Sex, Sleep or Scrabble

by Hammond, Phil

  Can you use cervical mucus to make string curtains?

  During ovulation, cervical mucus can indeed be stretched out to impressive length, something known by the curiously Germanic term, Spinnbarkheit, but I’d need photos to be convinced you can make string curtains out of it. The stretchiness of cervical mucus forms the basis of a natural birth control method pioneered by two Australians, Dr John and Evelyn Billings. When the mucus is at its most slippery, like an egg-white stalactite, it facilitates the passage of sperm through the cervical canal and it’s a sign that you shouldn’t have sex if you want to avoid pregnancy. The Billings Method is perhaps not the most reliable method of birth control (John and Evelyn had nine children, all planned, apparently) but it’s cheap, hormone free, the Pope loves it and it does make a great party trick.

  NOTE: Several other ‘fertility-awareness-based’ methods are available. At the very least, they’re a good biology lesson but they require far more time, diligence and commitment, and better eyesight, than many couples can muster.

  Which is harder? Remembering to take the pill or remembering what to do if you forget to take it?

  I’d never remember to take a pill every day, which is why I’d go for something longer acting (and reversible). Some combined pills require a week off, which would confuse me even more, but you can get packs that have dummy pills in so you take a pill every day, with whatever daily ritual you’ve chosen to associate it with (tooth brushing, eyebrow plucking, cat feeding).

  If you forget a pill, you need an amazing memory to remember what to do. So I’ve written it out in full …

  If you’re on a progesterone only pill, you have to take it at roughly the same time every day, unless you’re on Cerazette, which gives you twelve-hours’ leeway (but is more expensive so you may have to push for it).

  If you’ve missed just one pill by less than three hours (twelve hours for Cerazette):

  • Relax. Take a pill as soon as you remember, and take the next one at the usual time. You’re protected from pregnancy.

  If you’re more than three hours late (or twelve hours on Cerazette):

  • Relax. Take a pill as soon as you remember. If you’ve missed more than one pill, still only take one at a time.

  • Take your next pill at the usual time, even if means taking two pills in one day.

  • You are not protected against pregnancy for two days. Continue to take your pills as usual, but use an extra method of contraception, such as condoms, for those days. Or don’t have sex. If you’ve already had unprotected sex, get emergency contraception.

  If you’re on the combined pill, missing just one pill anywhere in your pack, or starting the new pack one day late, is not a problem.

  If you’ve missed up to two pills, anywhere in the pack (or just one if you’re on Loestrin 20, Mercilon, Sunya or Femodette):

  • Relax. Take the last pill you missed now.

  • Continue taking the rest of the pack as usual.

  • No additional contraception needed.

  • Take your 7 day break as normal.

  • You don’t need emergency contraception.

  If you’ve missed three or more pills (two if taking the pills Loestrin 20, Mercilon, Sunya or Femodette):

  • Relax. Take the last pill you missed now.

  • Continue taking the rest of the pack as usual.

  • Leave any earlier missed pills.

  • Use an extra method of contraception for the next seven days.

  • If you have had unprotected sex in the previous few days, get emergency contraception.

  If seven or more pills are left in the pack after the missed pill(s):

  • finish the pack have the usual seven-day break or take the placebo tablets.

  If less than seven pills are left in the pack after the missed pill(s):

  • finish the pack and begin new one the next day (this means missing out the break or not taking the dummy tablets).

  FOR ANY PILL: If you miss pills in this month’s packet, and have also missed pills in your previous packet, you may need emergency contraception or a pregnancy test.

  If you aren’t sure what to do (very common), continue to take your pill and use additional contraception, such as condoms, and seek advice.

  NOTE: Remembering what to do about missed pills is so hard that many doctors get it wrong. I usually have to look it up. There should always be instructions in your pill packet but we should be teaching this at school. It’s maths, biology, sociology, psychology, time management, future problem solving and communication skills in one riveting lesson. Master this and you can rule the world.

  WARTS AND ALL

  I once worked for a sexual health consultant who would take me out to lunch and talk about Chlamydia very loudly in a crowded room. And good for him. The first step in destigmatisation is to get it on the menu at Starbucks.

  If I had a dose, would I know?

  Probably not. The commonest symptom of a sexually transmitted infection is no symptoms at all. So not only do many people not realise they have one, but if it suddenly makes an appearance in the middle of a relationship it does not prove infidelity. Some infections, like herpes, can take years to surface. If you start getting into a pointless, blame game, your relationship could tailspin.

  What’s a morning drop?

  A milky drop that emerges from the tip of the penis when you get up in the morning. If it’s white or clear but you’re not sexually excited, then it’s not semen. If it’s yellow or green, it’s definitely not semen no matter what time of the day it is, or what sort of erection you have. Put it away and get down to your nearest sexual health clinic. It can be sorted and although some discharges appear to go with time, they just sit tight as you pass it onto others, and they can spread up to your balls, prostate and even joints (a disaster if you’re keen on sport). Professional careers have been ruined for want of a course of antibiotics.

  What’s the difference between an STD and an STI?

  Only the name. Sexually transmitted ‘diseases’ were renamed ‘infections’ to sound less threatening. Some people call them sexually ‘shared’ infections, to promote the idea that very few people pass them on purpose, and usually it’s impossible to say who had it first and for how long. Sex is all about sharing. If you share pleasure, there’s a risk you’ll share infection and it’s essential that you share treatment. And when you have, you can please each other again and again, preferably with a fresh condom each time.

  What’s the difference between a clap clinic and a sexual health centre?

  The clap clinics of twenty years ago were more properly called Genito-urinary Medicine (GUM) Clinics and had a ridiculous pseudonym to match, like ‘the special clinic’ or ‘clinic 19’ or ‘Lydia.’ They were generally buried in the back and beyond and because nobody knew what genito-urinary meant, and nobody could remember the pseudonym. The only patients who got treated were those brave enough to ask for directions to the clap clinic.

  Modern sexual health centres are far easier to find, both by name and location, all prescriptions are free, your notes stay within the clinic and are not passed onto anyone, nor placed on any central computer database. You get testing and treatment for all sexual problems, advice about safe and healthy sex, counselling, contraception and sometimes even coffee. Just about every problem can be helped, if not cured. And there are no umbrellas. So no reason not to get checked out.

  What’s the prettiest sexually transmitted infection?

  A lot of infections and even cancers look much less scary under a microscope. One way of coming to terms with them is to have a peek up close so you can visualise what you’re dealing with. Trichomonas vaginalis is my favourite STI, because it’s quickly diagnosed, easily cured and the infection rate is declining, when just about every other STI is becoming more common. It’s a single-celled creature that wobbles and rotates as it waves its four tiny antennae. Very entertaining down a microscope but it can irrita
te your parts; soreness, discharge and a nasty smell. However, it’s sorted with a single dose of antibiotics (for you and all your partners)

  Is herpes worth the hype?

  No. Genital herpes is just cold sores on your bits. No picnic, but not the end of the world either. Herpes does far more psychological damage than physical, largely because of the media. The misinformation started with the launch of a drug, acyclovir, which curtails and prevents attacks. So far so good, but the company was keen to get its investment back as quickly as possible, and the best way to do that was to inflate the importance of herpes.

  Acyclovir was discovered in 1974 and in the long run-up to its launch in 1982, the drug company Wellcome (now Glaxo SmithKline) put its marketing department into overdrive. The media took the bait, and Time Magazine took it twice, describing herpes as ‘the new sexual leprosy’ (1980) and ‘the new Scarlet Letter’ (1982).

  Absolute bollocks. Herpes is only incurable in the same way chicken pox is incurable. The virus hangs round in the nerve roots and can (but usually doesn’t) reactivate. When it does recur, each attack tends to be milder than the last and is often unnoticeable. We don’t call children with chicken pox ‘lepers’, so why pick on herpes?

  Herpes simplex virus comes in two types: type 1 typically causes cold sores around the mouth; type 2 causes sores in the genital area, but both can cross over. Up to sixty per cent of new genital herpes is type 1, passed on by oral sex. So a lot of people out there are having a lot of oral fun without realising they’re passing anything on. Seventy-five per cent of those with herpes have only mild or non-existent symptoms so you often don’t know you’ve got it or are shedding the virus.

  Very few people pass on an infection deliberately, and blame is destructive. First symptoms can appear months or years after the initial infection, so a sudden crop of blisters does not mean infidelity. Seventy to eighty-five per cent of people, depending on their age, have antibodies to type 1 herpes. We’ve nearly all been infected, but only a few get symptoms.

  Type 1 antibodies give you a lot of protection against the symptoms of type 2 infection, so if one person in a couple has genital herpes, and the other has a blood test showing antibodies to type 1, he or she is very unlikely to be troubled by type 2 infection, even if it occurs. If your partner has type 2 antibodies, even better.

  For the few people who get recurrent, severe herpes, acyclovir works well to suppress attacks. It’s now been around so long, has had a name change (aciclovir), and is cheap as chips. A whole month’s supply costs the NHS just £9, though many doctors are reluctant to give it because they still think of the very expensive wonder-drug launched twenty-seven years ago and they don’t know much about herpes. A lot of women treated for recurrent thrush have herpes.

  If you want good advice and great support, go to the Herpes Viruses Association (HVA). Founded over twenty-five years ago to counter the herpes hype, the HVA has been a beacon of sanity, destigmatising cold sores wherever they occur and counselling, supporting and educating those with herpes and those who treat it. Unfortunately, the Department of Health has just cut its funding, so its survival depends on donations. The HVA is so valuable to patients, partners and health professionals that I became a patron.

  Shortly after acyclovir was launched and herpes hype hit a peak, a study of 375 people with genital herpes found that half had suffered from depression, thirty-five per cent avoided intimate relationships, thirty-five per cent reported decreased sex drive, ten per cent gave up sex completely and fifteen per cent had suicidal thoughts. In the UK, it’s largely been left to the HVA to fight the stigma of herpes, and many of its supporters are in long-term relationships thanks to the support and advice it gives out. They’re only cold sores, and they go away even without treatment. But without the HVA, the guilt would last a lot longer.

  For further information and donations: www.herpes.org.uk/

  Is the UK the genital wart capital of the world?

  It may well be soon, but it so easily could have been different. Back in 2007, a vaccine called Gardasil was launched that protects girls and women who’ve yet to have sex from viruses that cause both cervical cancer and genital warts. Many countries snapped it up, but the UK sat on its hands and waited, and then – in 2008 – decided to go with a vaccine called Cervarix, which protects against cervical cancer only. It was a huge wasted opportunity, and I did my best in Private Eye, the British Medical Journal and Trust Me, I’m (Still) a Doctor to shout about it.

  Genital warts are very common (100,000 new cases a year in England alone) and although they don’t kill you, they can kill your sex life for a while, are fiddly and expensive to treat (£25 million a year), often reoccur and condoms offer only partial protection. Choosing Gardasil, which has the same list price as Cervarix, would quickly save a lot of anguish and money

  In Australia, they take genital warts seriously. Since April 2007, they’ve offered Gardasil to 12-18-year-old girls in a school-based programme, and it’s also widely available to those not in school. By the end of 2008, researchers at the country’s largest sexual health centre in Melbourne found a forty-eight per cent decrease in genital warts in women aged under twenty-eight years, and a seventeen per cent wart reduction in heterosexual men. This has resulted in substantial savings and freeing up of time to treat other sexually transmitted infections. Their biggest worry is that unvaccinated backpackers from places like the UK will spread genital warts in Oz, and it’s even been suggested (hopefully in jest) that travellers should have to prove they’ve had Gardasil to gain entry.

  Mass vaccination and patient choice don’t sit easily together. Some parents, quite reasonably, may want to wait until more safety data is available before vaccinating their daughters, some may want to choose Cervarix because they think it might offer longer term protection against cervical cancer than Gardasil.

  Everyone needs up-to-date, unbiased information to allow them to reach a conclusion. When I was researching Gardasil for my daughter, neither the NHS ‘Choices’ website nor the NHS vaccination website returned a single hit. Having made the choice for you, the government wouldn’t even admit the possibility of an alternative. Those running the vaccine programme at my daughter’s school hadn’t even heard of Gardasil, they weren’t allowed to give it and neither was our GP. Plenty of private clinics were offering it, for £400 and three trips into Bristol.

  When the NHS is a bit shit, doctors phone their friends. I spoke to two sexual health consultants, both of whom advised I would be ‘mad’ not to protect my daughter against genital warts if I could, and one sent me a prescription for Gardasil. At a conference, Dr David Salisbury – head of the UK government’s vaccination programme – dismissed my campaign for girls to be at least offered the choice of Gardasil and referred to me as ‘the comedian and doctor.’ I’d rather be a comedian and doctor than have all those genital warts on my conscience. Follow the link below, Dave. It’s not very funny. www.chestersexualhealth.co.uk/genitalwarts.htm

  Can you remove genital warts with a cheese grater?

  You can, but other treatments are available. It’s amazing the extent to which some people (particularly men) will avoid a trip to the sexual health clinic, using pipe cleaners, sandpaper, cigarette burns, detergent and even Domestos down the hole. The damage done by DIY is far worse than any infection.

  Genital warts can be hard or soft, occur singly or in groups (and sometimes whole communities, like a floret of broccoli). They often cause no symptoms at all, other than difficulty in wiping or altered aim. But they can itch, bleed and make you very wary of showing your genitals or anus to anyone. And if pregnancy wasn’t hard enough, warts often appear for the first time then.

  Sexually transmitted infections like to hang out together so if you’ve got warts (or any other STI), you may well have something else so it’s worth having some more tests. As with herpes, most people have encountered one of the thirty or so human papilloma viruses that can cause genital warts, but only the unlucky ones sh
ow signs of it. Like verrucas, treatment needs to be repeated, either with lotions or freezing. Don’t put your penis in the freezer overnight or use the verruca gels you buy over the counter. The drugs you need are prescription only (Podophyllotoxin or Imiquimod.) And the freeze-thaw-freeze of cryotherapy needs an expert aim.

  Treatment can be uncomfortable and the virus isn’t completely eradicated, so thirty per cent of people have recurrences. On a brighter note, most people develop immunity as they get older, and if you’ve had Gardasil, you’ll have immunity from the start. (BORING FACT: Smoking probably makes your warts last longer and in women increases the risk of cervical cancer … if you needed another reason to stop.)

  Does Chlamydia make a good Christmas present?

  No but it’s as common as socks. As sexual health consultant Peter Greenhouse puts it: ‘If you haven’t got Chlamydia by thirty, you haven’t been trying hard enough.’ As with many infections, you don’t often have any symptoms, which is why Chlamydia can cause damage under the radar. It is the commonest bacterial, sexually transmitted infection and the good news is that treatment is simple and nearly always successful. If isn’t treated, the consequences can sometimes be devastating, especially for women. The bacteria can gradually spread up from the cervix to the fallopian tubes between the ovary and womb, where they destroy the fine ‘hairs’ responsible for wafting eggs down the tubes. The damage can lead to ectopic pregnancy (where the embryo develops in the tubes), infertility and pelvic inflammatory disease.