Pregnancy and Sexually Transmitted Infections (STIs) - What Do I Need to Know?

This week I want to answer concerns regarding complications of STI's (Sexually Transmitted Infections) in pregnancy. Pregnancy brings on many changes, and causes most of us to worry about our diet, exercise and everything that touches our bodies. So finding out about an STI can be especially concerning to women.

In fact, what may seem like an STI may not be. Pregnancy changes your body so quickly that you may notice an increase in vaginal moisture & discharge, irritation or even a different odor than you're used to. Of course you may worry that something is very wrong.

During your first or second prenatal visit, your OB doctor will do several tests on you, including vaginal cultures and blood tests for the most common STI/STD's. This list may include: HPV (human papilloma virus), bacterial vaginosis (BV), herpes (HSV), chlamydia, trichomoniasis, gonorrhea(GC), hepatitis B, HIV and Syphillis. Often herpes is left off the prenatal panel, but it can be requested as an add on. This is because most women are already aware of having had an outbreak, so they have already been diagnosed. Herpes will generally only interfere with pregnancy if lesions appear at the time of delivery, and in that case a cesarean section would likely be performed.

Women who are pregnant can become infected with the same sexually transmitted diseases as women who are not pregnant. Pregnancy does not provide any protection for women or their babies. But, during pregnancy a woman's immune system has a harder time fighting off infection. The only way to be sure you are protected is to use latex condoms with each act of intercourse, unless you are sure you are in a monogamous relationship with a partner with no STI’s.

Women can become infected with an STI like herpes, HPV and condyloma, years before they meet their current sexual partner. When they become pregnant and their immune system is weaker, they can begin having herpes outbreaks, condyloma overgrowth and abnormal pap smears due to HPV infection, without ever being aware they were carrying these viruses. It can be very shocking to wake up with clusters of warts growing around the vaginal, labial and anal areas, or to find red, hot herpes blisters having never been aware you were harboring a virus. But remember, this does not necessarily mean your partner is being unfaithful.

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Can I Use WaterWorks to "Clean Up" After Sex?

A great question came this week from JMW. She has noticed that after having sex with her husband, she 'leaks' his semen for a day or two, and wondered if using WaterWorks after vaginal intercourse would stop this from happening. She also wondered how long it take for the water to drain out of your vagina after using WaterWorks. I'm assuming the last part comes from a worry that water, instead of semen, would 'leak' out for a day or two.

Your question is one of concern for so many women, and one that I am asked quite often. Women tell me that even bathing or showering after sex doesn't seem to help. After awhile, it's hard to know if the “leaking” is still semen, or perhaps the beginnings of an infection. How many of you have experienced this? WaterWorks is a perfect way to clean-up after vaginal sex. With proper cleaning between use, WaterWorks is designed to be used time and time again, so you don't have to keep spending money once you've purchased it. Plus it uses only plain tap water; no chemicals and no special solutions.

It is the design of the stainless steel nozzle that makes WaterWorks unique. The reaction of stainless steel and water with the vaginal mucosa removes any odors. Also, because it gently sprinkles water in a downward direction within the vagina (no high pressure or shooting action), the water drains out immediately. So, it will rinse out the semen or any vaginal discharge with no 'leaking' after use. WaterWorks can be used daily with no side effects.

We know from our previous answers that it is important for the vagina to maintain a low pH to stay healthy and keep yeast and bacterial infections away. That is why hygiene after vaginal sex is so important. It is important to rinse the semen out as soon as possible as it has a higher pH. The longer it stays in the vagina, the more likely it is to cause unusual vaginal odors, and destroy the delicate vaginal environment that keeps infections away.

You may be interested to learn that the vagina does not go straight up vertically. When a woman stands upright, the vagina actually lies in a slanted, horizontal plane; it goes up, in, and back towards your tailbone and this is why it takes so long for semen to drain out. Also, semen and discharge are thicker than water, and therefore take longer to drain out

One of the top uses for WaterWorks is to help with daily hygiene, especially rinsing out semen after vaginal intercourse. And with WaterWorks this can be done safely without disrupting the vagina's own defense like douching does. Don’t forget, douching with traditional disposable douches can actually create an environment that can lead to yeast and bacterial infections. So I hope this answers your question. I hope you are all having a great summer! It is hot, hot here in the Southwest, but lots of blue sky and sunshine.

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Should I be Tested For an STD?

For many of us this may be an uncomfortable and embarrassing question. I know many of my patients will tell the staff they are coming in for a different reason, and only when they are finally in the exam room with me they are comfortable enough to share their concerns about possible STDs. 

Some of them have just discovered that their partner has been cheating on them, and are emotionally devastated. Maybe you or someone close to you has recently experienced this and can understand how scary it can be not knowing if you might have contracted something serious from an unfaithful partner. Even if you are single and dating and are careful to use condoms everytime, the worry is still there as condoms don’t protect from all STDs. 

Testing for STDs should begin when you become sexually active or have symptoms that make you worry that something may be wrong. Symptoms like vaginal bumps, blisters or open sores should be shared with your OB/Gyn.

So should vaginal discharge that is odorous, itchy, bloody, or higher volume than normal. If the infection gets to your kidneys or fallopian tubes and into the pelvis, it can cause fevers, severe pain and possibly PID (pelvic inflammatory disease). PID can cause scarring of the fallopian tubes and eventually infertility. I would never want to think that any of you or my patients would suffer from this and try to self- treat because they were too embarrassed to see their doctor. We are here to help you and want to see you get better. 

The home tests that you can get from the drug store can be used, but will often read positive when no infection is present at all. So a follow-up with your doctor is still a good idea. 

The best time to screen for STDs & STIs is during your annual exam. It is also a good time to ask questions and get information on prevention.

Some STDs (like HIV, Hep B, & Herpes or syphilis) may not show up right away on initial testing and take a few months to pick up on a blood test, so follow-up in 6 months to confirm that tests are truly negative.

I hope this helps. I know a lot of my patients ask me if douching helps get rid STDs and I have told them that it can actually force the infection up further through the cervix and into the uterus and fallopian tubes. This in itself can cause PID as discussed above.

A much better way to clean out your vagina is to use the WaterWorks Vaginal Cleansing system. It will rinse out excess discharge and infection-causing bacteria. [Note: this will not cure any STD or prevent an STD]. WaterWorks uses only fresh water (no chemicals!) and is FDA cleared. It does not use a shooting action so will not push the infection further up into the uterus or fallopian tubes. It may help you heal faster along with taking the prescribed medications. Don't share your WaterWorks with anyone else!

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What is the Difference Between an STD and STI and How Can You Prevent Them?

Essentially, they represent almost the same thing. STD is an abbreviation for a Sexually Transmitted Disease and STI is an abbreviation for a Sexually Transmitted Infection. The best way to describe the difference between an STI and an STD is that you can have an infection without having any symptoms; however once symptoms appear, it becomes an STD.

STIs, like many infections,can be passed from one person to another, even when there are no symptoms. Examples include Herpes, HIV, HPV and Hepatitis. A mother can pass these to her infant through childbirth and breastfeeding when she is unaware of being infected. Other infections such as the flu, common cold and mononucleosis, can also be transmitted during sex from oral contact and kissing, but would not be considered to be 'sexually transmitted infections'.

It’s important to know that just having sex won't necessarily give you an STD or an STI. You have to have sexual relations with another person who is infected in order to receive the infection. Also, if a person is treated for a STD/STI and returns to the same sexual partner they can become re-infected if their partner has not been treated. So if you get an STD/STI it is important that your partner be checked and treated as well.

So how do you protect yourself from contracting an STD/STI?

Prevention through avoiding exposure is the best strategy for controlling the spread of STIs. We know that protected vaginal and anal intercourse carries the highest risks for the most dangerous sexually transmitted infections. Abstaining from sex is the only way to be 100% confident of avoiding Sexually Transmitted Infections but let's get real! If abstinence is not an option, then condoms, used properly, can reduce your risk  significantly. Condoms be used with each act of sexual intercourse. But even this practice not completely eliminate the risk of transmission of STIs. Condoms can fail, slip off, be punctured, or break down from spermacides or lubricants. In the best conditions, they provide great protection against HIV and Gonorrhea, but are less effective against Genital Herpes and Chlamydia. They provide no protection from HPV.

Nearly everyone has taken risks sexually, but please beware of the potential consequences which can impact your health and the course of your life. Many STDs can last a lifetime, put stress on relationships, cause sterility or birth defects and even lead to major illness and death. Know the risks! Sexually Transmitted Infections are not all transmitted the same way.

Unprotected Vaginal and Anal sex can lead to the transmission of:
-trichamonas
-gonorrhea
-chlamydia
-syphylis
-pubic lice, Hep B, HPV,HSV,HIV

Unprotected oral sex can lead to the transmission of:
-gonorrhea
-chamydia
-syphilis
-Hep B, HSV, HPV

Even sexual play without intercourse can lead to the transmission of:
-HSV,HPV
-pubic lice
-gonorrhea
-chlamydia
-trichamonas

The most important thing to remember is to take care of yourself, and if you feel that something isn't right, make an appointment with your doctor.

Always be safe when it comes to your health.

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Will My Sex Drive Disappear When I Go Through Menopause?

Menopause can be an extremely difficult time for women as they begin experiencing so many physical and mental changes. There can be hot flashes, night sweats, insomnia, weight gain, and mood changes which can affect relationships and a woman's self esteem. Sex drive will be affected due to a lack of confidence many women have about their appearance, and the worry that their partner will still desire them as they journey through these changes. Sex drive may also be diminished due to a decline in overall physical health or side effects caused by many medications.

Menopause is a time of extreme hormonal change and imbalances linked to the ovaries’ inability to maintain production of estrogen, progesterone and testosterone as they did before. It is the complete loss of estrogen, the main female hormone that diminishes sexual desire and genital sensitivity. This lack of hormones can also cause vaginal dryness and pain during intercourse, which many women fear could mean an end to sexual intimacy with their partners. Testosterone, the male hormone, also plays a big role in vaginal lubrication and libido.

Many women choose to take some form of hormone therapy, if only for a few years, to help transition into this next stage of life. They find it can block weight gain by increasing metabolism, with a secondary benefit of increased energy levels and a return of outside interests (“libido for life”). A good diet and exercise is also important to maintain health and vitality during this stage.

About 70% of couples actually report an improvement in their intimacy levels and romance as they transition though their later years and menopause. They report that they no longer have the worries of a family to raise, and are much more comfortable with themselves and their partners sexually. This is good news.

Some reports suggest it is ovulation in our youthful years that increases sex drive in women, (all in the name of reproduction) Other studies are showing that decreasing estrogen plays only a small role in lowering sexual desire in later years.

We do know that intimacy seems to grow and become more important/deeper with age. So, there is hope for a healthy sex drive for our entire lives. Let's all hope for a wonderful partner to spend those years with.

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Can Douching After Sex Prevent STIs?

No, douching after sex will not prevent STIs or STDs. In fact, there is no post-sex STD/STI protection, and even condoms won't protect against all infections. The only 100% fool-proof method is abstinence, and since that isn't likely to happen, knowing how to protect yourself is important.

But douching is not the answer. I know many of you douche for a variety of reasons, even though over the past few months we have talked about the many reasons you should not douche. Douching is not healthy, and regular douching can change the delicate chemical balance of the vagina, actually making a woman more susceptible to infections. Douching can introduce new bacteria into the vagina which can spread up through the cervix, uterus, and fallopian tubes. Researchers have found women who douche regularly experience more vaginal irritations and infections such as bacterial vaginosis, and an increased number of sexually transmitted infections.

We have discussed the WaterWorks vaginal cleansing system in past blogs. It is important to note that WaterWorks will also not prevent STI/STDs after sex. However, because it uses a unique medical grade stainless steel nozzle and plain tap water it will not destroy the natural flora or chemical balance which protect the vagina. It also uses a downward rinsing action unlike traditional douches and has been FDA cleared to safely eliminate vaginal odor. You can use it every time you bathe or shower after sex to safely clean the vagina of unwanted discharge or blood without the worry of pushing infection or sperm further up into your cervix and uterus.

Please, choose your sexual partners wisely, be careful and use protection against STDs.

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Orgasms Are Causing Excruciating Pain - Why?

Sex should not be painful, right?  So why is it painful for some women and not others?  For most women it can be a shock the first time they experience it.  It usually happens during ovulation when the ovaries are swollen and tender with maturing follicles.  If one of the ovaries is bumped or tugged with deep penetration or thrusting this can cause significant sharp, stabbing pain. 

You know it's common for women to have pain like that, and now and then with sex.  But for some of you, it has become a regular thing, and every time you are intimate with your partner, it causes significant pain.  Then afterwards the pain continues long past orgasm.  In these cases, sex can really become a scary experience rather than exciting and satisfying.  This was how Kelly felt, and orgasm changed from wonderful and satisfying to painful all the time:       
                                                                                                                          

“In the past couple of months, whenever I have an orgasm, it is excruciatingly painful.  The pain is only on my outer pelvic area. It's like all the muscles from my pubic bone all the way down to the rectal area goes into painful spasms. Just like bad menstrual cramps, only external. 

The pain is awful, and the worst of it lasts for about 5 minutes (feels like an eternity), and then gradually starts to get better.  I have to sit on a heating pad to get a bit of relief, and I can still feel it the next day.  This happens even without intercourse. Just having a clitoral orgasm is enough to cause the intense pain over the whole groin area. I'm single anyway, and not married, so sex is pretty rare these days.”

There are so many reasons that women can experience pelvic pain and sexual pain, that is why it is so important to see your healthcare professional if you are concerned.

Pain at orgasm can occur because of the contractions of the uterus, and this can expose underlying problems that would normally be ignored or thought to be from something else like gas pain, IBS, constipation, bladder infection, or ovulation pain.  It's only when it happens time and time again that professional help is sought.

Clitorism is a continued, painful condition in the female with recurring erection of the clitoris.  The word is also used to describe an abnormal enlargement of the clitoris. Clitorism is painful, much like its male counterpart, priapism. 

Clitoral phimosis is a condition in women, whereby the clitoral hood cannot be retracted, limiting exposure of the clitoris.  Imagine an uncircumcised man not being able to pull back his foreskin during intercourse, this is similar to this condition in women.  It is rare, but some baby girls are born this way and feel that they do not have a clitoris when they become sexually active.  

This condition is one of the reasons some women are unable to have an orgasm, due to the clitoris being 'buried' under so much tissue.  The usual treatment is surgery to unbury the clitoris so it can be normally stimulated during intercourse.  Care has to be taken not to expose too much of the clitoris by removing too much skin.  That is why it should always be done by an experienced professional. 

Some women have been found to have clitoral adhesions which can be congenital (present since birth) or acquired from recurrent infections or injury.  In this condition, the clitoris and clitoral hood are connected by little adhesions or pieces of scar tissue.  Again, this requires surgical treatment with the utmost care, as removing them can promote more adhesions. 

Endometritis refers to inflammation or infection of the endometrium, the inner lining of the uterus - which is the portion that releases during the menstrual cycle and also remains should implantation occur.

The most common cause of endometritis is an infection from compromised abortions, delivery, medical instrumentation, and retention of placental fragments. Cesarean section or prolonged rupture of membranes and long labor with multiple vaginal exams during labor are important risk factors.  

Symptoms include lower abdominal pain, fever and abnormal vaginal bleeding and discharge. Treatment is usually with broad-spectrum antibiotics.  Menstruation after acute endometritis can be excessive and scary, but should improve after a couple cycles. 

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Sexy time and your cycle...

Dear KnowYourV, , my husband travels for his job right now and it seems like every time he comes home I'm on my period. Is it okay to have sex while I’m on my cycle?"
I know many of you have the same question and I encourage you to do whatever you and your partner enjoy. The only health risk is a slight increase in the chance of catching an STD, so if you are single and having ‘casual’ sex with more than one partner, be sure to practice “safe sex” precautions. The cervix is slightly open during our cycles, which puts us at a much higher risk for PID (pelvic inflammatory disease), and other ascending-type diseases.

Remember to use your WaterWorks feminine cleansing system after sex. It is the only FDA-cleared reusable vaginal cleansing device of its kind. Everyone I have recommended it to loves it because not only does it help rinse the vagina , but it also will help with odor. I would not recommend the use of WaterWorks on heavy flow days, but on light days it definitely help you feel more confident and clean.

WaterWorks uses only plain tap water and can be used daily or even more often, if used after sex to clean out semen. It is the unique reaction of water with the medical grade stainless-steel nozzle that clears odors and discharge. WaterWorks uses a gentle downward sprinkling/rinsing action instead of a forced pressure action, which keeps the flow of bacteria and discharge out, not back up inside your body.

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Sex and your well-being

Many women have asked me about the benefits of sex in relation to health and well-being. Well, it turns out there has been a lot of scientific research done to give us some insight into this.

Studies done in the U.S. and England have revealed that couples who have sex at least 2 times a week had significantly lower stress levels. This was monitored by putting participants into highly stressful situations like public speaking or intense exercise and the checking their diastolic blood pressure and catecholamine levels afterward. The couples having more frequent sex showed better levels. Hmmm, interesting.

Sex also boosts the immune system. The same studies also found that having sex at least 2 times per week helps boost the amount of immunoglobulin in your bloodstream. This helps combat colds, flu viruses and other illnesses.

Sex can also be a great way to burn calories. A recent study showed that thirty minutes of sex burns 85 calories or more. It may not sound like much, but it adds up! Every little bit helps; plus, this exercise is enjoyable. 42 thirty minute sessions will burn 3,570 calories, so burning off those pounds may be within reach after all! In addition, lowered stress and lowered weight can lead to a reduction in cardiovascular disease. Amazingly, this reduction can be quite significant. The study in men actually showed that, when they had sex two times or more a week, there was a reduction in the risk of fatal heart attack by ½ as compared to those who had sex less than once a month.

Isn’t this interesting? Who would have thought sex could have so many positive health benefits
The studies also found that frequency of ejaculations in men in their 20’s correlated with reduction of prostate cancer later in life. The number of partners didn’t matter, but 5 or more ejaculations a week in the 20’s reduced prostate cancer by 1/3. Another study showed that 21 ejaculations or more per month in elderly men (as opposed to 4-7) was also linked to lower rates of prostate cancer.

And listen ladies, the more orgasms we have, the stronger it makes our pelvic floor muscles, which helps bladder control and frequency issues, especially as we get older. If your pelvic floor muscles are stronger, then you have better bowel control and are better able to hold back gas at those crucial times, oohhlaalaa! The stronger the muscles the stronger the orgasms, too.

During sex we release a very strong hormone called oxytocin. This is the hormone that gives us all the warm, loving feelings. Women release it during labor and when breast-feeding, and it helps them bond with their babies and make breast milk. They have found that when people are given this hormone, they are able to tolerate pain better, and that is why many of us find our headaches, PMS, and arthritis pain improve after sex. Oxytocin also improves our self-esteem, and that’s why having sex makes us feel better about ourselves. It has been called the love hormone, and because of that, having sex can improve intimacy and help us learn to bond and trust. When couples were tested for higher levels, they were shown to be more loving and generous to each other.

The last thing which I think we all know already, is loving sex promotes good sleep. What a surprise.

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How soon can I have sex after giving birth?

Dear KnowYourV,  

"I know the standard rules for returning to vaginal intercourse after vaginal birth, but what is the real 411? How soon can we have sex or how long should we wait, really?" 

Well, Janet, so many women want to know the "real" answer to this question because the standard rules always seem so vague. What's really frustrating is grandma & auntie say one thing, I say another & the nurse says something else when you are discharged from the hospital. The truth is that no one can tell you when it is going to be alright, because it is different with each baby.

The basic post-partum rule, whether someone has had a c-section or vaginal birth, is that all women are given the standard “pelvic rest”, meaning nothing vaginally for at least 2 weeks. This means do not: use tampons, have vaginal intercourse, douche, or take tub baths (as fluid may get into the vagina). Bleeding after birth can be heavy for about 2 weeks (and sometimes last up to 4 weeks) and the uterus takes about 4-6 wks to go back to pre-pregnancy size. It can take up to 2 weeks for the cervix to close again. If the cervix is open, it's easy to get an infection after delivery. Of course, this is usually not a problem as most women aren't concerned about jumping right back into sex. In fact, the opposite is true, and I've had some patients who have been so afraid that they waited 3-4 months afterwards.

I think what most of you really want to know is, when is it really ok, and when is it better to wait.
Honestly, if you have an uncomplicated vaginal birth or c-section, with no tears or episiotomies, then 2 weeks is the minimum time to allow your body to heal. As for bathing and tampons, those are usually OK to use after about 4-5 days.

We never recommend douching, as it is known to cause infections and create more harm than good. However, using the WaterWorks feminine cleansing system, as we've mentioned before, is considered safe, and it can be used to cleanse the vagina around four weeks after delivery. It is nothing like douching in that it uses only plain tap water and a medical grade stainless steel nozzle, with no harmful chemicals. It also uses a gentle downward sprinkling action to rinse the vagina, instead of a forceful outward blast like traditional douches which can force infection upward into the vagina.

The other very important thing to keep in mind is that, if you did have an episiotomy or vaginal tear, it is best to wait at least 4-6 weeks to allow maximum healing of the tissues. When you do have sex for the first time after delivery, be sure to use lots of lubrication. It may feel tender where you tore, but that is normal. It is best to continue as much as you can tolerate, because the more it is stretched, the more elasticity that will return.

Just remember, everybody is different, and every delivery is different. So if this is not your first child don't expect the after-effects to be the same as the last one. Also, trust yourself and your own intuition. If you feel something might be wrong, make an appointment with your doctor, sooner than your post-partum visit.

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I’m pregnant! What risks do Sexually Transmitted Infections (STIs) pose for my developing fetus?

Sexually Transmitted Infections cause the same problems in pregnant women as they do in non-pregnant women. But in pregnancy they pose added risks to the unborn child. These infections can cause preterm birth, preterm labor and early breaking of the water which can cause infections of the uterus. Once the uterus becomes infected, the baby can become sick and this could cause the baby to suffer brain damage, pneumonia, low birth weight, blindness, deafness, meningitis and even death.

Of course many of these problems can be prevented, as most STI/STD's (Sexually Transmitted Diseases) can be effectively treated with antibiotics. When women get routine prenatal care, routine screening can be done any time there is a suspected problem. Many STI's like chlamydia,`gonorrhea, trichomoniasis and BV (Bacterial Vaginosis) remain in the vagina, and as long as the water is not broken, can be treated without ever impacting the baby. Unfortunately, some STI’s can cross the placenta and make their way via the mother's blood to the baby. HIV and Syphilis are examples of this but studies have shown that women who are treated for syphilis do not pass it to their babies. Likewise for women who are HIV positive but treated with antiviral therapy will have only a 2% chance of passing it to their babies.

Some STD’s if untreated, can be passed to the baby via the vaginal fluids during the delivery process. So the best, safest approach to preventing STI's in pregnancy and reducing the chance of harm to the baby is to go to your doctor for prenatal care. Make sure you are checked for all the necessary STI's. Ask questions there is no such thing as a dumb question. Ask to be rechecked if you are worried. Remember it's important.  It could impact your baby's life and your ability to have more children in the future.

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