Sex Made Easy (10 page)

Pre-ejaculate (pre-cum) does not contain sperm,
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which may be why withdrawal (the pulling-out method) is a decently effective method of birth control.
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It's not a perfect method, as many men try to pull out in time but don't, and they end up ejaculating in or near their partner's vagina. That said, if a man ejaculates and then he and his partner start having sex soon after he ejaculates, and he doesn't pee in between, his urethra may have sperm hanging out in it. Then, if intercourse has begun when his Cowper's glands release pre-ejaculate the next time, those fluids may pick up the leftover sperm and carry them out of the penis and into the vagina. And in that case, pre-ejaculate could contain leftover sperm and may lead to a pregnancy.

My advice? If you don't want to become pregnant, use condoms and/or consider highly effective methods of birth control such as the birth control pill, shot, patch, or ring. And if you accidentally get pre-ejaculate in or near the vagina, chances are extremely low that you could become pregnant from that. If you're super worried about pregnancy, consider emergency contraception (the morning-after pill)—and take better precautions the next time.

Don't panic! Semen in one's eye isn't likely to cause blindness, but it might sting badly. You may find it helpful to splash lukewarm water on your eyes to help get the semen out. Your eyes may be pink and feel irritated for hours or into the next day. If you normally wear contacts, you might be more comfortable wearing glasses until your eyes feel better. If you're not sure of your partner's STI status, or if you're concerned that he might have chlamydia, gonorrhea, syphilis, or HIV, tell your health care provider what happened; you may need to be tested for STIs and may benefit from an eye exam. Pubic lice (crabs) may take up residence in your eyelashes if you perform
oral sex on a man who has pubic lice and whose hairs get awfully close to your face. Why? A friend of mine who's an ophthalmologist says it's likely because eyelash hairs are spaced similarly to pubic hairs. Again, an eye doctor (an optometrist or an ophthalmologist) is a good place to start for any suspected pubic lice on your eyelashes. Finally, if you experience ongoing redness, irritation, or eye discharge, or if you have questions about your eye health, check in with a health care provider ASAP so as to avoid further problems or damage to your eyesight. There is no need to feel embarrassed: truly, this happens more often than many people would like to admit. Next time, don't let your partner come on your face or, if you do, use a hand shield maneuver to protect your eyes from his ejaculation. Your eyes will thank you.

This isn't likely to be a health problem. However, if a man feels embarrassed about wetting his pants this way, he can check in with a health care provider. There have been several case reports of men being successfully treated with medication for this issue.
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Other men just wear two pairs of underwear on dates, so they don't have to worry about soaking through their clothes when they lean in for a kiss. Just as some women get extremely wet when they feel aroused, so do some men. Remember: we all have our own individual body quirks. The more we can accept each other's quirks and peculiarities, the better sex can be.

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ome of the most common sex questions I receive at the Kinsey Institute and through my columns, blog, and classroom teaching are about sexual health.

Students and strangers aren't the only ones who ask me questions about sexual health though. My friends and family also have a great deal of curiosity. Recently, on a beautiful late summer evening, I joined a group of five or six girlfriends at a friend's house. We were sitting in her living room, drinking wine and talking—and often laughing—about our lives, relationships, exes, and work, the way we women often do. At some point, we started talking about various health issues and the conversation wound its way to the nitty-gritty details of gynecological exams. There was a lot of uncertainty among this group of friends (a group of women in their late twenties to early forties) about Pap tests, pelvic exams, vaginal pain, itching, HPV vaccines, and what should be a part of a normal GYN exam. In my experience, most women—no matter how smart, well-educated, or inquisitive—haven't been told much about gynecological health issues by their moms, teachers, or health care providers. We're all a bit in the dark. Many of us aren't quite sure what it is our doctors are doing when they're “down there.” And some issues never stop being important. For example, even if you are in an exclusive, monogamous relationship and you and your partner don't have sex with anyone else, it's a good idea to stay up to date on information about sexually transmissible infections (STIs) so you can teach your daughters, sons, nieces, or nephews about them or so you can share the information with a friend. And given how many preteens and teenagers are more comfortable asking sex questions of adults who aren't their parents, if you're a school teacher, counselor, or aunt, you can never
know too much about sexual health.

This chapter is meant to provide you with a solid update on sexual health issues that are important to many women. Some issues are familiar to many of us (like vaginal itching or burning) whereas others are less common but still important for women to learn about so they can be prepared if the issue happens to them, a friend, or a child (such as having vulvar problems from bike riding).

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ven women who regularly go to the gynecologist aren't always sure what their health care provider is accomplishing through a routine GYN exam. A number of my friends and students say that they generally stare at the ceiling or make small talk with their gynecologist while being examined. My doctor talks to me about triathlons (we both run, swim, and bike, though I suspect he takes it more seriously than I do) and he asks me about my work. Or I ask him GYN-related questions my students have asked me that I've been unable to answer on my own. We also, of course, talk about my body and my health—after all, that's why I'm there! Everyone has their own way of going through a GYN exam.

And although some health care providers make great efforts to involve women in the exam and use a mirror to point out their vulvar parts (and maybe even let them see inside to view their cervix), many of them are content to do the exam quietly and then move on to the next patient. This is too bad because it means that women aren't always sure what kinds of tests they are getting—or potentially what kinds of tests their health care provider has chosen, for whatever reason, not to conduct. My advice? Talk to this person. Ask questions such as “What are you doing?” or “What kinds of things are you looking for?” And if you have questions about your health, write them down on the intake form, let the nurse know, or let your health care provider know early in the visit (preferably before the pelvic exam begins) rather than wait until they're about to walk out the door. The more time they have to answer your questions, the better your visit is likely to be.

Most of the time, you can expect a few basic things to happen at an
annual GYN exam (also sometimes called one's “annual exam”):

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Paperwork.
There's no escaping it: nearly all clinics and doctor's offices ask you to complete a range of paperwork that involves questions about your own health as well as your family health history. If you don't know much about your family health history, ask your parents, siblings, grandparents, or others who might be able to help you fill in the blanks. If you have questions about your health or special concerns you want to talk about (such as painful sex, vaginal itching, a lump in your breast, unprotected sex you recently had, pregnancy, or fertility), write your question on the intake questionnaire.

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A general exam.
Once you're called from the waiting room, the more formal intake begins. This general part of the exam is often done by a nurse and may involve taking your height, weight, and blood pressure (normally, your clothes are still on). The nurse might also ask when your last period was, so try to come into the office knowing this information. Again, if you have questions or concerns that you want to make sure to talk about with your health care provider, it's a good idea to let the nurse know (though she or he might ask you about it after they read your intake questionnaire comments). This is also a good time to state whether you would like a nurse to be present in the room during your gynecological exam. The nurse might also ask you to pee in a cup so that they can conduct urine testing.

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Changing into a gown.
After intake, you might be sent back to the waiting room or you might be taken directly back to the exam room (offices vary in how they manage this part). Once you're in an exam room, the nurse will likely ask you to change into a paper or cloth “gown” and then typically leave the room so you can have privacy to change. It's a good idea to take off all your clothes and then change into your gown, including your bra, as health care providers often do a clinical breast exam (meaning that they feel your breasts and areas around your underarms) to check for abnormalities such as lumps.

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Small talk.
Once your health care provider (e.g., your gynecologist, nurse practitioner, or physician's assistant) enters the room, they will often introduce themselves if it's your first visit. Even if you've been going to the same provider for years, this is the “small talk” phase where they ask how you're doing. This is the perfect time to ask the questions that are on your mind. Write your questions down on a piece of paper in advance and bring them with you if you're worried you will forget—I always do this for my annual exams and it's been very helpful. By asking questions before the pelvic exam starts, you clue your provider in to what they should be looking for. As an example, if you've been having painful sex or vaginal itching, they can make certain to look more carefully for unusual causes of pain or itching that they might otherwise not look for as closely.

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Clinical breast exam.
As I mentioned earlier, many health care providers examine women's breasts as part of an annual exam. This may occur before or after the pelvic exam. Your provider might also ask you to breathe in and out while they use a stethoscope to listen to your heart and lungs.

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External genital exam.
At some point, your health care provider will probably ask you to scoot your hips/butt to the edge of the exam table. This is when what women normally think of as the “GYN exam” actually begins. You may not even notice it, but health care providers typically start by looking at a woman's vulva and perianal area (the area around the anus) to make sure that all is well. With a relatively quick look, they can check for any discoloration, lumps, bumps, discharge, or areas of inflammation that may be signs of benign (noncancerous) or cancerous conditions. If they notice a red inflamed area, they might ask if you're experiencing any pain. If they notice a white patch of skin, they might ask if you've had any genital itching and may recommend taking a quick biopsy (which is a sample of your tissue) to be sent to the lab. Asking for a biopsy doesn't necessarily mean that your provider is worried about cancer; rather, white
patches of genital skin are sometimes a sign of a noncancerous skin condition called lichen sclerosus. A biopsy is an important way to get a more accurate diagnosis.

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Pelvic exam.
After the vulva (external genital) exam, the health care provider will use a speculum to look at the vagina and cervix. Smaller-sized speculums are available, so let your provider know if you have a history of painful GYN exams, painful sex, or difficulties with tampon use. A
Pap test
is often, but not always, conducted during a woman's pelvic exam. It is used to look at the health of your cervix and to test for abnormal changes. It does not test for STIs, so if it has been a while since you've been tested for STIs, including HIV, or if you have had unprotected oral, vaginal, or anal sex since your last STI test, let your health care provider know. Providers will also generally check internal organs using their glove-covered fingers and/or hand.