News Highlights
• A new birth control pill decreases symptoms of PMS
• “Uh oh” - what's your Plan B in case of emergency?
• New HPV vaccine on the horizon
• Teachers: Understanding teenage sexuality workshop
• Healthcare professionals: PHAC releases preliminary 2006 STI guidelines

Ask sexualityandu.ca
• Does the birth control pill affect sexual drive?
• What is Essure®?  Can I get it in Canada?
• Are two condoms safer than one?

Tips
• I have recently started to have periods.  I am interested in trying out tampons, but am worried that it might hurt.  Help!

Quick facts
• Teens clueless about safe sex

Did you know?
• A recent study reported the findings of a survey about the use of drugs and sex toys to enhance sexual experience.

A new birth control pill that decreases symptoms of PMS (PMDD)

A recent study found that women who were known to have Premenstrual Dysphoric Disorder (PMDD) had improvement in their symptoms while taking a birth control pill that contains drospirenone.  This pill provides 24 active pills (20 mcg of ethinyl estradiol and 3 mg of drospirenone) followed by 4 days off, as opposed to conventional oral contraceptives which deliver 21 days of hormone-containing pills followed by a 7 day pill-free interval.

The study involved 64 women.  DSM-IV criteria were used to diagnose PMDD (at least five distressing symptoms that occurred in the week before menstruation, improved once menstruation ended, and were severe enough to interfere with work, activities, or relationships).  The women were divided into two groups: one group that started with the drospirenone-containing birth control pill and the other group that started with a placebo (sugar pill).  Questionnaires were used to evaluate symptoms while on therapy.  After 3 months, all women had a month off medication and were then switched to the opposite treatment so that responses to both medications could be compared in all women.

At the end of the study, women who were on the hormonal pills had a significant improvement in their symptoms:  -22.94 for active treatment and -10.46 for placebo, for an adjusted mean difference of -12.47 (95% CI=-18.28, -6.66; p<001).  Also, 62% of the women treated with the hormonal pills felt better, compared to only 32% of women who received placebo.

This study demonstrates the large placebo effect that can be seen when treating mood related symptoms.  However, there was a significant improvement in PMDD symptoms in women who took the birth control pill containing drospirenone, even after taking the placebo effect into account.

This product is not available in Canada.  In Canada we have a birth control pill that contains 30 mcg of ethinyl estradiol and 3 mg drospirenone and is given for 21 days in a row followed by a 7 day break (Yasmin®).  Studies have shown some improvement in selected premenstrual symptoms for Yasmin®).

Pearlstein TB, Bachmann GA, Zacur HA, Yonkers KA. Treatment of premenstrual dysphoric disorder with a new drospirenone-containing oral contraceptive formulation. Contraception. 2005 Dec;72(6):414-21

CFSH launches nation-wide “Uh Oh” Campaign to raise emergency contraceptive awareness

The Canadian Federation for Sexual Health (formerly the Planned Parenthood Federation of Canada) has kicked off its nation-wide “Uh Oh” campaign to raise awareness that Emergency Contraception is now available directly from pharmacists without a prescription. 

Because Emergency Contraception (EC) is more effective at preventing pregnancy the sooner it is taken, it is very important that women know how to get it when they need to.

The new campaign is directed at youth, pharmacists and other healthcare professionals. To promote EC’s availability through pharmacies, the CFSH is distributing bilingual postcards and posters that depict two EC pills pressed with the words “Uh oh…”.  In addition, the campaign also features an extension of the EC info available on the CFSH website, and the launch of a new toll-free number to provide callers with up-to-date information on EC and where to get it.

The new toll free number for information on Emergency Contraceptive is 1-888-270-7444.  More information on EC and the “Uh Oh” Campaign is available on the CFSH website, at www.cfsh.ca.

New HPV vaccine on the horizon

Human papilloma virus (HPV) is the most common sexually transmitted infection.  There are over 100 types of HPV, and it is estimated that over 75% of sexually active people will be infected in their lifetime.  In most cases, the body’s immune system is able to fight off this infection over the course of one to two years.  In other cases, the virus becomes established within the cells and continues to grow.  Some types of HPV (mainly types 6 and 8) causes genital warts, and other more aggressive types, like Types 16 and 18, are responsible for 99% of cervical cancers.  It is estimated that 1350 new cases of cervical cancer will be diagnosed in Canada this year.

Researchers have been working to develop vaccines against the most common strains of the virus. These vaccines are expected to reach the general public sometime next year.  The seroconversion rates (i.e., whether the vaccine “takes” or not) is between 90-100% and the rate of HPV infection after exposure decreases in vaccinated people by 90-95%.  It appears that the most effective time to give the vaccine is before the person has been exposed to the virus.  Some recommend that the vaccine be given by the age of 12, before the onset of sexual activity.

Many parents may have moral and ethical concerns about giving children a vaccine to prevent a sexually transmitted infection and it is important that parents and their children make an informed choice about the vaccing.  We must all consider the important possibility of essentially eliminating one of the more devastating gynecologic cancers.

Foerster V, Murtagh J. Vaccines for prevention of human papillomavirus infection [Issues in emerging health technologies issue 75]. Ottawa: Canadian Coordinating Office for Health Technology Assessment; 2005.

Attention Teachers!

On April 28th, 2006, www.sexpressions.ca will be hosting an all-day workshop titled Understanding Adolescent Sexuality at the downtown Montreal YMCA.  This intensive workshop will explore new trends in sexuality and provide participants with accurate information on sexual health and risks. The workshop will also help teachers to become more comfortable and prepared for teaching sex education to students.   In addition, participants will be provided with practical tools for presenting sex education.  The cost of the workshop is $175.  As space is limited, reservations are required by April 14, 2006.  For more information, download the registration form today!

Note to healthcare professionals: PHAC releases preliminary STI guidelines

In February, the Public Health Agency of Canada (PHAC) released advance chapters from the 2006 Canadian Guidelines on Sexually Transmitted Infections (STI).  The guidelines provide evidence-based recommendations for the treatment, prevention, diagnosis, and management of Sexually Transmitted Infections in Canada.

Expected for release this summer, the new STI guidelines will replace the 1998 edition, and come amidst a rising number of reported cases of Chlamydia, Syphilis and Gonorrhea in Canada since 1997.

Some of the advance chapters cover specific STIs such as Syphilis, Chlamydia, Gonococcal Infections, HPV and HSV.  Others deal with treatment and prevention in specific population groups such as inmates/offenders and sex trade workers.

Advance chapters of the 2006 Edition of the Canadian Guidelines on Sexually Transmitted Infections (STI) are available in the main STI section of the PHAC website, www.phac-aspc.gc.ca/std-mts/

Does the birth control pill affect sexual drive?

Although some reports say that by reducing menstrual-related symptoms and preventing unplanned pregnancy the pill can improve sexual enjoyment for some women, contraceptive hormones may be responsible for a reduced sexual drive in some women.

All women have some testosterone.  The birth control pill (or patch or ring) is known to increase levels of a protein (SHBG), that attaches to testosterone and reduces the activity of testosterone in the body.  This is why women who use the birth control pill often have less acne or less facial hair – good side-effects!

However, researchers have looked at the affect of testosterone levels and SHBG levels on women’s sexual function and pleasure. A few studies have suggested a connection between taking the birth control pill and a decrease in sexual stimulation and enjoyment for women.  One particular study looked at the levels of SHBG in women on the pill, women who recently stopped taking the pill, and women who have never taken a birth control pill.

That particular study looked at 124 women who were being seen in the clinic for sexual dysfunction.  They had all been diagnosed with “androgen insufficiency” using a symptom rating scale and had androgen levels in the lower range of normal for women of reproductive age.  Sixty-two women were on the pill, 39 had discontinued the pill, and 23 women had never used the pill.  The SHBG levels were 4 times higher in women who were on the pill or who had recently stopped it.  SHBG levels were still elevated in many women after one year,but gradually the levels of SHBG returned to the levels seen in women who had never taken the pill.

These findings are of interest because the benefits (less acne and facial hair growth) and risks (reduced sex drive) of decreased testosterone action may persist for longer than previously thought after the pill is stopped.  This study will promote further research into the long term effects of the pill on hormonal function.

Panzer C, Wise S, Fantini G, Kang D, Munarriz R, Guay A, Goldstein I.  Impact of oral contraceptives on sex hormone-binding globulin and androgen levels: a retrospective study in women with sexual dysfunction.  J Sex Med. 2006 Jan;3(1):104-13.

What is Essure®?  Can I get it in Canada?

Essure® is a form of permanent contraception, like a tubal ligation (i.e., “getting your tubes tied”).  A tubal ligation requires a surgical procedure to enter the abdomen and either tie off the fallopian tubes, burn them, or place a clip across them.  Unlike a tubal ligation, Essure® does not require a general anaesthetic or incisions in the abdominal wall.  Instead, little coils of metal are inserted into the opening of the fallopian tubes where they enter the uterus.  This is done using a telescope device (hysteroscope) inserted from below the uterus.  This procedure requires that local anaesthetic be placed into the cervix, and that the cervix is gently dilated open so the hysteroscope can be inserted.  This gives access to the inside of the uterine cavity.  The surgeon can then see the openings to the tubes and the coils are placed.

Sometimes, there may be difficulty seeing the tube openings and placing the coils.  If this technique is successful, it is considered impossible to reverse.  If a woman were to change her mind about having children after having an Essure® procedure, even in vitro fertilization (IVF) may not be an option for her, as the Essure® device sticks into the cavity of the uterus. 

This procedure is available in Canada.  They are inserted by gynecologists or other physicians with the special training.  Speak with your primary care physician about a referral.

A certain amount of vaginal discharge is normal.  It is a result of the hormones that are produced by your body.  Normal vaginal discharge does not have a strong odour and is usually clear, white, or slightly yellow.  If you find that the discharge is smelly, has changed color, or is itchy or irritating to your skin, see a healthcare provider.

Are two condoms safer than one?

The basic answer is no. Condoms still provide the best protection against sexually transmitted infections, so one is definitely better than none. However, this is one case where if one is good, two is NOT better. Because of the friction of latex on latex, using two condoms is more likely to cause one of them to tear.  And do not use a male condom and a female condom at the same time. Check out the rest of sexualityandu.ca for more on condoms, their benefits, and how to use them properly.

How long is an egg good for once it is released from the ovary?

When an egg is released from the ovary (ovulation), it is usually picked up by the end of the fallopian tube.  This occurs within minutes after ovulation.  There are many tiny hairs inside the tube that help sweep the egg along its length.  Muscle fibres in the wall of the tube also help move the egg.  The egg is in the tube for approximately 80 hours (just over three days) before it enters the uterine cavity.  It is while the egg is in the tube that it can be fertilized.  If an egg has been fertilized in the tube, it may implant into the uterus 1-3 days after entering the uterine cavity.

The absolute length of time that an egg can be fertilized is unknown, but is thought to be between 12 and 24 hours.  This means that even though the egg remains a living cell for longer, it is only able to create an embryo for a short period after being released from the ovary.

By comparison, sperm have a life of up to 7 days, although they are most able to fertilize an egg for the first 2 to 3 days after they are released into the vagina.

A recent study reported the findings of a survey about the use of drugs and sex toys to enhance sexual experience.

Over 1100 sexually active people aged 18-39 in the Seattle area responded to a telephone survey that looked at their use of sex toys and drugs such as alcohol, marijuana, and sildenafil (Viagra®) during sexual encounters.

About 45% of responders claimed to have used sex toys at some time and 27% used them regularly.  Twenty-eight percent had used drugs or alcohol at some time to enhance sexual experience, and 13% used them regularly.  The most commonly used drugs were alcohol (83.7%), marijuana (34.7%), ecstasy or “sextasy” (ecstasy combined with sildenafil) (8.2%), and sildenafil (7.5%).

The use of sex aids or drugs was associated with several high risk behaviours for acquiring a sexually transmitted infection (STI), including younger age at first intercourse, more lifetime partners and multiple partners at any given time.  People who used sex aids or drugs were more likely to report having an STI in the past. 

The authors proposed that drug use may lower a person’s inhibitions, possibly enhancing the sexual experience but also placing them at higher risk of partaking in risky behaviours.  Also, the use of sex toys may place people at increased risk of being infected with an STI, due to improper cleaning of the sex aid or because of small tears in the skin that may occur during use.

Foxman B, Aral SO, Holmes KK.  Common use in the general population of sexual enrichment aids and drugs to enhance sexual experience. Sex Transm Dis. 2006 Mar;33(3):156-62

Teens clueless about safe sex

The results of a recent survey of Canadian youth and mothers were released in February 2006 by the Canadian Association for Adolescent Health (CAAH).  Almost 1200 teens ages 14-17 and 1139 mothers (not the mothers of teens interviewed) participated in an online survey about their knowledge and beliefs about sex, sexuality, and the consequences of sexual behaviour such as sexually transmitted infections (STI’s). 

Twenty-seven percent of teens between the ages of 14-17 reported being sexually active, and have had an average of 3 partners.  Only 1 in 4 used protection against STI (such as a condom or dental dam) the last time they had sex.

Two out of three teens have participated in oral sex, and 17% did not know that common STIs such as HPV, gonorrhea, and chlamydia, can be passed along by oral sex.

While 90% of teens consider themselves very or somewhat knowledgeable about sex and sexual health, only 19% of them had heard about HPV (the most common STI) and the majority believed that HIV was the most common STI (even though it is rare).  Many teens were aware of the possible long-term consequences of STIs such as chlamydia (infertility), herpes (pain), and HPV (cancer).

Of particular interest: 63% of teens consider parents as a major source of information on sex and sexual heath, and 45% of teens consider parents to be their role models with regards to sex.

“Sexual Behaviours and Attitudes, Canadian Teenagers and Mothers”.  Lead Author Jean-Yves Frappier, Canadian Association for Adolescent Health.

I have recently started to have periods.  I am interested in trying out tampons, but am worried that it might hurt.  Help!

This is a really common concern for many adolescents, and it’s often a bit hard to talk about.

Here are a few tips:

1. Tampons come in several sizes and absorbencies and are available at any drugstore or supermarket
   
2. Talk to your mom or a friend who has used them before
3. Relax!  The more nervous and worried you are, the tighter your muscles become, and the harder it is to insert the tampon.
4. Find a comfortable position.  This may be sitting on the toilet, lying on the floor or a bed, or standing up. Hold the tampon in the middle, with the string pointing away from you.  With your other hand, spread the labia (folds of skin around the vaginal opening) and insert the tampon into the vagina.  Push the tampon in, aiming for the middle of your back.  Once the tampon applicator is in about halfway, push in the inner tube of the applicator to finish inserting the tampon.  Pull the outer and inner tubes out, but be careful not to pull on the string.  If the tampon is in the right place, you should not feel it at all.  If it is uncomfortable, you may not have inserted it in far enough.  Pull this tampon out and try again with a new one.
5. Have patience!  If it doesn’t work the first time, relax and try again.
6. If you are having trouble, try using a mirror and a small amount of lubricant (like K-Y jelly) on the tip of the tampon.  If that does not work, consider seeing your doctor or another healthcare provider.  A small percentage of teens have a smaller opening in their hymen and may have trouble inserting tampons.
7. Have a look at the instruction manual that comes in the tampon package.  There are usually good diagrams to help you out.