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.
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.
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 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.
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|
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.
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.
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.