Asking my gynecologist mom your sex questions

| Senior Forum Editor

Due to persistent stigma about sex and sexuality, especially in the U.S., openly discussing sexual and reproductive health can be uncomfortable and hard for a lot of people. At the same time, there is a lack of standardized and comprehensive sex education in the United States. This stigma and lack of education leave people with gaps in their understanding of sexual health, while providing them with few spaces to ask questions. A couple of weeks ago, Student Life sent out a form for students to anonymously ask their sexual and reproductive health questions to a gynecologist. For this year’s Sex Issue, I wanted to give people a place to ask these questions, so I called my mom, obstetrician-gynecologist Dr. Jody Steinauer.

It is important to note that while gynecologists specialize in reproductive health medicine for people with uteruses, they are not experts on sexual health and sexuality. Sexuality educators specialize in teaching and training culturally-informed sex education. My mom answered these questions by using her professional knowledge and consulting other reliable resources. WashU has many stigma-free, inclusive, and accessible sexual health education resources that you can consult if you have further questions.

Q: Can women get “blue balls”?

Dr. Jody Steinauer: Thank you for asking me this question! I honestly did not know the answer until I researched it. “Blue balls” is a slang term for epididymal hypertension, where people with testicles are highly aroused but do not orgasm. They can experience swelling in their genitals that can be uncomfortable and painful. According to a study of 2,600 people, about 56% have experienced pain when they got close to orgasm without ejaculating, and 7% described it as severe pain. This experience is not life-threatening and can be relieved by time or masturbation. People with vaginas can also experience uncomfortable engorgement or swelling of their genitals when they are very aroused and do not orgasm. In the same study, 42% had experienced it, and 1% found it to be severely painful. Some interesting names that I found for this were pink pelvis, blue vulva syndrome, and, my favorite, blue bean (referring to the clitoris). 

I was sad to see that in the same study, amongst people with a penis or a vagina, many reported experiences of coercion because of their sexual partners’ “blue balls.” I want to make it clear that if someone ever says that you must have sex with them or bring them to orgasm because they will otherwise experience “blue balls,” that is sexual coercion.

Q: I really hate my body on birth control (have tried so many and each one has different horrible side effects for me) so I stopped taking it. Can condoms be reliable enough to prevent pregnancy?

JS: I want to first acknowledge that every single contraceptive method has side effects, and I’m so sorry you experienced them. I also want to make sure that if you do want to be on a method that is more effective than condoms, please go and see your clinician to talk about your side effects because we can sometimes make modifications to make them better tolerated. 

But here are the basics: If someone has sex for a year and uses absolutely nothing to prevent pregnancy, there is about an 85% chance of pregnancy. Using condoms drops it dramatically to about 13%. Pills, patches, and vaginal rings take it to about 8%; the injection to about 3%; and the IUDs and implants to less than 1%. These are “typical use” statistics. If the methods are used perfectly, the failure rates drop. The perfect-use condom failure rate is about 2%. It’s hard to use condoms perfectly, but some people do and it works great for them. 

I also recommend that people consider having emergency contraception available as a backup method, so if a condom breaks, you can use it. Remember that emergency contraception pills need to be taken within 5 days of sex (the sooner the better) and work by preventing ovulation, thereby preventing fertilization.

Author’s note: On campus, free Plan B is available in Zenker Wellness Suite and the bathroom next to Zenker Wellness Suite

Q: When should a non-sexually active person with a vagina begin to see a gynecologist? Are there any annual checkup tests you can skip if you’ve never had sex?

JS: Whether or not you are sexually active, beginning at age 21, it is recommended that you are screened for cervical cancer (also known as a pap smear) every three years. But you can definitely start seeing someone earlier for gynecological care if you have specific symptoms, questions, or concerns. This care can be done by anyone with gynecologic expertise — it can be a gynecologist OR a nurse practitioner, physician assistant, family physician, pediatrician, or internist (anyone who provides primary care). Also, remember that gynecologic care is not the only aspect of health care that you need to pay attention to. A helpful resource is MyHealthFinder by the U.S. Department of Health and Human Services, where you put in your age and gender and it will tell you all the basic health care screening you should have.  

Q: Is peeing after sex a myth or actually something we should be doing?

JS: If you have a vagina and the sex involves putting something in the vagina, I would recommend peeing within 30 minutes to prevent a UTI. All of the bacteria in the vagina can get pushed around and move up to your urethra. Penises have a longer urethra, so people with penises are at a lower risk of getting a UTI, and peeing is less important (but still a good practice).

Q: Is there a reason why everyone’s vaginas look so different? Like is there a purpose to the extra folds?

JS: Everyone’s vulvas are completely different, and we should celebrate it! I don’t know if we can prove that the folds have an evolutionary purpose, but I think of them as a gateway to the vagina, helping to prevent infection. I’m assuming you mean vulvas because vaginas are hard to see, but I will note that vaginas also have folds called “rugae” (which is kind of fun) that allow expansion and resiliency of the vagina, and they give more space for all of the natural, good vaginal bacteria to reside. The vaginal folds have nerve endings that provide arousal, so they make sex more fun!

Q: Why do many people who take birth control experience mood changes such as depressed mood or emotional instability? What is the science or reasoning behind this?

JS: There are many studies with conflicting evidence about this, but I have seen patients who were taking hormonal birth control and started having mental health symptoms like depression after starting it. Hormones definitely can affect mental health — many people have different mood experiences throughout their menstrual cycle. There is at least one good study that showed that the risk for depression went from about one out of 100 people to two out of 100 people after starting a hormonal contraceptive method. It is important to keep an eye on your mental health, and if you do start a contraceptive and experience a mood change, go back to your healthcare provider to talk about it with them.

Q: For context, I am a transgender woman, and I have been on HRT for around two and a half years now. Is incontinence a symptom that can arise from estrogen therapy? I did not experience this during my first year, but around the last nine months or so I have begun to experience this.

JS: Hormone therapy can lead to relaxed pelvic floor muscles. This can cause urge incontinence (where you suddenly need to run to the bathroom), or stress incontinence (when coughing, sneezing, or jumping, causes leaking), or both. I recommend that you see your physician about it so that they can try to help you!

Q: What are good prep and aftercare practices for people that are new to bottoming/anal sex?

JS: Many people love having anal sex! Keep in mind that it doesn’t just include anal intercourse with a penis — it can involve other body parts and sex toys. But it can also be intimidating for people who have never done it or who tried it and found it uncomfortable or unpleasurable. There are lots of guides with tips. I picked these two about preparing to bottom or receive anal sex and this one about topping. The most important things to consider are using lubricant and taking it slowly. Consider anal masturbation at first to get to know your body and try it out. 

Women’s Health: How To Prepare For Anal Sex, According To Experts

Men’s Health: A Beginner’s Guide to Topping During Sex

Men’s Health: A Beginner’s Guide to Bottoming During Sex

Q: How can I (cis female) actually tell if I am orgasming? Sex is pleasurable, but I can never actually tell if I’ve “finished.” Is this normal? Is there something wrong with me?

JS: Everyone has different experiences of orgasms and it can be hard to tell. The articles below describe hints that can help you tell if you’ve had an orgasm.

Planned Parenthood: Orgasms

Healthline: What Real Orgasms Feel Like and How to Claim Your Own

Q: What can I do if my partner can’t give me an orgasm?

JS: If you haven’t yet figured out what helps you have an orgasm — either with previous partners or on your own, I recommend masturbating and also experimenting with your partner to figure it out. I would also work on developing trust and open communication with your partner so that you can get to the point where you can have frank discussions about what you need from them to achieve orgasm. I know it’s not that easy, but I hope that with (not too much) time it will happen. Good luck!

Q: Is having unprotected sex that dangerous if you track your fertility?

JS: Overall, I think it’s a great idea to get to know your body. There are many apps now that people can use to track their menstrual cycles and ovulation times. But sadly, there’s not great evidence that those apps are particularly effective at preventing pregnancy. Many apps claim to be useful for avoiding pregnancy and automatically identifying the fertile window, but reviews have demonstrated a large proportion are not based on evidence-based methods of fertility awareness. 

The most effective apps are ones that include both tracking the days of the month and length of your cycle, along with some kind of biological measure like your basal body temperature or the consistency of your cervical mucus. However, even the most effective fertility apps have about a 7 percent chance of failure each year in real-life use.

If you want to try natural family planning either with or without one of these tracking apps to prevent pregnancy, I recommend that you learn a lot about your menstrual cycle and how to know the times when you can be fertile, and then ideally be strict about abstinence or condom use during fertile days. One of the challenges is that these methods often end up with up to a 2-week window when you can get pregnant! So if you prefer to have sex during this time or would prefer to not use condoms, you might consider a different contraceptive method.

Q: What is the best way to remove hair “down there”?

JS: The bottom line on this is that clipping and trimming (not all the way to the skin) is the healthiest. Waxing at a hygienic establishment is probably second best. Laser hair removal is the most expensive option, but is also safe. You have to be very careful about shaving because all of the nicks can lead to ingrown hairs, rashes, and infections. And even though these infections are rare, believe me, you don’t want to know how bad they can become, so if you notice anything that is beyond a small pimple-size bump, go see a doctor. And don’t forget about the option to free the bush and let your hair be as it is! Or to do the most minimal amount of trimming! As a gynecologist, I see many amazing, happy people who leave their pubic hair as it is.

ACOG’s “An Ob-Gyn’s Guide to Pubic Hair Care” is a great resource for some best practices.

Q: How do you prevent chafing “down there”?

JS: In terms of vaginal chafing during sex, if you are not using condoms, you can use any kind of lubricant. If you are using condoms, use a silicone-based or water-based rather than oil-based lubricant. In terms of vaginal chafing outside of sex, you can also use a lubricant like Aquaphor, wear looser clothing, and avoid wearing underwear all the time (like when you are sleeping).

Q: What are the most common misconceptions you see or hear that you wish people didn’t have?

JS:

  1. People shouldn’t go to the gynecologist when they are on their period. If this were true, a quarter of my patients would cancel on me all the time. If there is one thing we are comfortable with — it’s bleeding. We handle birth and miscarriages (lots of blood).  It’s totally normal for us.
  2. People should shave their pubic hair. See above.
  3. People should douche or clean the inside of their vaginas. This is a bad idea — just clean with soap and water, and just on the outside. Putting solutions with weird chemicals in the vagina can mess up the microflora of the vagina and put you at risk of inflammatory conditions like yeast infections or conditions where the stinky bacteria grow too much, called bacterial vaginosis. 
  4. Pap smears screen for sexually transmitted infections. They only screen for cervical dysplasia and cancer. If you want to be screened for STIs, please let us know. Some of these tests can be done on urine samples, and others in a blood sample.
  5. Emergency contraception and medication abortion are the same. They aren’t! Emergency contraception is a medication you take (pills) or an IUD you have placed in your uterus after intercourse to prevent fertilization. Medication abortion is medication you take when you are pregnant to end the pregnancy and pass the pregnancy like a miscarriage.
  6. Getting a sexually transmitted infection means that you are bad or did something wrong. STIs are common and there is so much stigma around them! Chlamydia is common, Herpes Simplex Virus is common, they are all common! Please become informed about them and how to prevent them, and do what you can to lower your chance of getting them. That includes talking openly with your partners, getting screened, and using condoms if a penis is involved. And once you and your partners decide it is okay to not use condoms, that is okay, too. If you have symptoms, please get checked and treated as soon as possible. 
  7. Abortion is dangerous and causes long-term harm to fertility. There is so much evidence about this, and it’s absolutely not true. Abortion is one of the safest health experiences — it’s safer than having a baby and even safer than a tooth extraction, and there’s no impact on long-term health issues like infertility. Abortion is also very common, yet it continues to be stigmatized.
  8. Withdrawal is a highly effective birth control method. While it is safer than doing nothing at all, it is still not that effective. Out of 100 people who rely on withdrawal as their contraceptive, about 20 will get pregnant in a year. 
  9. IUDs are dangerous. They aren’t! There are some very small risks when they are placed (discomfort, for example, but ask your clinician to use local anesthesia), but once in, IUDs are very safe.
  10. The vagina gets looser if you have more sexual partners. Not true. The vagina is highly resilient and can relax and tighten back to its normal size. 

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