & post-wedding things as well. I’ll have some clothes talk in the mix, sure, but it won’t be all the time. Starting off the series today with a topic that I feel is super, super neglected particularly in our desi culture and I’m really excited to share it with you.

In our society, understanding your body as a female, how it works and managing your sexual health are things we don’t talk about because we don’t even know what to discuss. Half the women will be virgins prior to getting married and will suddenly step into a sexual relationship having no idea about what can happen and what to do prior to getting into such a situation without having the right information (unplanned babies on wedding nights are not the most uncommon). Our expert is either our best friend or phupho ki beti (who both by the way don’t know shit) or the magical world of Google.

Think about it. If you wanted a nose job, would you get it done through a cousin or do it yourself after reading about it on the internet? Sex is natural but a lot of shit happens inside your body when you launch that mission, so it’s super important to know what it’s all about.

I’ve partnered with Fakih IVF Clinic, which is primarily a fertility clinic (and more on that will come in later posts) for an amazing two part series on general knowledge for women about sex and their bodies pre-wedding. Even though I want to mainly reach out to women who have been sexually inactive prior to getting married, this is brilliant for even those who are sexually active, because most of us end up only going to the gynecologist for the first time in our lives when we think we’re pregnant. That’s actually horrific.


I had the chance to meet the amazing Dr. Monika Chawla who’s a fertility specialist at Fakih IVF. I kid you not, when I say to you that she was amazing. She’s incredibly good at her job, her office is flooded with thank you notes from people who she’s helped conceive since she’s a fertility expert and above everything else, she has the kindest attitude. For a sensitive topic like sex and fertility, she puts you at ease in seconds. I’m thrilled that I got her to answer these questions, even though her prime area of interest is fertility.

The first part today is going to be about understanding the basics of gynecological exams, why you need them, what birth control options are available, how your body works. The second part coming next week (see here) is going to be about sexual intercourse particularly for women doing it for the first time. Let’s get started?


I’D LOVE IT WE COULD ALL KEEP OUR RELIGIOUS BELIEFS OUT OF THIS. THAT WOULD BE JUST GREAT.


[Terms you’ll see used in this post – OB-GYN: Obstetrics & Gynecology / STD: Sexually transmitted disease]

1. When should one schedule their first gynecologist appointment?
Any female should ideally schedule their gynecologist appointment as soon as reaching adulthood, regardless of her sexual activity. In case of a sexually inactive woman, traditionally gynecological appointments may be scheduled once a year as part of annual health checks. Contraceptive advice is very important for all sexually active women or before they get married if sexually inactive. Additionally, even those women seeking fertility advice should meet with their gynecologists even prior to getting married to help develop the right family planning model for them.

2. Should I schedule a gynecologist appointment even if I haven’t been sexually active or plan on remaining sexually inactive temporarily or permanently? 
Definitely. A gynecologist appointment is extremely useful for all women, irrespective of their sexual behavior. It’s important for all adult women to understand their body, how the female hormonal cycles work as well as share any concerns that they may not be able to disclose to even close family members. Additionally, you can be educated on other important exercises like breast exams and how to perform them on yourself at home. Other deeper issues can also be diagnosed, for example, if you are sexually inactive but have irregular periods, a specialist can help you identify if this is a condition indicative of something more. Potentially, this could indicate polycystic ovaries (PCOS) which your gynecologist can diagnose and intervene at the right time. Such a treatment can help take care of a large number of problems associated with PCOS especially improving your lifestyle and/or losing weight. Medical advice from a licensed practitioner can help in just not creating the correct awareness but also help with a number of potential issues that cannot be handled via an internet search.

Whether you plan on being sexually inactive in the short or long term, a gynecological visit should be in your top priorities. 

3. What can I expect from my first gynecologist visit?
This can vary however typically the gynecologist will start with a screening of general health through a detailed history to elicit any symptoms pointing toward any gynecological problems (infections, irregular periods, etc ), any factors which may have impact on child bearing and fertility in the future (even if you’re not planning on getting pregnant any time soon). Breast examinations are done in various positions to rule out any masses or lumps. Abdominal and pelvic exams are done on sexually active women with simple instruments. The rest of the evaluation is carried out based on individual requirement such as fertility, contraception or cancer screening. Blood tests may be needed for hormonal evaluation especially for thyroid hormones and milk hormone apart from ovarian hormones. An ultrasound examination of the uterus and ovaries may also be conducted to get detailed information about these organs .

Other than these exams, you can also be taught self-care exercises like at-home breast exams and how to perform them on yourself after each period. Additionally, you should report anything abnormal you may have noticed like abnormal vaginal discharge, breast lump/pain, severe period pains, unusual abdominal pain abdomen, etc.

Dr. Monika herself

4. Can you explain what the female hormonal cycle is like? What are the different steps?
The menstrual cycle is the monthly series of changes a woman’s body goes through in preparation for the possibility of pregnancy. Each month, one of the ovaries releases an egg — a process called ovulation. At the same time, hormonal changes prepare the uterus for pregnancy. Having regular menstrual cycles is a sign that important parts of your body are working normally. The menstrual cycle provides important body chemicals, called hormones, to keep you healthy. A cycle is counted from the first day of 1 period to the first day of the next period. The average menstrual cycle is 28 days long. Cycles can range anywhere from 21 to 35 days in adults and from 21 to 45 days in young teens.

Steps

a) In the first half of the cycle, levels of estrogen (the “female hormone”) start to rise. Estrogen plays an important role in keeping you healthy, especially by helping you to build strong bones and sustain their strength as you get older. Estrogen also makes the lining of the uterus (womb) grow and thicken. This lining of the womb is a place that will nourish the embryo if a pregnancy occurs. As the lining of the womb is growing, an egg or ovum, will start to mature in one of the ovaries. At about day 14 of an average 28-day cycle, the egg leaves the ovary. This is called ovulation.

b) After the egg has left the ovary, it travels through the fallopian tube to the uterus. Hormone levels rise and help prepare the uterine lining for pregnancy. A woman is most likely to get pregnant during the 3 days before or on the day of ovulation. Keep in mind, women with cycles that are shorter or longer than average may ovulate before or after day 14.

c) A woman becomes pregnant if the egg is fertilized by a man’s sperm cell and attaches to the uterine wall. If the egg is not fertilized, it will break apart. Then, hormone levels drop, and the thickened lining of the uterus is shed during the menstrual period.

5. What birth control options are available and how do I know which one is the best for me?
There are over 15 birth control options available and the choice for them depends on several factors such as what kind of contraception is required (permanent/temporary), whether you can remember to take it daily or likely to miss, whether you can accept heavy periods or irregularity, if you prefer non-hormonal methods, etc. If a female is overweight and smokes, then a contraceptive without estrogen is preferable. If a woman is breastfeeding, a progestin containing tablet is prescribed. Depending on your individual preference and health, a gynecologist will be able to advise which option will perform the best for your sexual and overall health.

The more commonly used contraceptive methods are:
Birth control pills: Oral tablets that need to be started a few days prior to intercourse.

Birth control patches: Sticky patches for the skin that deliver hormones into your body. They basically halt ovulation by preventing the eggs from leaving the ovary. Typically have to be changed every 3 weeks. They’re as effective as the pill but just don’t have to be taken daily. Although, they don’t prevent STDs.
Birth control shot: An injection typically given every 3 months.
Birth control sponge: A plastic foam sponge that is inserted deep into the vagina prior to intercourse and removed after.
Birth control implant: A small, plastic piece containing hormones which is inserted under the skin in the upper arm. Can last upro 4 years.
Condoms: Male and female versions both exist. Used prior to intercourse, topically for the male and inserted into the vagina for the female.
Vaginal Ring: Inserted in the vagina. 
Intra-uterine device (IUD): A small t-shaped plastic device inserted in the vagina. Is long lasting, can last for up to an average of 5 years, some even for longer. This may contain copper which acts like a foreign body or it may contain a hormone which effects the way the sperm moves so it cannot join the egg. 
Diaphragm: A barrier contraceptive which is like a silicon cup inserted through the vagina to prevent pregnancy. This can last upto two years. This works by keeping the sperm from joining the egg and should ideally be used with a spermicidal cream or gel.
Cervical cap: Again a barrier contraceptive like a silicon cup that can last up to 2 years.
Emergency contraception: This is what is known as the ‘morning after’ contraception. This is only to be taken in the case of accidental, unprotected intercourse and can be used for up to 5 days/ 125 hours after the sexual activity. One form is the pill and the other is intrauterine contraceptive device that can be inserted within those 5 days and can prevent the pregnancy from implanting. The pill has to be taken immediately because the longer you wait, the efficacy goes down. Emergency contraception is safe but not to be used again and again. Temporary side effects include nausea and vomiting.
Sterilisation: This is a permanent form of contraception where the female fallopian tubes are blocked.
At Fakih IVF, when I was chilling prior to the interview 

6. How long before the first intercourse, should birth control pills be started?
You will be protected from getting pregnant after a consistent 7-day use of birth control pills. Consistent use means that you’re taking the pill every day at the same time (plus or minus 2 hours). So basically, one week of birth control pills is enough to put the ovaries to sleep and keep you from getting pregnant. The pills can be started from the same cycle if it can be taken one week prior to intercourse or one previous cycle for better protection .

7. Will birth control pills make me gain weight?
It’s rare, but some women do gain a little bit of weight when they start taking birth control pills. It’s often a temporary side effect that’s due to fluid retention, not extra fat.

8. Some people say that birth control pills can make it hard to conceive later?
This is not true. Birth control pills are a temporary form of contraception so the moment you stop taking them, you can get pregnant, provided no other factor is involved. In fact, missing a few pills can cause pregnancy, and therefore they are not 100% effective. Unless there are other factors that have not been identified before moving onto a birth control plan, for example the performance of the sperm may be low or the tubes may be damaged in the female leading to problems in conception or infertility later – these issues may appear to be a consequence of birth control pills which is not accurate. Birth control pills are in fact very beneficial and can potentially offer big non-contraceptive advantages like preventing period pain/ cysts in the ovaries or breasts.

9. Can my OB-GYN help me with my family planning?
Yes. Your OB-GYN will provide you all required information on managing your family planning in the best way possible. What choices of contraception are available, which is the best one for you, whether you want temporary or permanent contraception, what plan should you be on based on any medical problems you may have. Contraceptive advice can also vary for people who already have had children or have not started yet. Additionally, people who may want to take care of an STD can also get advice on what combination of contraception is best for them until fully cured and to avoid further risks.

10. If the doctor does a pelvic exam, will that make me lose my virginity?
No. In any case, if you’re not sexually active, then doctors don’t usually perform pelvic exams unless indicated because of suspicion of disease. Diagnosis of sexually inactive woman can be done though non-invasive tests like ultrasounds, blood tests as well. At times an abdominal exam can also be sufficient.

One of the many messages in Dr. Monika’s office

11. Any tips to prepare for your first OB-GYN appointment?
It’s very important to be comfortable with your OB-GYN. Don’t be anxious or nervous and try to be relaxed. If you have any specific concerns or first time questions, write them down so you don’t miss anything. Don’t be nervous, anxious. Remind yourself that the appointment is to get comfortable about your body and be reassured about it. There is no other requirement except coming with a clear mind.

However, if you’re sexually active and require a pap smear, only in that scenario, you’ll be required to not have intercourse a day prior to your appointment. Or any activity that results in cleaning of the vagina from the inside since a pap smear requires cells to be taken from the vagina. Also if you have a vaginal infection and need a discharge to be inspected, it’s best to not wash it prior to the appointment so the diagnosis can be accurate. 

My opinion: If you’re cautious of asking any specific questions in front of a family member who may accompany you to an appointment, you can always schedule it alone or request the doctor to meet with you separately if you cannot ask your family member yourself. Additionally, since a 30 year old virgin can actually be a badge of honor in our culture instead of social suicide like in the West, if you are scheduling your first appointment with a doctor who may not be aware of your cultural setup, you can politely request at the beginning of your appointment for the doctor to understand and not express surprise at your sexual inactivity. While all doctors should be understanding of any personal decisions regarding your sexual life, there can be a scenario where this may not be true, and therefore requesting your gynecologist right in the beginning can let be you more open and ask any questions without fear of experiencing ‘jokes’ or ‘surprise’ on your lack of sexual activity.   





12. Are there exams I should schedule regularly? 
You should schedule your exams regularly, especially breast exams which should be done once a year by your gynecologist or general practitioner. You must schedule an appointment to understand how breast exams should be conducted on yourself, so you can perform them at home after your period every month. Pap smear testing is also important and should be done cyclically every 1-3 years. Some people do pap smears as part of their annual health checkups, but this is also dependent on your health as well as geographic location. If your pap results are normal, then it can be done once every 3 years. But if indications are abnormal, then it has to be done more frequently. Pelvic exams are not necessary on a regular basis unless there are indications like irregular bleeding or an abdominal or pelvic mass is suspected, in which case you need to schedule them immediately.

13. General good habits to adopt related to your sexual health?
You must have an awareness of your body and how the female cycle works. Also, it’s important to be aware of any STDs that you or your partner may have and be taking corrective measures regarding these. Always report symptoms early for conditions like vaginal discharge, burning in urine/genitalia, blood stained discharge, development of small wounds or vesicles in genitalia. Early reporting results in early cure with chances of no long term consequences. Time is specifically very important in the treatment of STDs because the earlier you catch it, the more fully it can be cured with no long-term risks.

14. What should be in my medical kit at all times related to sexual health?
The most important tool in your medical kit is having the right advice and knowledge about your body. Also understanding how sexual contact can cause STDs. There are some at-home kits available to check for these. However, complications and risk can increase if it takes longer to start treatment. You can always get rid of symptoms of an STD but sometimes cannot get rid of consequences like tubal damage that can happen easily in the female. All of this can be avoided through early treatment so your most important tool is to understand what to do and who to contact about your sexual health.

That’s it for Part 1. Give me your feedback?
Dr. Monika handles more advanced fertility queries so if you have any questions or concerns about that, get yourself an appointment at Fakih IVF. She works out of the Abu Dhabi clinic but Fakih has clinics all over the UAE. Check them out here. You can read more about Dr. Monika here. For general appointments, check out their gynecology and obsestrics department on their website.
Part 2 is up now and it’s all about your first sexual intercourse post-wedding and other things related to it.  Check it out here.

All inputs in this post from Dr. Monika are based on typical scenarios. For any individual concerns, doubts or medical conditions, please make sure you check with a certified doctor before you execute anything. Myself or none of the partners in this post are responsible for any loss or damage incurred from following any advice contained within this post, without expert medical consultation. Basically don’t be stupid and consult an expert, I don’t want a lawsuit because I have no money.

31 Comments

  1. I'm extremely impressed with this series. I had no one to guide me before my wedding about these topics. I couldn't ask anyone such questions because we have a very 'conservative' household. I did not have any birth control plan when I had sex for the first time. I love your blog and today I respect you even more because of how well thought out your posts are. Kudos!!

  2. Thank you for writing this. I'm not Pakistani, but live in a very Pakistani area of England. (I'm Mauritian and this is also true of many girls from that culture). The level of knowledge about sex and the female body itself is surprisingly very poor. Girls don't understand their menstrual cycles, and being on their periods is considered something to be ashamed of.

    Breast cancer and cervical cancer are often detected much later than in the general population, because going for mammogram and smear tests are considered to be dirty and unnecessary. This leads to higher rates of mortality, and much more complications.

    Girls don't know much about sex, and when they encounter it, it can be very distressing, and shocking. It often leads to unintended pregnancies and confusion about sex in general.

    Some girls I've grown up with didn't actually know where they urinated from other than somewhere"down there". While this may seem trivial, it just highlights the level of misinformation about one's own body. There's no autonomy.

    I assume there's going to be a lot of nasty comments for this, but ignore them. Some people like to be holier than thou and would say "Pakistani women don't have sex before marriage" to which I'll say your level of ignorance says a lot about your opinions.

    1. Author

      I know EXACTLY what you mean. I've totally heard some friends have confusion about the peeing & baby making parts. It's just not considered a part of your health, pretty much like going to the dentist is mostly done when your teeth are dying. Thank you for showing the love!

  3. More like Gynae talk than sex talk.

  4. Im soo soo glad you started with a Wedding Series now. And you firsr article is so apt. Love you for this!!

  5. Girl, I kid you not. This series is really appropriate for women esp where it's taboo to talk about your sexual health. I am not only happy but thankful as well that someone thought of doing such a thing. Warm jhappi for you -MBS

  6. Ummm That was Useful Information Although Am not 18+.But Awareness Is important.

  7. I am getting married soon, i needed all this information. Thank you for this much needed series.
    Waiting for part 2.

  8. I'm actually really happy about this. My family isn't very conservative when it comes to discussing sex, but it's still nice to know that someone else can also help me regarding this.

    Also, as someone who has PCOS, PLEASE do meet with a gynecologist because it really is a pain in the ass and you'll need help understanding how to manage it. Believe me.

    Also, I understand that most women only go to gynecologists when they're adults, but I feel like mothers should also take their teens as well so they don't grow up with the same stigma against sex and periods as we did.

  9. I'm loving this series already. As someone who has PCOS, believe me,it's a good idea to know how to manage it early on. Also, I feel like maybe we shouldn't be so against taking our teenage daughters to the gynecologists as well. I mean, if we did, they would know that it's alright and there's nothing to be ashamed of. Not to mention they would get 'the talk' early on as well which I feel is really important nowadays.

  10. Being a Final year Medical student. I am impressed. This is all medical knowledge conveyed in a simple easy languge which every woman should have.
    Way to go Shehzeen!

  11. I have taken levlen ed birth control pill for about 8 months and it worked for me as in i didnt get pregnant but i gained few pounds, severe mood swings( which my husband suffered the most and offcourse me as well) and skin breakage .. So because of all this we decided to stop them and use condoms instead.. Had few accidents in the beginning of my marriage and ended up buying $25 morning after pill which was very expensive..
    Apart of this i love the idea of ur new blog topic.. I myself is more interested in what u will bring in part 2 ?

  12. Thats a very good idea of educating people.. ����
    My doctor has sent me a reminder for pap smear test but i am not sure about it , never heard my elder sister or anyone around me taken it ��
    Althought it should be done every year if u r sexually inactive

    1. Please go to your smear test. It's a test to check your cervical cells for abnormal cell growth (a precursor to cervical cancer). It takes 5 mins to do! And it's not painful or anything. You literally lie on the examining table, a plastic thing is inserted inside and a swab is taken. That's it!

  13. Thank you for taking this initiative. This will help alot of pakistani girls because we don't have anyone to inform us about all this. Waiting for the next post. girls who are going to get married soon can never talk about these things with family so it's going to help us alot. Thanks

  14. This just amazing wealth of knowledge thats so rarely available. Kudos to you for being so thoughtful

  15. So I have a lot of body image issues, and I'm petrified of ever having to open my legs in front of a doctor (or even my future husband). Like honestly, I lose sleep at night, just thinking about a doctor peering through my legs. What if they think I have the ugliest and hairiest vagina in the world? I'm super terrified, seriously.

  16. This is a great initiative! I'll be getting engaged soon, and although I'm marrying my longtime boyfriend, I'm very unsure about how to approach the whole birth control thing. You can't exactly take a man with you to the gynecologist if you're unmarried in Pakistan lol.

    Also, as someone who suffers from polycystic ovaries, please do go to your gynae the moment you notice anything off. I had a cyst that was close to bursting by the time I dragged myself there. So yeah, do go.

    Another thing- could you please cover how to approach gynecologists for family planning before you're married in Pakistan? Also, other things like the morning after pill, how to respond to questions from prying relatives etc? There's a lot of things about this on the internet, but not really from a desi perspective. Thanks!

  17. Hi!
    That was an amazing job to do as in our culture, no matter a girl/woman is married or not, see is considered a taboo. And no one even talks about it so the majority of women don't have any knowledge and being a medical student I know that personally. Have seen even some women whom when asked is this pregnancy planned or unplanned they reply as "Hum tu nahi chatty thy lekin jaisay Allah ki marzi". They don't know that something like contraceptive pill or any other method do eexist.
    So I really thing that you have done a great job, Hats off to you!

  18. So proud of you for doing this. So, so proud.

    – Mahnoor

  19. Please include public hygiene in your next post. I grew up not knowing that I should be shaving down there. In college I used to feel dirty because of all the hair down there and started shaving. But was always scared that my mother will find out. Used to hide the razors. Would use the same razor for 2-3 months because I couldn't go and get a new razor. Used to think I was doing something wrong. Thankfully started reading up stuff online before getting married hence wasn't a clueless soul on the wedding night. But imagine the risks I put myself through due to lack of knowledge. The same razor for three months! And I am sure there are a lot of girls out there who are in the same boat as me.

  20. Due the sensitivity of topic in south asian culture the selection of words and articulation of topic couldn't be better than this ?
    Very much like it ..BRILLIANT !!

  21. Hi, It is really thoughtful of you to do this, and it couldn't be a better forum. One thing that I found was really useful, before getting sexually active/and then while trying to conceive as well, is to religiously track your period. This is particularly great not only while trying to track ovulation for pregnancy but also because there is a supplemental method of contraception called the calendar method- http://www.mayoclinic.org/tests-procedures/rhythm-method/basics/definition/prc-20013489. There are so many apps out there that will calculate the fertile/infertile days for you (for eg. Period Tracker on iphone), and as long as you're very careful, this can be great as a supplement with condoms for example, especially if you're avoiding medication based methods, which are inevitably a pain because of their side effects.
    Keep up the great work.
    -aniqa

  22. I am surprised how so many people did not know about this as everything is available on the internet.

  23. Good job. Much needed

  24. Hi shehzeen! Thank you so much for taking this initiative! Please include stuff about endometriosis in your part 2 as well. It's a really common problem we girls suffer from but is mostly left undiagnosed till a later stage. It causes ovarian cysts which is so common these days! Painful periods are one of the main symptoms of endometriosis. And in our culture girls are hushed when they complain about painful periods. Regular check ups prior to and post getting married are super important!! Especially now that are diets have become so horrible!

    Looking forward to part 2!

  25. Shehzeen excellent job starting this topic on ur blog as its STILL considered a taboo discussing this in our society so most girls end up wasting their years fretting about gynae visits. Also in ur next post please discuss abt the 'fear of losing virginity' (first time sex). It really exists ! I personally know a friend who went through this trauma for 2 years who was unable to do intercourse ending up in severe panic attacks which always forced her husband to stop trying. She was reluctant in having gynae visits as the first doc she went to (LNH (karachi)) made the situation worse for her by making a jock out of her state (not to mention she even went on explaining an incident of how some couple faced similar situation & the husband ended up marrying someone else. So much for our educated docs!)

    Anyways pls do consider the suggestion & again love ur blogs (y)

  26. Hey Shehzeen…anything coming up on fibroids or endometriosis (think that's how it's spelt)? It is a struggle finding a good and affordable gynae here as the government ones barely see you for 5 minutes and you end up waiting to see them for 2 hours or more!! And the private practice gynae are so expensive that i have been putting off seeing one for a few years now… Your explanation is much appreciated. Much thanks in advance! XO, Saadia


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