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10 Things You Always Wanted to Ask an HIV-Positive Guy


 

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I’m a gym homo. I love Neapolitan pizza. I hate scary movies. I have six tattoos. I take cock like a champ. And, I’m HIV-positive.

After living with HIV for four years, I’ve heard the same questions over and over. Sometimes I wish I could present quick, pre-packaged answers — a list of “saved phrases” on my phone — but then I remind myself how desperately I asked questions during that first impossible week after getting my test results.

So today, I’m answering the questions that everyone secretly wants to ask an HIV-positive guy. What would you like to know?

1. Do you know who infected you?

I don’t. Most HIV-positive guys I’ve talked to do not know who infected them.

Few people intend to give someone HIV. There are random crazies, but most guys are just doing what I was doing — fucking around, having fun, and assuming everything is fine. You can give someone HIV without knowing you’re positive.

The virus has to “build up” to a certain point in your body to trigger an HIV test, which means you can test negative and still have transmittable HIV.

There’s an ugly myth that HIV-positive folks recreationally go around infecting others. That’s a lie regurgitated by fearmongering, anti-fact, sex-negative, poz-phobic people. It’s likely that the man who gave it to me did not know he had it. I feel for him, whoever he is, because at some point after playing with me, he got news that no one is ready to hear.

I do not, but don’t take that as an indicator of what most HIV-positive guys do. Many HIV-positive men become more diligent about condom use after seroconverting.

In the age of PrEP, condoms are no longer the only way to protect yourself (or others) from HIV — or the most effective. PrEP — a once-a-day, single-pill regimen that has been proven more effective than regular condom use at preventing HIV transmission — is something I urge all HIV-negative guys to learn about.

I play bare. I accept the risks of catching other STIs and STDs as an unavoidable part of the sex I enjoy. I get a full-range STD check every three months, and sometimes more frequently.

3. How did sex change for you after becoming positive?

Since seroconverting, I have more — and better — sex. Forced to see my body and my sex in a new light, I started exploring fetishes and interests I had never tried. In my early days of being positive, I played every week with a dominant. Today, I’m a skilled, kinky motherfucker.

4. Has anyone ever turned you down because of your status?

Many times. When I was newly positive, those refusals really hurt.

I remember one occasion that was especially painful. I was eating Chinese food with a friend and started crying at the table because several guys that week had turned me down on Grindr.

He let me cry for a few minutes, then said, “HIV is something in your blood. That’s all it is. If they can’t see how sexy you are because of something in your blood, they’re boring, uneducated, and undeserving, and you can do better.” He was right.

5. How old were you when you tested positive?

I was 21. I didn’t eat for a few days. I slept on friends’ sofas and watched movies instead of doing homework. Somehow I continued acing my college classes.

I walked down to the Savannah River every night to watch cargo ships roll through, imagining their exotic ports — Beijing, Mumbai, Singapore, New York — and their cold passage across the Atlantic. I wanted to jump in the black water every night but I knew some drunk tourist would start screaming and someone would save me.

I made it through those months, and I’m glad I did. The best of my life came after becoming positive.

6. What does “undetectable” mean?

“Undetectable” is a term used to describe an HIV-positive person who is diligently taking their meds. In doing so, they suppressed the virus in their body to the point that their viral load is under 200 copies/m — unable to be detected on a standard HIV test (hence, “undetectable”). Put simply: the virus is so low in your body that it’s hard to transmit.

“Hard” is an understatement. The PARTNER study monitored 767 serodiscordant (one positive, one negative) couples, gay and straight, over several years. In 2014, the results showed zero HIV transmissions from an HIV-positive partner with an undetectable viral load to an HIV-negative partner.

Being undetectable means the likelihood of you transmitting HIV is slim to none. It means you’re doing everything scientifically possible to be as healthy as you can be, and you are protecting your partners in the process.

7. Have you had any side effects from the meds?

Yes, but side effects today are mild in comparison to what they were in the past. AZT was hard on the body, but we’re past that. New HIV drugs come out every year. We’re in a medical age where new treatment options, such as body-safe injection regimens, are fastly approaching realities.

On my first medication, I had very vivid dreams and nightmares, an upset stomach for a week or two, and I developed weird fat deposits on my neck and shoulders. I switched meds a year in and couldn’t be happier.

There are options. Talk to your doctor if you have shitty side effects and ask about getting on a different medication.

8. What’s it like to date after becoming HIV-positive?

It’s just like dating for everyone else. There are losers and jerks, and there are excellent, top-quality guys I love. My HIV status has never impeded my dating life.

I’m non-monogamous, polyamorous, and kinky, and I think these characteristics drive away interested guys faster than anything else. My status never comes up. I put my status loud and clear on every profile, and I say it directly before the first date. If you don’t like it, don’t waste my time — I have other men to meet.

9. How do you respond to HIV stigma?

It’s an automatic turn-off. Disinterested. Discard pile.

I have active Grindr and Scruff profiles (and a few others). Each profile reads: “If you’re afraid of my HIV status, block me.”

I’m not interested in someone who, in 2017, walks around terrified of HIV. Learn your shit, guys. Learn about how HIV is prevented. Get on PrEP. Use condoms.

Educate yourself and learn how it’s treated, and what the reality of living with HIV is like today (it’s so mild and easy that I forget about it, TBH).

Yes, you should take necessary steps to prevent HIV. However, you don’t need to live your life in fear or abstain from having sex with people merely because they’re positive. I no longer believe HIV is the worst thing you can catch. Hep C is way worse. Scabies is pretty miserable. And bad strains of the flu kill people.

HIV? It’s one pill (or a couple of pills) a day. Yes, you will have it forever. Yes, you will face stigma for having it. But, the people who stigmatize you are ignorant and out-of-date. Dismiss them.

10. What would you tell someone who just tested positive?

Welcome! You inadvertently joined a club you didn’t ask for, but the membership includes some of the greatest minds in history, so you’re in good company. The virus felled many of the greatest campaigners for LGBTQ rights and freedoms that ever lived. They struggled so that you can get up in the morning, pop your pill, and live a long life.

Those who lived and died paid your initiation fees. They fought, protested, rallied and organized so that you can be here — so that you can stick around and enjoy your fabulous, queer life. Always respect their sacrifice and dedication.

You are loved. You will find love. You will find impossibly good-looking men who want to fuck you (or want you to fuck them) who don’t give a shit about your HIV status. And if it’s in the cards, someday you’ll marry one of those fellas.

You have brothers and sisters who share this quality with you. In the words of Sister Sledge, we are family.

Complete Article HERE!

Maybe Monogamy Isn’t the Only Way to Love

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In the prologue to her new book, What Love Is and What It Could Be, philosopher Carrie Jenkins is walking through Vancouver, from her boyfriend’s apartment to the home she has with her husband. She wonders at how the romantic love she experiences firsthand is so different than the model presented by popular culture and academic theory alike. “If indeed romantic love must be monogamous, then I am making some kind of mistake when I say, ‘I’m in love with you’ — meaning romantically — to both my partners,” she writes. “I am not lying, because I am genuinely trying to be as honest as I can. But if romantic love requires monogamy, then despite my best intentions, what I’m saying at those moments is not, strictly speaking, true.”

Her book examines the long, sometimes awkward legacy of philosophers’ thinking on romantic love, and compares that with a new subfield in close-relationships research — consensual nonmonogamy, or CNM. While singers and thinkers alike have been riffing on a “one and only” for decades, she argues that space is being made in the cultural conversation to “question the universal norm of monogamous love, just as we previously created space to question the universal norm of hetero love.” These norms are more fluid than they appear: In Jenkins’s lifetime alone same-sex and cross-ethnicity relationships have become common.

When I asked Jenkins to describe how it feels to have both a husband and a boyfriend — she rejects the “primary relationship” moniker altogether — she said that it’s like having more loving relationships in your life, like a close family member or friend. She and her boyfriend, whom she’s been with for about five years, used to work in the same building; he was teaching creative writing on the floor above her philosophy department, though they didn’t meet until they matched on OkCupid. While both men have met each other, they’re not close; Jenkins describes the relationship as having a “V shape,” rather than a triangle. Both helped in the development of the book: husband refining philosophical arguments; boyfriend editing the writing, and helping her to sound like a normal person, rather than an academic.

Still, CNM faces lots of stigma; even the study of it is stigmatized. Yet in the limited yet rich vein of research out there, the evidence suggests that it’s a style that, in some populations, leads to greater relationship satisfaction than monogamy. In any case, the researchers tell me, the insights into what makes more-than-two relationships work can be applied to any given dyad, given the communicative finesse required when three or more hearts are involved.

In a forthcoming Perspectives in Psychological Science paper, Terri Conley, a University of Michigan psychologist who’s driven the field, defines CNM as “a relational arrangement in which partners agree that it is acceptable to have more than one sexual and/or romantic relationship at the same time.” That’s distinguished from the “polygamy” practiced by some religious groups, where it’s not always clear whether wives can opt out of the relationship.

I was surprised to discover how common it is: A 2016 study of two nationally representative samples of single Americans — of 3,905 and 4,813 respondents, respectively — found in each case that about one in five people had practiced it during their lifetime. A 2016 YouGov poll found that 31 percent of women and 38 percent of men thought their ideal relationship would be CNM in some way. Other research indicates that around 4 to 5 percent of Americans in relationships are in some sort of CNM, be it swinging, where partners have sex with people outside their relationship at parties and the like; an open relationship, where it’s cool to have sex with other people but not grow emotionally attached to them; or polyamory, where both partners approve of having close emotional, romantic, and sexual relationships outside of the couple itself. People are curious, too: From 2006 to 2015, Google searches for polyamory and open relationships went up. Other data points to how sticking to the boundaries of monogamy doesn’t come easily to lots of people: A 2007 survey of 70,000 Americans found that one in five had cheated on their current partner.

Jenkins says that as a tenured philosophy professor at the University of British Columbia, she’s in a unique, privileged position to openly talk about being in a nonmonogamous marriage. She’d been interested in being in more than one relationship ever since she can remember, but it used to seem like some sort of impossible dream situation — she didn’t realize it could be an option in her real life until she was about 30. (She’s now 37.)

Jenkins met her husband, Jonathan, who’s also a philosopher, back in 2009, at a philosophy workshop that he organized at the University of St. Andrews in Scotland; they later got married in the same hall the conference took place. They took one another’s last names as middle names.

Now married for almost eight years, they talked about polyamory early on, though defining the relationship that way came later. As philosophers are wont to do, they soon wrote a bit of a manifesto about their arrangement. They observed that even if their wedding guests were woke in any number of ways — not batting an eyelid if a colleague was gay or bi, eschewing heteronormative assumptions, and the like — there’s still the shared assumption that a nonmonogamous relationship is less sexually safe and less committed than a regular ol’ monogamous one. “Even our very liberal pocket of our relatively liberal society is massively — and, to us, surprisingly— mononormative,” they write. “Acquaintances, friends, and colleagues are constantly assuming that our relationship, and indeed every relationship that they think of as ‘serious’, is a sexually monogamous one.”

To Jenkins, the biggest struggle with polyamory isn’t from managing multiple relationships — though Google Calendar is a crucial tool — but rather the strong, sometimes violently negative reactions that she gets, especially online. When I spoke with her by phone, she was struck by a comment to a YouTube interview of hers, where a pseudonymous user invited “everyone” to read her column in the Chronicle of Higher Education about having multiple loves.

“THIS WOMAN IS A DISGUSTING ANIMAL,” the troll wrote. “Every bit as twisted and queer as the Mormons with their multiple lives [sic]. This femme-pig is the spectral opposite of Trump; a far far left-wing freak that desires to completely overthrow Western Christian Civilization.” Jenkins walked me through a deep reading of the bile: Bundling in politics — the “left-wing freak” bit — with the monogamy norms signals to her that there’s a judgment of what it means to be a good person in here, since politics is about living correctly, collectively. Plus “if you’re an animal, you’re out of the range of humanity,” she says. She’s also gets a lot of “get herpes and die, slut” suggestions, she says, which speaks to the hypersexualization of CNM. Nonmonogamy leads to lots of sex, the presumption goes, and with that STIs, and it proceeds from there. The way news articles covering CNM tend to be illustrated with images of three or four people in a bath or bed doesn’t help, either.

“The way we normally think about romantic love, we don’t imagine that it’s entirely about sex,” she says. “For a lot of people sex is a part of it; if we’re just having a hookup or a friend with benefits, we don’t call that romantic love. When it comes to polyamorous relationships, if you’re in love with more than one person, the same applies — to fall in love with someone is not the same as to sleep with them. We’re clear with that distinction in monogamous relationships, but in CNM that distinction between love and sex gets collapsed.”

Researchers who have studied stigma around CNM have found lots. In a 2012 paper, Conley and her colleagues found that monogamous relationships were better rated on every metric by different sets of the population, including nonmonogamous people. When 132 participants recruited online read relationship vignettes that were identical except for one being monogamous and the other not, the CNM was seen as riskier sexually, more lonely, less acceptable, and having a lower relationship quality. People in CNM were also seen as worse with non-relational things, like making sure to walk their dog or paying their taxes on time. Amy Moors, a co-author on the paper, says it had some of the biggest effect sizes she’s seen in her research. Elisabeth Sheff, a leading polyamory researcher who left academia for lack of grant funding, now frequently serves as an expert witness in custody battles; she says that often a grandmother or a former spouse will find out that a co-parent has multiple relationships, be scandalized, and demand to take the kids — even though her longitudinal research, reported in The Polyamorists Next Door: Inside Multiple-Partner Relationships and Families, indicates that kids who grow up in polyamorous families aren’t any more screwed up than average American children.

That same paper finds that there were no differences in relationship functioning between monogamous and nonmonogamous couples. People in CNM had lower jealousy and higher trust — yet also lower sexual satisfaction with their partner. Polyamorists were more satisfied than people in open relationships, perhaps because it’s hard to block of feelings for people you sleep with frequently. Polyamorous people were a special case, with higher satisfaction, commitment, trust, and passionate love than monogamous individuals, though they had lower sexual satisfaction. CNM people also had higher sexual satisfaction with their secondary partners than their primary partners, though that difference fell away when controlling for relationship time, with primary relationships averaging three times the length of secondary relationships.

“Overall, the standard for human responses for relationships is habituation,” Conley says. “That involves a loss of sexual attraction, and we can tell that from stats from therapy. And to the extent that a couple is frustrated sexually, it spills over to other parts of life.”

There are other explanations for high satisfaction scores for polyamorous people, she adds. It could be that they’re just acting out a social desirability bias, given that they’re participating in a study about CNM and want the lifestyle to look good; it could also be that people who enter into polyamory have self-selected themselves into a hypercommunicative population — all the poly self-help books emphasize the importance the need to explicitly talk things out. “People interested in polyamory are more relationship-y than the average person,” she says. “They like thinking about relationships, talking about relationships. That’s great in monogamy, but needed in polyamory.”

All this suggests the kind of people that are the right fit for CNM. Beyond being relationship-y, a Portuguese study out this year found that people with a high sociosexuality, or disposal to casual sex, had less relationship satisfaction when in a monogamous relationship, but those effects disappeared if they were in CNM. Still, they were just as committed to their relationships — signaling that exclusivity and commitment may not be one and the same. Harvard sexologist Justin Lehmiller has found that people who are more erotophilic — i.e., that love sex — will be a better fit for CNM; same with if they’re sensation-seeking.

Amy Moors, the Purdue psychologist, has found that people with higher avoidant attachment — where you’re just not that into intimacy — have positive feelings about and a willingness to engage in polyamory, but they were less likely to actually partake of it. While a correlational study, Moors explained that from a subjective perspective, it makes sense: “When you have avoidant attachment, you like a lot of emotional distance, physical distance, time by yourself,” Moors says, which is not a fit for the relationship-y remands of a poly lifestyle. Also, there’s reason to believe that folks who have relational anxiety, and are thus sensitive to separation, might be prone to the jealousy that’s known to flare up in CNM, though it’s not like that doesn’t happen in monogamy, too.

What motivated Jenkins to write What Love Is, she says, was a gap — or silence — in the philosophical literature, that polyamory was rarely discussed or even acknowledged as a possibility. “Noticing these philosophical silences and denials, while simultaneously being made aware of how society at large viewed me for being a polyamorous woman, made me realize there was something important here that I needed to do,” she says. “To do it meant bringing my personal life and my philosophical work into a conversation with one another. The familiar slogan says that the personal is political, but the personal is philosophical, too.”

Two key themes emerge from reading the book: that love is dual-layered, with social scripts overlaying evolutionary, physiological impulses. And that the “romantic mystique,” like the feminine one before it, assumes that love is mysterious and elusive and corrupted from examination — a sentiment that protects the status quo. But with investigation, and conversation, the mechanics of love reveal themselves, and norms can change socially, and be tailored locally. Like Jenkins, you can custom-fit your relationships to your life — if you dare to talk about them.

Complete Article HERE!

Swinging offers sexual freedom, but you have to play by the rules

Don’t assume ‘the lifestyle’ does not come with a rulebook. Communication is important, and rules can make relationships better.

Fatima Mechtab, Marketing Supervisor and events coordinator at Oasis Aqualounge, poses at the Toronto adult playground.

Toronto’s Oasis Aqualounge, at Carleton and Church Sts., is a pretty open environment. The clothing-optional sex club hosts events each week for people to explore their sexual fantasies. But for such a sexually free venue, there are certainly a lot of rules.

No photos. Certain areas are off limits to men unless accompanied by a woman. No touching of any kind unless given permission. No means no, of course, but the club takes it a step further: only yes means yes. That means there are no sexy times until consent is verbalized, says Fatima Mechtab, the marketing and events co-ordinator at Oasis, which had approximately 16,000 members last year.

The clothing-optional space, where sex is allowed, is by its nature vulnerable, she says. The rules are to make sure everyone feels safe, comfortable and encourage people to talk. “A big problem with consent is people assume it’s something you don’t have to verbalize,” she says. In fact, when it comes to sex, there’s lots that people don’t talk about — but should.

Mechtab, a queer woman who has explored swinging and polyamorous relationships in the past, says these types of strict rules — don’t make assumptions, ask before touching — are common in “the lifestyle,” a term for consensually nonmonogamous couples. And, she says, rules make relationships better.

Couples and the locations they go to play have to create an environment in which all parties feel not only safe, but also heard. These boundaries take away the grey areas, forcing couples to say what they do or don’t want and what they need from sexual encounters. And there’s a lot non-swingers can learn from them about building a healthy (and satisfied) relationship.

A successful swinging relationship is based on constant communication, says Carol Hunt, founder of VenusCouples, a Montreal-based online forum for “sex-positive” exploration of the lifestyle. She and her husband have been swinging for a decade. Before any party or outing, they agree upon a set of boundaries (such as they’ll always be in the same room during sex) and expectations for the evening (be it sex with another person or a night observing others). Afterwards, they always break their experience down: what they liked, what they didn’t like, and what would they like to try in the future?

While it might seem exhausting to always talk about sex, Hunt says it means both parties feel their needs are being heard. If her husband wants to try something new, but she’s not interested, the decision isn’t shut down entirely. Instead, they discuss both points of view and try and find a happy middle ground in which they can explore. No always means no — but that’s only the start of the conversation.

That consensus building trickles out of the bedroom, says Edward Fernandes, a professor of sexuality specializing in swingers, at Barton University in North Carolina. “I’ve had people say, ‘We used to have trouble with our finances — we couldn’t talk about this,’ and once we went into swinging, that (inability to communicate) went away,’” says the Toronto expat. “Now, they’re able to talk about everything.” If you can talk about a taboo topic like sex freely, there’s nothing to stop you from vocalizing issues with the chores, he says.

One 2014 study from the University of Oklahoma, which compared monogamous and consensually nonmonogamous couples, found those in open relationships rated their happiness and health higher than their counterparts. Another study from 2000, found 90 per cent of couples said their marriage became happier after they started swinging.

“People will often avoid talking about things, because they don’t know how (their partner) is going to respond,” says Fernandes. “So we hide. Swinging tends to pull that curtain, and allows them to have direct communications with each other.”

Write your own sexy rule book

  • Hunt suggests couples looking to spice up their bedroom can start small: make it a point to go to a sex shop, for example, to discuss what both parties might enjoy or not. To avoid embarrassment, make it a rule that neither party can wander off on their own: you’re in it together and that can decrease the awkwardness.
  • Watching porn can be a great way to get both parties in the mood. But before hitting play, Hunt suggests setting expectations: you’ll only watch for an hour, and collectively pick one act to try and re-create.
  • If you’re trying something new and don’t enjoy it the first time, Hunt say don’t shut it down right away. Commit to revisiting the act at least once at a later date, and if you still don’t enjoy it, then it’s OK to take it off the table for the future.
  • Great relationships need work, she says. Set aside a couple hours each week just to be with each other. No television, no distractions (and if you want, no clothes).
  • Make a relationship rule to do one sexy thing a day — even if it’s just kissing each other deeply for a few minutes, Hunt says. It doesn’t have to be anything more than that, but it ensures a daily connection with your partner.

Complete Article HERE!

Happy in a low-sex marriage

By Nara Schoenberg

For many writers, it would have been an occasion to celebrate: Hazel McClay’s book group had chosen to read an anthology containing an essay that McClay herself had written.

But McClay’s essay was about being happy in a low-sex relationship, a sensitive topic in a culture where intense desire is widely celebrated. Hazel McClay is a pen name, so no one in her book group knew that she was the author; in fact, she hadn’t talked about her essay with anyone — not even her boyfriend, who had since become her husband. “This should be interesting,” she thought when she learned she would be hearing her book group’s unfiltered feedback, and so it was.

First, McClay sat through the comments of a woman who seemed to think the essay was a celebration of sexual relationships that start awkwardly but improve markedly over time. The woman explained — in some detail — that this had been her own experience with her husband.

An awkward silence followed, and when no one came to the speaker’s rescue, she turned back to the essay.

“This sounds like a wonderful relationship,” she said.

“Sounds like a boring relationship to me,” another woman said, and then she and her friend burst out laughing.

McClay, whose essays appear in the recent book “The Bitch Is Back: Older, Wiser, and (Getting) Happier” and the 2002 best-seller “The Bitch in the House,” is tackling one of the few remaining taboo topics in a time of marked sexual frankness. We have respectful news articles about the polyamorous, who openly engage in multiple romantic relationships, and we have blogs and Facebook pages for asexuals, who may have no interest in sex at all. A popular reality TV show, “Sister Wives,” tells the story of a man with multiple wives. But low-sex marriages that are neither unhappy nor dishonest? When was the last time you heard about one of those?

“It really is something under the radar,” said McClay, a writer and editor in her early 50s.

“There is a bit of shame attached to it because there’s kind of a pressure to be highly sexed and highly performing sexually in this culture. And so if you’re not, that’s considered to be a problem.”

A much-quoted 2016 study in the journal Social and Psychological Personality Science found that, on average, couples in romantic relationships who have sex once a week are happier than couples who have sex less frequently. (Having sex more than once a week wasn’t associated with additional happiness.)

But the study looked at averages; it didn’t rule out the possibility that some individuals are very happy in low-sex marriages.

About 40 percent of married couples in part of the study were having sex, but less than once a week, co-author ‪Amy Muise said in an email exchange.

Asked what percentage of that group reported being very happy, Muise said she hadn’t broken down the data in that manner.

In “The Bitch Is Back,” McClay writes that she and her husband, “Charlie,” laugh a lot, love each other deeply, and have a son who’s thriving.

“With Charlie,” she writes, “I felt, and still feel, like somebody in the world gets me; I feel, at the risk of sounding cliched, loved for exactly who I am. This is something that was missing in every relationship I had before him, including the ones that were filled with sexual passion. … Within weeks of meeting him, I loved him — his brain, his quirks, his humor, and the grounded way he made me feel. I still do.”

They don’t have sex often: at this point, once a month at most. When they do, she’s always glad, but for different reasons: Sometimes because the sex itself is really good, sometimes because she knows sex is important to her husband, even though he doesn’t press the issue or seem dissatisfied.

“I never crave sex,” she writes, “so if I never had it again, I don’t think I’d miss it. If I never had another brownie, now, that would bum me out.”

McClay does have her fleeting moments of self-doubt. At one point, she writes, she tried medication to increase her sex drive; it didn’t work. And there have been rare times when she’s missed feeling the kind of intense passion that makes “your bones seem to melt away underneath your skin.”

“I know that there are women out there who think that (a marriage like mine reflects) a very 19th-century Victorian attitude, and that that’s sort of horrifying to them. And I guess I understand why they would see things that way, and why they would think I had settled for something terrible, and that you should hold out for the whole package,” she said.

“But all I can say to that is, ‘Maybe you’ve never loved somebody the way that I love my husband.’ There are just too many good things here for me to throw it all away and go looking for something I might never find. And again, I can see people saying ‘That’s a very fearful attitude on your part,’ but I don’t think it’s fear. I don’t want to go. I want to be with him.”

Complete Article HERE!

What your gynecologist wishes you would do

By Linda S. Mihalov, MD, FACOG

No matter a woman’s age or how comfortable she is with her gynecologist, she may still be unsure about a few things — like which symptoms are worth mentioning, how often to make an appointment and how to prepare for an exam.

Based on my 30 years of providing gynecologic care to women of all ages, I thought it would be helpful to provide a few tips about how to make the most of your care visits.

Keep track of your menstrual cycle

Dr. Linda Mihalov

Menstruation is a monthly recurrence in women’s lives from early adolescence until around the age of 51, when menopause occurs. Because of the routine nature of this biological process, it’s easy to become complacent about tracking your periods. Thankfully, there are numerous smartphone apps that help make tracking periods easy.

Keeping track of your period is important for numerous health-related reasons. A missed period is usually the first sign of pregnancy. Determining the due date of a pregnancy starts from the date of the last menstrual period. Most forms of birth control are not 100 percent effective, and an unplanned pregnancy is best recognized as soon as possible.

Conversely, women attempting to get pregnant can use period tracking to learn when they are most fertile, which may greatly increase the chances of conception.

In addition, a menstrual cycle change can indicate a gynecologic problem, such as polycystic ovarian syndrome, or even uterine cancer. It is also often the first obvious symptom of health issues that have no obvious connection to the reproductive organs. When a regular menstrual cycle becomes irregular, it may indicate a hormonal or thyroid issue, liver function problems, diabetes or a variety of other health conditions. Women also often miss periods — or experience menstrual changes — when adopting a new exercise routine, gaining or losing a lot of weight or experiencing stress.

One late, early or missed period is not necessarily reason for alarm. But if menstrual irregularity is accompanied by other symptoms, a woman should schedule an appointment with her gynecologic care provider.

Get the HPV vaccine

Human papillomavirus, or HPV, is a very common virus. According to the Centers for Disease Control and Prevention, nearly 80 million Americans — about one in four — are currently infected. About 14 million people, including teens, become infected with HPV each year. Most people who contract the virus will clear it from their systems without treatment, but some will go on to develop precancerous or even cancerous conditions from the infection.

The HPV vaccine is important because it protects against cancers caused by the infection. It can reduce the rate of cervical, vaginal and vulvar cancers in women; penile cancer in men; and anal cancer, cancer of the back of the throat (oropharynx), and genital warts in both women and men.

This vaccine has been thoroughly studied and is extremely safe. Also, scientific research has not shown that young people who receive the vaccine are more prone to be sexually active at an earlier age.

The HPV vaccine is recommended for preteen girls and boys at age 11 or 12 so they are protected before ever being exposed to the virus. HPV vaccine also produces a more robust immune response during the preteen years. If you or your teen have not gotten the vaccine yet, talk with your care provider about getting it as soon as possible.

The CDC now recommends that 11- to 12-year-old girls and boys receive two doses of HPV vaccine — rather than the previously recommended three doses — to protect against cancers caused by HPV. The second dose should be given six to 12 months after the first dose.

Teen girls and boys who did not start or finish the HPV vaccine series when they were younger, should get it now. People who received some doses in the past should only get doses that they missed. They do not need to start the series over again. Anyone older than 14 who is starting the HPV vaccine series needs the full three-dose regimen.

Young women can get the HPV vaccine through age 26, and young men can get vaccinated through age 21. Also, women who have been vaccinated should still have cervical cancer screenings (pap smears) according to the recommended schedule.

Do not put off having children

Fertility in women starts to decrease at age 32 and that decline becomes more rapid after age 37. Women become less fertile as they age because they begin life with a fixed number of eggs in their ovaries. This number decreases as they grow older. Eggs also are not as easily fertilized in older women as they are in younger women. In addition, problems that can affect fertility — such as endometriosis and uterine fibroids — become more common with increasing age.

Older women are more likely to have preexisting health problems that may affect their or their baby’s health during pregnancy. For example, high blood pressure and diabetes are more common in older women. If you are older than 35, you also are more likely to develop high blood pressure and related disorders for the first time during pregnancy. Miscarriages are more common in older pregnant women. Losing a pregnancy can be very distressing at any age, but perhaps even more so if it has been challenging to conceive.

So, women who are considering parenthood should not put off pursuing pregnancy for too long or it may become quite challenging.

See your gynecologist for an annual visit

For women to maintain good reproductive and sexual health, the American College of Obstetricians and Gynecologists recommends that they visit a gynecologist for an exam about once a year. Generally, women should have their first pap test at age 21, but there may be reasons to see a gynecologic care provider earlier than that if there is a need for birth control or periods are troublesome, for instance. Although pap tests are no longer recommended every year, women should still see their provider annually for a gynecologic health assessment. This may or may not involve a pelvic exam.

Other reasons to visit a gynecologist include seeking treatment for irregular periods, sexually transmitted diseases, vaginal infections and menopause. Women who are sexually active or considering it can also visit a gynecologist to learn more about contraceptives.

During each visit, the gynecologist usually asks about a woman’s sexual history and menstrual cycle. The gynecologist may also examine the woman’s breasts and genitals. Understandably, a visit like this can cause discomfort among some women. However, periodic gynecological exams are very important to sexual and reproductive health and should not be skipped. The patient’s anxiety can be significantly decreased if she knows what to expect from the visit. Prepared with the knowledge of what actually occurs during an annual exam, women often find it can be a straightforward, rewarding experience.

There are several things women should do to prepare for a gynecological exam, including:

  • Try to schedule your appointment between menstrual periods
  • Do not have intercourse for at least 24 hours before the exam
  • Prior to the appointment, prepare a list of questions and concerns for your gynecologist
  • Since the gynecologist will ask about your menstrual cycle, it will be helpful to know the date that your last period started and how long your periods usually last

The pelvic exam includes evaluation of the vulva, vagina, cervix and the internal organs including the uterus, fallopian tubes and ovaries. Appearance and function of the bowel and bladder will also be assessed.

The gynecologic provider will determine whether a pap test is indicated, and order other tests as necessary, including tests for sexually transmitted infections, mammograms and screening blood work or bone density studies. Even a woman who has previously undergone a hysterectomy and, as a result, no longer needs a pap test can still benefit from visiting her gynecologist.

Primary care providers, including family practitioners and nurse practitioners, internists and pediatricians can also provide gynecological care.

Menopause

Menopause can be a challenging time. Changes in your body can cause hot flashes, weight gain, difficulty sleeping and even memory loss. As you enter menopause, you may have many questions you want to discuss with your gynecologist. It is important that you trust your gynecologist so you can confide in them and ask them uncomfortable questions. The more open you are, the better they can guide you toward the right treatment.

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