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Being safe during sex

Sexual health: your questions answered

Dr. Rebecca Rohrer answers questions about sexual health and practising safe sex.

Transcript

Who are you and what is your background?

My name's Dr.

Rebecca rra. I'm a doctor practising clinically

and a medical director at Bupa,

and I've got a passion for supporting women's health.

What is contraception?

Contraception or birth control is ultimately designed

to prevent pregnancy,

and in some cases can also help

to prevent sexually transmitted infections or STIs.

It does that in a couple of ways:

it can prevent eggs being released by the ovaries,

it can thicken cervical mucus to stop sperm getting

through into the womb,

it can also act as a barrier

to stop sperm entering the vagina in the first place.

So there's lots of different options for you.

What does contraception do?

So contraception or birth control is ultimately designed

to prevent pregnancy,

and in some cases can also be used to prevent

sexually transmitted infections.

It's good to think about

contraception in two different groups.

Reversible contraception, which provides that temporary

prevention of pregnancy or sexually transmitted infections

and non-reversible forms where fertility won't return,

and that, for example,

includes surgical options like sterilisation.

Also, really important to remember that some forms

of contraception can be used

to treat medical conditions like endometriosis, acne,

and polycystic ovarian syndrome.

What does 'safe sex' mean?

Safe sex is sex

that ultimately means that you and your partner

or partners aren't at risk of

contracting a sexually transmitted infection

or having an unplanned pregnancy.

That means sex that doesn't allow you to share blood, semen

or vaginal fluids between each other.

The opposite of that is unprotected sex,

where you are at risk

of developing sexually transmitted infections

or having an unplanned pregnancy.

Who can use contraception?

Contraceptive services are free

and confidential to anybody who's sexually active.

The legal age to have sex in the UK is 16,

and we'd recommend that anybody who wants

to talk about contraceptive services

or to ask about them to go

and see a specialist sexual health nurse or their gp.

What are the most common types of contraception?

I like to think about contraception

in different categories.

Firstly, there are medicines.

This is most commonly known

as the birth control pill typically taken by women.

That can include an oestrogen and progesterone pill,

or just a progesterone only pill.

There are also devices, things like the implant,

which is a soft, flexible device put into the top

of the arm, and things like the coil,

which are inserted into the neck of the womb.

There's also options like condoms, which can be used by men,

and female condoms, which can obviously be used by women.

Finally, there are surgical options, which include female

and male sterilisation.

What types of contraceptive pills are there and how do they work?

So broadly, there are two kinds of contraceptive pills.

There's the combined oral contraceptive,

which contains oestrogen and progesterone.

That's the one that many women will be familiar with.

That works by stopping your ovaries from

producing an egg each month,

and it also thickens the cervical mucus to prevent

sperm reaching the egg in the first place.

There's also the progesterone only pill.

Some people know that as the mini pill,

and that mainly works by thickening the cervical mucus again

to stop sperm reaching the vagina

and some forms of that pill can also prevent ovulation.

Do you have to take the pill at the same time everyday? What happens if you don't?

My first piece of advice is that each pill is different

and has different instructions in terms of how to take it.

So please speak to your sexual health nurse or your gp.

It's really important that you follow these instructions

to prevent pregnancy.

That's because things like the mini pill

or the progesterone only pill have a really narrow window,

so actually you have to be very

strict about when you take it.

That matters less for other pills,

but we know that some women can forget the pill sometimes,

and so actually getting into a regular habit in terms

of when you take it is only going to improve effectiveness.

In terms of if you forget a pill,

again, each pill is different, so it's really important

that you discuss this when you get the pill

with your sexual health nurse

or your GP so that you are very clear about what

to do if you do miss pills.

How many days do women usually take the pill?

Every pill is different.

Lots of women will be familiar with the traditional pattern

of taking the pill for 21 days

and then having a break for seven days

during which you have a bleed.

There are actually lots of other options

and I'd really recommend that you discuss that with your GP

or your sexual health nurse.

Some other options are taking packets back to back so

that you don't have a bleed.

There's also options that you can finish a pack,

have a break for four days, and then start another pack.

But as I mentioned, every pill is different.

So please do discuss, with whoever prescribes the pill,

what's going to best work for the pill instructions

but also for you in your life.

What are condoms and how do they work?

Condoms are a form of contraception,

and importantly, they're the only form of contraception

that can be used to prevent the transmission

of sexually transmitted infections.

That's because they form a barrier

that stops the sperm reaching an unfertilized egg.

A couple of considerations that are important.

They're usually made of latex,

which some people are allergic to,

but there are lots of other alternatives,

so always worth speaking to your GP

or sexual health nurse if you've had a bad reaction

to a latex condom.

How does the implant work?

The implant is a really small, flexible plastic device

that is inserted into your upper arm.

It works by releasing small amounts

of progesterone into your bloodstream

and lasts for three years.

Now, how it actually acts as birth control

is kind of twofold.

Firstly, it thickens the cervical mucus

to stop sperm reaching an

unfertilized egg in the first place,

and it also thins the lining of the womb

to make it less likely that a fertilised egg would implant

and develop into a pregnancy.

What is the coil?

You might've heard some people talk about the coil

as any device that sits inside the neck of the womb

and prevents pregnancy.

Actually, the coil is known as the intrauterine device

or an IUD, and some people might know it as the copper coil.

So they're one and the same thing

What are the longest lasting contraceptive options?

Lots of people will be familiar with contraceptive options

that are inserted through the vagina

and sit in the neck of the womb.

Those are really long lasting, lasting up to five years.

Now, there are a couple of different options here.

They're both T-shaped flexible plastic devices

that are inserted through the vagina,

sit in the neck of the womb.

The difference between them is what they contain.

Lots of people have heard of the copper coil.

That's where there's copper wrapped around the top of

that device that sits in the neck of the womb.

The copper's released slowly over the course

of the time period and it changes the cervical mucus

to make it less likely for a sperm to be able

to enter the womb and fertilise an egg.

And it can also prevent the implantation

of a fertilised egg in the first place.

The second kind contains the hormone progesterone.

Some people will know it as the Mirena. Now

that thickens the cervical mucus

to stop the sperm coming into the vagina to fertilise the egg.

It also thins the lining of the womb to make it less likely

that a fertilised egg can implant,

and in some people it'll prevent the ovulation

or the production of an egg to be fertilised

on a monthly basis.

Can putting in contraceptive devices be painful?

So when we think about the contraceptive devices

that need a procedure to put them in,

what we're really talking about is the implant

and also the contraceptive devices that go

through the vagina and sit in the neck of the womb.

In terms of the implant, it shouldn't be painful,

but it might be a bit uncomfortable.

What it involves is some local anaesthetic in the arm,

a very small cut just to pop the implant in.

And then obviously as that local anaesthetic wears off,

it might be a bit sore.

But bear in mind that procedure's going to be done

by somebody who's really experienced,

you can take some pain relief around that,

and then what you have is, hopefully, a really long lasting,

effective form of contraceptive for you.

In terms of the ones that are put in through the vagina,

that's usually done in a GP setting

or a sexual health clinic setting, again,

by a really experienced practitioner,

and that'll involve opening up the vagina

and then a very small, thin plastic tube being inserted

through the neck of the cervix just into the

opening of the womb.

That can be a little bit uncomfortable,

but again, with a really experienced practitioner,

some good pain relief on board,

it's done very, very quickly.

And what we don't want is for women

to be put off having these kinds of contraceptive,

which are really long lasting and really effective

because they're worried about it.

So if you're worried about it, please speak to your GP

or your sexual health nurse.

How do I reduce the risk of pregnancy without the use of contraception?

Fertility awareness

or natural family planning can be

considered a form of contraception.

Essentially, what it allows you to do is

to monitor changes in your body during your monthly cycle to

identify when you're at your most fertile,

and then to avoid unprotected sexual intercourse

during that time.

And that in theory, allows you

to prevent pregnancy without the use

of any other medicines or devices.

If it's done really carefully, it can be effective,

but it takes time, commitment, and practice.

So I'd really recommend that you speak

to a specialist advisor, your GP or sexual health nurse

before you start trying this method.

How can I keep track when using natural family planning or fertility awareness?

Natural family planning

or fertility awareness involves people measuring three

different things, firstly, when their periods start and end.

Secondly, their daily body temperature

and thirdly, their vaginal secretions.

They can record those things in a diary

or an app-based system, and taken together

it can form a picture of where in the cycle you are going

to be at your most fertile

and then when you can avoid any unprotected

sexual intercourse.

It takes a lot of time commitment

and a lot of practice to get this right.

So I'd really recommend getting some specialist advice on

board from an advisor from your GP or sexual health nurse

before you start this approach.

What are some side effects of different contraception?

So any contraception that you take, in the form

of a medicine or a device, will have some side effects.

The important question is whether those side effects are

okay in terms of minimising its impact on your quality

of life and whether you can live with them.

So hormonal contraceptives, things like the pill

or the implant, or the hormone releasing intrauterine system,

can have side effects like bloating,

acne, can have an impact on mood,

can also increase your appetite, and

therefore make it more likely to put on weight.

The copper coil, which doesn't have any hormone in it,

can make your periods heavier.

And really important to take account

of these side effects when you are balancing out what kind

of contraception might work for you,

but if you are already trying one of these forms

of contraceptives and you find these side effects are really

impacting the quality of your life, please go

and speak to one of your GPs, your sexual health advisors,

to be able to talk about these side effects

and to be able to think about what you might want

to do next.

How do I find the best type of contraception for me?

Every person is different

and every kind of contraception is different.

So I always recommend having a think about your lifestyle,

about what kind of sexual partner or partners you have,

and what you think might work for you.

It's also a really good place to start is by talking

to friends about what their experience has been.

Then I recommend going to speak to a GP

or a sexual health advisor to be able to

talk in detail about all

of the contraceptive options out there

and how they might work for you and your lifestyle.

If you choose something that works for you to start with,

it's more likely to be effective and act in the longer term.

Where can I get contraception, and is it free?

Contraceptive services in this country are free

and they're confidential.

There are lots of options for you, so a lot

of pharmacists will be able to issue you free contraception.

You can also go to sexual health clinics

and you can find those by looking online

for your nearest one or your local GP.

It's also you are able to walk into any high street pharmacy

where you are able to purchase a number

of contraceptive options like condoms.

What is emergency contraception?

Emergency contraception is used to prevent a pregnancy

when your usual form of contraception has failed.

For example, when a condom has split

or if you've missed a pill. It's worth bearing in mind

that emergency contraception won't protect you from sexually

transmitted infections.

What are the options for emergency contraception?

If your regular form of contraception has failed

for whatever reason, then there are two options.

The first is a tablet, often known as the morning

after pill that contains a high dose of hormone.

It can be taken up to five days after unprotected sex,

but it's worth bearing in mind that the longer you leave it,

the less effective it might be.

As most people know, you can get

that from most high street pharmacies.

The other option is actually the copper coil, so

that can also be inserted up to five days

after unprotected sex

and can obviously then be in place for up to five years.

That is not available through pharmacies,

but if you go to your local sexual health centre

or your GP, then they'll be able

to advise you on the best next step.

Can you still get pregnant if you use contraception?

The short answer is yes. Unfortunately,

no contraception is a hundred percent effective.

Now, your risk of pregnancy varies between different types

of contraception, and that's why it's really important to have

that conversation with your sexual health advisor or your GP

before you start using it.

Now, your risk of getting pregnant not just varies

by the type of contraception,

but also how closely you follow the instructions for

that type of contraception.

So I'd really recommend that people are fully aware of how

to take their contraceptive safely.

Does contraception protect against STIs?

The only form of contraception

that protects against some sexually transmitted infections

are condoms, and that's

because it forms a barrier between sharing of bodily fluids

between sexual partners, things like semen,

vaginal secretions, and blood.

It's worth bearing in mind

that some other sexually transmitted infections like genital

herpes or lice are exempt from that.

Does contraception affect your fertility?

The short answer is no.

No contraception will permanently impact your fertility.

What contraception is designed to do is

to prevent pregnancy in the short term.

When you stop contraception, the amount of time

that it takes for your fertility to return

to normal can vary depending on the

contraception you choose.

So I'd always recommend that if you do want to try

to conceive sooner rather than later, that's something

that you factor in with that discussion with your GP

or sexual health nurse.

How does contraception affect my periods?

Contraception, particularly hormonal forms

of contraception, can affect when your periods are,

how long they are, how painful they are,

and also how heavy they are.

The exact impact can really vary based on

what kind of contraception you're on,

but also what your periods

and your cycles were like beforehand.

I think it's probably worth bearing in mind

that many hormonal forms

of contraception can make periods a bit lighter

or more infrequent, and actually in some cases

can stop periods altogether.

The copper coil, many people can associate with heavier

periods, but again, it can vary on a case by case basis.

So really worth speaking to your GP

or sexual health advisor.

Can hormonal contraception affect my mood?

So hormonal contraception can have an impact on mood,

and that's been shown in scientific studies,

but it really varies by person to person.

So for some people, they find an improvement in mood

and some people can find it has a negative impact.

The important thing is to be aware of your mood,

particularly when you're starting a new contraceptive,

and if you find that it's changing, please go back to speak

to your GP or sexual health advisor.

Are there any male contraceptives?

Most people will be aware that contraceptive options

for men involve condoms, which form a barrier

to sperm reaching an unfertilized egg,

and also male sterilisation,

otherwise called a vasectomy,

where the tubes carrying the sperm are sealed, closed.

Beyond that, although it's an area of research

and an interest,

there aren't any other current options available for men.

Do I have to tell anyone if I'm using contraception?

Contraceptive services are confidential.

If you are with a partner, I think it's a really good thing

to discuss your contraceptive choices with them,

but that decision is up to you.

If you are worried about disclosing whether you are on

contraception with anybody, I'd really recommend

that you speak to your sexual health advisor

or your GP about it.

If you've been using contraception for a long time, do you need to take a break?

So there's no need to take a break from

contraception for the sake of it.

You can use contraception for really long periods

of time without having any negative impact

on you and your health.

I think what's right for you is a contraception

that's effective and safe,

and in terms of choosing the right kind of contraceptive

at different times in your life.

There are some exceptions to that.

So for example, for the combined contraceptive pill,

which uses oestrogen

and progesterone, that's not advised, for example,

over the age of 35, if you are a smoker

or over the age of 50,

and that's to minimise the risk

of developing more harmful side effects like osteoporosis

or cardiovascular problems like heart attacks or strokes.

I think it's always worth speaking to your GP

or your sexual health advisor if you have any concerns about

how long you've been on contraception

or if your life has changed

and you think you might want to have a new form

of contraception.

I am using contraception now but want to stop. What's the best way to stop?

So I'd always recommend that you reflect on why you want

to finish using contraception.

Is it that you want to change

to another kind of contraception?

Is it a change in where you are in your life?

Or is it that you want to try to conceive?

Because all of those will impact what kind

of advice your GP or sexual health advisor might give you.

So I'd always recommend making an

appointment with them first.

In general, for the hormonal medications like the pill,

they can be stopped at any point in your cycle.

It might take a while for your cycles to return to normal,

so it's worth bearing that in mind.

For things like the implant, for the copper coil

or for the hormone system like the Mirena, then those need

to be removed by a health professional.

So it is definitely worth making an appointment with one

of those health professionals and then booking yourself in

to have one of those removed.

I am going through menopause - do I still need to use contraception?

So it's really worth bearing in mind

that the menopause isn't a moment in time.

It actually includes a period called the perimenopause

where you might still be having periods irregularly,

and that means that you are still fertile.

In general, you can stop contraception if you haven't had

your period for one year after the age of 50

or for two years below the age of 50.

You can stop contraception

after the age of 55 as it's extremely rare,

but not unheard of to get pregnant after that time.

I am post-menopausal - do I still need to use contraception?

After you've been through the menopause, you don't need

to use contraception to prevent a pregnancy.

However, you may still want to use forms of contraception

to prevent sexually transmitted infections.

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