Tag Archives: CDC

Is There A Link Between Injectable Contraceptives And HIV? ASK AN OBGYN

Ask an OBGYN 2 Comments

Dear SuzyKnew!,

 I heard that there is a link between using “the shot” (injectable contraceptives) and HIV, is this true? What about other contraceptive methods?  I want to continue using injectables, but as a Black woman born in Africa living between the States and an African country with a high rate of HIV, what should I do?

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Dear Reader,

The World Health Organization (WHO) issued guidance in March 2017 on the use of progesterone-only injectables, including DMPA (brand name Depo-Provera) and NET-EN, stating that women who use this contraceptive method need to be informed that there may be an increased risk of acquiring HIV.  So yes, there is a link, but the reason this happens with some users is not yet clear to scientists.  There seems to be something going on with how the hormone in the injectables affects the cells in a woman’s genital tract and cervix, making her more vulnerable to HIV infection, if in fact she is exposed to HIV.

It appears that the link does not exist for other hormonal contraceptives, such as implants, hormonal IUD, or oral contraceptive pills.  Remember- the ONLY way to protect yourself from HIV is using a barrier method- male or female condoms.

Sistas’ need to know: Protect yourself from HIV and other STIs with a barrier method, no matter what contraceptive method you choose.

This news is significant because millions of women around the world depend on “the shot”,  “the jab”, Depo-Provera, or the Sayana Press in order to avoid getting pregnant.

Injectables are some of the most commonly used contraceptive methods in the world, and are heavily used by women in Sub-Saharan Africa, a region of the world that also has high rates of HIV.  Take Malawi, for example, where 10% of the population is HIV+ and 26% of women have an unmet need for contraception, meaning that they want to use birth control, but are unable.  In countries like Malawi, injectables play a major role in meeting the needs of women, with 32% of the women making injectables their method of choice. The University of California at Berkeley analyzed 12 studies from sub-Saharan Africa covering nearly 40,000 women which showed increased HIV risk but no similar risk increase with oral contraceptive pills.

Injectable contraceptives also play an important role in the contraceptive mix in among women of color in the U.S. where there is a relatively high prevalence of HIV.  According to the Centers of Disease Control (CDC), although the pill is the most common form of contraception for U.S. women, 27% of Latina women and 34% of African-American women have used Depo-Provera, or “the shot” compared to 20% of white women and 10% of Asian women.  And, while HIV rates have fallen recently among Black women, we are the most affected by HIV in heterosexual communities. Because injectables are 99% effective, low cost, and need to be taken only once every three months they are the method of choice for millions of women.

If you want to continue using DMPA or NET-EN, know that there is some increased risk for HIV compared to other contraceptive methods. 

Health leaders are currently developing messages (due to come out in April 2017) for health care providers and community leaders so that they can educate women and men about the potential risks of HIV and use of injectables.  Please check back with us at SuzyKnew! if you have any questions when these messages come out.

Take care.

ASK AN OBGYN is not meant to replace consulting your ob/gyn or primary care provider. Ask your questions at obgyn@suzyknew.com

ASK AN OBGYN: How Important Is It To Use A Condom For Oral?

Ask an OBGYN 1 Comment

Question- How important is it to use a condom for oral?  Can I get herpes, HIV, or anything else? Does it make a difference if the oral is done on a girl or a guy?

******

This is a great question.

The short answer is YES!

It’s been hammered in our heads to use condoms for vaginal and anal sex, but oral?  To most people this is a confusing area.

If you have not seen your partner’s recent HIV and STI test results, YES, you should use male condoms and female condoms or another barrier method such as plastic wrap for the vagina.    STIs can be transmitted from the “giver” to the “getter” and back and forth and back and forth (you get the picture).   They can be transmitted through giving oral pleasure to the penis, vagina or anal area.  

But, you should know, in general, the risks of contracting the big uglies are less with oral sex, compared to vaginal and anal.    There are several reasons for this, but the most interesting is research showing that our saliva actually strips down viral proteins– Wow!    However, there are some viruses that love the mouth and some bacteria that thrive in the soft tissue in the throat.

Here is a short-list of the most common sexually transmitted infections that can be transmitted through oral sex:

HIV– According to the CDC, it’s hard to know the exact risk for HIV transmission through oral sex, but clearly the risk of getting HIV through oral sex is lower than vaginal or anal sex.  Your risk of contracting HIV (or any other STI) is higher if there is a sore, broken skin, or the presence of blood or ejaculate.  Oral sex should be avoided is one partner has bleeding gums, oral ulcers, genital sores, or another STI.

Herpes-  This is one that we should all be concerned about.  Herpes is extremely common, in fact between 65%-85% of adults will test positive for herpes by the time they reach age sixty.  That’s right, your grandma may test positive for herpes! Oral herpes (HSV-1) is what most folks call a “cold sore”.   Genital Herpes (HSV-2) is a sore found on, you guessed it, the genitals.   Here’s the problem- HSV-1 and HSV-2 are not polite enough to stay on their carpet squares and will spread to other areas.

Increasingly, doctors are seeing oral herpes (HSV-1) show up on the genitals and vice versa.

Gonorrhea-  Here’s another big one.   Remember when I said that some STI’s like to live in your throat?  Gonorrhea will camp out there, too, and unless you are tested, it can be spread very easily through oral sex.   It’s a very common STI and it’s on the rise.   The CDC estimates that 820,000 people in the U.S. get new gonorrhea infections each year and that less than half of these folks know they have the disease and receive treatment.  To make things even more interesting, gonorrhea is emerging as a super-bug and multi-drug resistant strains have been found in several different countries including the US.

HPV-  We know that HPV causes cervical cancer and is spread through vaginal sex, but new studies show a link with oral sex and throat cancer.   A recent report from the American Cancer Society shows that HPV is now a more common cause of throat and other oral cancers than tobacco.   Wow!   Check out this awesome infographic from Mount Sinai Hospital illustrating the risks of HPV from oral sex.

Hepatitis A, B, C-   Hepatitis is a chronic liver disease that can lead to cancer and even death.   There are vaccines for Hepatitis A and B, but not for C.   Hepatitis A is highly concentrated in  feces, and can be easily transmitted through oral sex involving anilingus.  Hepatitis B and C are viruses spread through blood and semen, and carry the same risk profile as HIV, so a lower risk compared to vaginal and anal sex, but still nothing to ignore.

Keep your oral pleasure sexy and keep it safe!

 

S. Brockman, RN, MPh.

 

ASK AN OBGYN is not meant to be a substitute for your doctor or health care provider. Contact your provider with any health issues you may have.

ASK AN OBGYN: Can I Get Pregnant If I Douche After Sex?

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Dear SuzyKnew Obgyn, 

Can I get pregnant if I douche right after sex? I mean like only 15 minutes after we finish?

Precious.

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Dear Precious,

Yes. You can still get pregnant if you douche after sex.

Douching with over the counter products such as Summer’s Eve, Massengill or Tiny Kit are not a method of birth control.

I am glad you asked about douching, because it is an often-misunderstood practice, and one that has associated risks.

A review of medical literature from 2004-2008[i] shows that douching is associated with problems with pregnancy, bacterial vaginosis (BV), as well as serious diseases such as cervical cancer and pelvic inflammatory disease (PID).  Douching can also put women at increased risk for sexually transmitted diseases, including HIV.  Douching can cover up symptoms of an infection or serious condition, which can make some ladies wait before seeking treatment.

The American Congress of Obstetrician and Gynecologists (ACOG), the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services Office of Women’s Health (HRSA), all recommended that women do not douche.   For another SuzyKnew piece on the topic see Straight Talk On Feminine Hygiene.

Despite the messages from the medical community, douching is still practiced by an alarming number of women. A survey by U. of Rochester found that nearly one-third of American women aged 15-44 years old douche regularly, and douching is most common in teens, African-American and Hispanic women[ii]

Why do women still douche if we know the harmful effects?  One reason could be advertising campaigns aimed at minority women.   In 2010 and 2011, Summer’s Eve launched a controversial ad campaign chock full of racial and ethnic stereotypes.   One particularly demeaning aspect of the campaign was a print ad in Women’s Day magazine which linked using feminine hygiene products to achievement in the workplace.

As humans, we are highly influenced by cultural health practices and peer pressure.   If our mother and aunties douched, then we likely got the message that we need to douche as well.

My message for you and all SuzyKnew readers:  Your vagina has its own way of naturally keeping clean.  If you experience symptoms like foul odor, itching, pain or irritation with sex or urination, visit your medical provider to rule out an infection or other serious condition.

For more information: www.womenshealth.gov

Keep the questions coming!  Info@suzyknew.com

S. Brockman, RN, MPh.

 

ASK AN OBGYN is not meant to be a substitute for your doctor or health care provider. Contact your provider with any health issues you may have.

 

 

 

[i] Cottrell, B. An Updated Review of Evidence to Discourage Douching.  The American Journal of Maternal/Child Nursing.  March/April 2010. v. 35, n. 2, p. 102-7.

[ii] Science News 1999.  v. 155, n. 1, p. 7.