What is family planning?

World Health Organization’s definition: Family planning allows individuals or couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through the use of contraceptive methods [either natural or artificial] and the treatment of involuntary infertility. A woman’s ability to space and limit her pregnancies has a direct impact on her health and well being, as well as, on the outcome of each pregnancy.

The need for publicly funded family planning:

  • In 2008, there were 1,462,400 women in Texas in need of publicly supported contraceptive services and supplies. Of these, 401,000 were in need of publicly supported services because they were sexually active teenagers, and 1,061,400 because they had incomes below 250% of the federal poverty level. Source: Guttmacher Institute
  • Publicly funded family planning services help women to avoid pregnancies they do not want and to plan pregnancies they do. In 2008, these services helped women in Texas avoid 98,700 unintended pregnancies, which would likely have resulted in about 43,900 unintended births and 41,200 abortions. Source: Guttmacher Institute
  • Even in states where Medicaid enrollment is relatively high, considerable numbers of women remain uninsured. In Texas in 2006, 31.7% of women aged 15-44 were uninsured, but only 8.7% of them were enrolled in Medicaid. Source: Guttmacher Institute

Unintended births to low-income women are the leading cause of welfare dependency in Texas. Low-income women cannot become productive members of society, break the poverty cycle, or properly care for themselves and their families without the means to control their own fertility. They need the opportunity to make responsible choices about childbearing.

What can you expect from a family planning visit?

Other special services may be included:

Although the following services may not be covered, you may have heard about them and wondered what they are:

Anemia screening:

Anemia is a decrease in the normal number of red blood cells or less than the normal amount of hemoglobin in red blood cells. Hemoglobin is found inside of red blood cells and it is what carries oxygen from your lungs to the cells of your body. The oxygen allows your cells to use fuel (sugars and fats) for energy. Because all of your cells need oxygen, the severity of anemia can cause a wide range of problems.

The three main kinds of anemia include:

  • Anemia caused by large amounts of blood loss.
  • Anemia caused by large numbers of red blood cell damage.
  • Anemia caused by decrease red blood cell production.

Because iron is part of hemoglobin’s structure, it is important to eat foods rich in iron like red meat, fish, chicken, lentils, beans, leaf vegetables, tofu, chickpeas, black-eyed peas, fortified bread, and fortified breakfast cereals. Vitamin B12 is important for red blood cell production. It is found in foods that come from animals, including fish and shellfish, meat (especially liver), poultry, eggs, milk, and milk products. Anemia symptoms include a feeling of weakness, tiredness, and sometimes poor concentration and shortness of breath.

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Birth control methods:

Birth control methods are not one-size-fits-all. A method that is perfect for your friend may not be right for you. Picking a birth control method that fits your life is the key, and only you can decide what is best for you. The answers to the questions that follow will help you and your healthcare provider decide which contraceptive method(s) is best for you.

  • Do you want protection from HIV and other sexually transmitted diseases? Male and female condoms are the only birth control methods that can reduce your risk of HIV and other STIs, other than not having vaginal, anal, or oral sex.
  • Are you allergic to latex? Most condoms and diaphragms are made of latex. If you are allergic to latex, you may want to try silicone diaphragms or condoms made of other materials.
  • Are you allergic to spermicide? Some birth control methods (the female and male condom) are used with or contain spermicide. For more information, check out Bedsider’s website.
  • Will your sex partner be OK with using a condom? Some men are allergic to latex, find condoms uncomfortable, or just don’t like using them.
  • Are you OK with stopping sex play for a couple of minutes to put your birth control in place? Some methods – such as condoms, sponge, and spermicide – must be put on just before intercourse.
  • Would you remember to take a pill EVERY day? Birth control pills work best when taken every day.
  • Are you afraid of needles? Depo-Provera requires a shot every 3 months.
  • Do you want to get pregnant in the next year? Getting your tubes tied or a vasectomy are permanent methods of birth control, while the implant and IUD are intended for long-term use. Also, when you stop using the birth control shot, it may take several months before you can get pregnant. Talk with your healthcare provider about birth control methods that may better work for your situation (e.g. a condom or diaphragm).
  • Do you ever want to have a baby in the future? There are many forms of birth control that your healthcare provider can suggest for you. Getting your tubes tied or a vasectomy are permanent methods of birth control, therefore, not a good choice if you plan to have children in the future. Bedsider.org  has a great tool to help you decide which method is best for you.
  • Are you 35 or older and smoke cigarettes? Cigarette smoking by women who are 35 or older can increase the risk of serious side effects when used with the birth control pill, path, or ring.
  • How much can you afford to pay for your birth control? Under provisions of the Affordable Care Act, all health insurance plans must pay for a broad range of birth control methods as part of your guaranteed “Essential Health Benefits.” Selecting the right birth control method for you is an important decision that can impact your life plan significantly. Some of the most effective and long-acting methods can also cost more up front, but are actually the most affordable over a long period of time. Methods such as the Nexplanon implant and Intrauterine Devices such as Mirena, Guardasil, and Skyla, all last between 3 to 10 years and give you peace of mind without needing to refill a prescription frequently. As a patient at a Title X Clinic, you may qualify to receive these methods for free or low-cost depending on your income.
  • What would it be like if you got pregnant today? Exploring your answer to this question will better help you decide which birth control method fits with your reproductive plan.
  • How important is it to keep your birth control method private from your partner? Some methods are easier to keep private than others (explore your options here: http://bedsider.org/features/105).
  • Is it OK if you have to go to a healthcare provider to get your birth control method? Some methods require you to visit a healthcare provider at least once (diaphragm); others require several visits (shot); and some require no visits (condom).
  • Are you OK with putting a birth control method in your vagina yourself? The birth control ring, female condom, sponge, and spermicide need to be inserted by you into your vagina.
  • Are you OK with using hormones for birth control? The birth control pill, patch, ring, shot, implant, Mirena IUD, and emergency contraception contain hormones. These methods are very effective and serious problems are rare.
  • Would you be OK if your birth control method stopped your monthly period for as long as you use it? The Mirena IUD, the shot, the ring, and some birth control pills are likely to stop your periods.
  • Would you be OK if your birth control method makes your monthly period heavier for as long as you use it? The ParaGard IUD is likely to make your period heavier.
  • Would you be OK if you had spotting off and on instead of having your regular period for as long as you use your birth control method? You may have less bleeding, but the timing will be less predictable than having a period. This happens most often with the shot, implant, and some birth control pills.
  • Are you OK with possibly having side effects for the first few months you’re on a method, if you knew they were likely to go away? Some possible temporary side effects are nausea, breast tenderness, bleeding between periods, or increased vaginal discharge.
  • Which of the following is most important to you when choosing a birth control method? Cost, how often you take it, likelihood of side effects, how well it prevents pregnancy, privacy from partner.

For a comprehensive list of birth control methods, click here.

For more information on birth control download the Texas Department of State Health Services Birth Control brochure.

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Breast cancer screening:

Breast self-exam
The goal of breast cancer screenings, such as breast self-exams (BSE) or mammograms, is to help find breast cancer in its earliest, most treatable stage. Women find most breast cancers themselves. A BSE can actually detect some cancers before mammography can. Early detection is more likely if you perform a BSE regularly, because you become more familiar with your normal breast and you are more likely to notice changes, such as a lump, that a health professional can check for you.

The technique for performing a BSE has changed over the years. It was once suggested that women perform the entire exam while standing up, but it’s now known that it is best for women to lie down for part of the exam. Lying down allows the breast tissue to spread out evenly over the chest which makes it easier to feel all of the breast tissue.

Choose a time when your breasts are least tender — usually a few days after your period has ended.

There are three positions for performing a thorough breast self-exam.

1. Lying back with a pillow or folded towel under your right shoulder:
Breast Self-Exam 1
a. Place your right hand behind your head
b. Examine every part of your right breast

  • Use the flat part of the three middle fingers of your left hand to feel for lumps, bumps, or thickenings. Your hands move more easily over the skin if you use some hand lotion.
  • Slide from spot to spot on your breast using a straight up-and-down pattern.
  • Press each spot using a small, circular motion.
  • Use three levels of pressure in each spot — light, for the breast tissue near the surface, medium, for the tissue underneath, and firm, for the tissue that is closest to the ribs.

c. Now switch positions and feel the let breast with your right hand.

2. Standing up in front of a mirror:
Breast Self-Exam 2
a. First place you hands at your sides, then raised over your head, and lastly, your hands pressed firmly on your hips.
b. Look at each breast for changes in size, shape, and form. Look for lumps, a change of position of a nipple, swelling, discoloration, or dimpling of the skin. It is common for the breasts not to match exactly.

3. Raising your right arm slightly to the side:
Breast Self-Exam 3
a. Examine the underarm with your left hand.
b. Feel for lumps, bumps, or thickenings in the same way as you examined your breasts standing up in front of the mirror. Again use hand lotion.
c. Repeat with the other underarm.

You should report any changes you find to your health care provider as soon as possible.
To watch a video from the Susan G. Komen Foundation on how to perform a Breast Self Exam, then scroll down to “Click here to watch” and select the appropriate language delivery for you.

When should I start doing a breast self-exam?
The American Cancer Society recommends to start doing a regular breast self-exam in your 20s so you can get to know what is normal for your breasts. Examine your breasts once a month, the week after your period starts, when your breasts are less lumpy and/or tender due to hormonal changes. If you no longer have a period because you use a contraceptive method that stops your period, you have had your uterus removed, or you are post-menopausal, do your BSE on the first day of every month or whenever you can best remember to do it. For example, if your birthday is May 11, you could pick the 11th day of each month.

Clinical breast exam
A clinical breast exam is the same as a self-exam except that a healthcare provider performs it instead of you. If you are under 40, it is recommended that you have a clinical breast exam every three years. After age 40, it is recommended that you have a clinical breast exam every year.

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Cervical cancer screening:

What is a Pap and HPV test?
A Pap test looks for pre-cancerous cell changes of the cervix and is usually part of a regular pelvic exam [go to Cancer.org for more information]. During a Pap test, your healthcare provider inserts a metal or plastic speculum, an instrument shaped like a slender duckbill, into your vagina much like a tampon is inserted. The speculum is opened to separate the walls of the vagina so that the cervix (the entrance to your uterus) can be seen. You may feel mild discomfort or pressure during this part of the exam, but you should not feel pain. Breathe slowly and try to keep your vaginal muscles relaxed. The healthcare provider then uses a small brush to gently collect cells from the outer opening of the cervix. The cells are sent to the laboratory for a PAP test to detect any signs of unusual looking cells.

Cervical Cancer Screening

Can I prevent cervical cancer?
You can reduce your risk of cervical cancer by getting regular PAP tests, using condoms correctly and consistently, and talking with your healthcare provider to find out if you should get the HPV vaccine.

When should I get my first Pap test?
It is recommended that your first Pap test be done three years after you become sexually active or by age 21, whichever comes first.

What is an HPV test?
An HPV test looks for the high-risk kinds of HPV that can lead to cervical cancer. The test process is the same as it is for the Pap test – cell samples are taken from the outer opening of the cervix and sent to a laboratory where a computer checks a sample of cervical cells for the HPV virus.

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Diabetes screening:

Diabetes (DM) is a condition in which you have high blood sugar either because your body doesn’t produce enough insulin (a hormone produced by the pancreas) or because your cells don’t respond to insulin. Insulin enables sugar to enter most cells and the cell uses the sugar for energy.

There are three major types of diabetes:

  • Type 1 diabetes: results when your pancreas stops producing insulin.
  • Type 2 diabetes: results when your cells don’t respond to insulin and is often associated with being obese or overweight.
  • Gestational diabetes: occurs in pregnant women, who have never had diabetes before, and have a high blood glucose level during pregnancy.

The classic symptoms of DM are:

  • Frequent peeing
  • Increased drinking
  • Increased hunger

These symptoms develop quickly in type 1 diabetes but much more slowly in type 2.

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Female sterilization

Sterilization is one of many birth control methods available to women and it is meant to be permanent. Sterilization in women is called a tubal ligation or “getting your tubes tied.” It is a surgical procedure to cut and “pinch shut” your oviducts (also called fallopian tubes). This prevents sperm from reaching the egg.

Female Sterilization

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HIV/AIDS testing and counseling

Human immunodeficiency virus (HIV) is a viral infection that causes AIDS, which can lead to death. HIV breaks down the immune system – the body’s defense against disease. HIV can be spread through semen, vaginal fluids, blood, or breast milk of an HIV-infected woman. Without treatment, about 25 out of 100 babies born to women with HIV are also infected. It can be spread by vaginal, anal, or oral sex or by using infected needles to inject drugs. HIV is not spread by simple casual contact such as kissing, sharing drinking glasses, or hugging. In the U.S., more than 980,000 cases of AIDS have been reported. About 40,000 women and men in the U.S. get HIV each year. HIV symptoms may develop shortly after being infected but it usually takes more than 10 years for symptoms to appear. About one out of four people have no symptoms.

Using latex condoms, dental dams, or choosing not to have sex may reduce the risk of infection.

Don’t “shoot” drugs, especially with unclean needles.

Don’t share personal items that may have blood on them, like razors.

There is no cure for HIV/AIDS, but it is manageable with medications.

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Hypertension screening:

Hypertension is high blood pressure. About 90-95% of cases have no medical cause. Untreated hypertension is one of the risk factors for strokes, heart attacks, heart failure, and arterial aneurysm (artery wall is weak and balloons out and eventually breaks), and is a leading cause of long-term kidney failure. Normal blood pressure is 120/80 mmHg. Stage 1 hypertension is 140-159/90-99 mmHg; stage 2 is equal to or greater than160/equal to or greater than 100 mmHg. Mild hypertension often does not have any symptoms. More sever hypertension is associated with headaches, drowsiness, confusion, vision trouble, nausea, and vomiting.

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Pelvic exam:

During a pelvic exam, a healthcare provider examines your pelvic area. It includes your external reproductive organs or vulva and your internal reproductive organs — your cervix, ovaries, fallopian tubes, uterus, and vagina.

Pelvic Exam 1Pelvic Exam 2

Your healthcare provider will ask you to undress and put on a paper or cloth gown. Next, they will ask you to lie down on the exam table, bend your knees, and slide your hips to the end of the table. You will then rest your feet in holders called stirrups, which are positioned at table height at the end of the table. Relax! You can cover your stomach area and thighs with a sheet to feel less exposed.

During your pelvic exam, your provider will look for signs of infection and other conditions. It will most likely include taking a few cells from your cervix for a Pap Test. At the end of your pelvic exam, make sure to find out when you should expect results from any tests you had.

When should I have my first pelvic exam?
Unless you have a medical problem, you should have your first pelvic exam three years after you first have vaginal intercourse or when you turn 21 — whichever comes first. Your healthcare provider will tell you when you should have your next pelvic exam.

Bimanual Vaginal exam
After the Pap test is finished and the speculum is removed, your healthcare provider will gently insert one or two gloved and lubricated fingers into your vagina while pressing on the outside of your pelvic area with the other hand. This allows your health care provider to check your uterus, fallopian tubes, and ovaries for proper size and position, abnormal growths, pain, or other signs that indicate a problem.

Rectal exam
Your healthcare provider will gently insert a gloved and lubricated finger into your rectum to check for tenderness or growths. A rectal exam is not always a routine part of an annual pelvic exam for healthy, young women.

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Pregnancy testing:

Pregnancy tests are usually simple urine tests that show if a woman is pregnant. They test for a hormone called human chorionic gonadotropin (hCG). The fertilized egg releases hCG when it attaches to the lining of the uterus. HCG is only found in a woman’s body if she is pregnant. You can either take a home pregnancy test or go to a healthcare provider for one. Home pregnancy tests are sold in most drugstores and cost about $15. If you take a home test, it’s important to follow all of the instructions in the package. The results will be either positive — meaning pregnant, or negative — meaning not pregnant.

You can take a pregnancy test as soon as your period is late; some pregnancy tests even work a few days before a missed period. Read the label on the pregnancy test box to see when the test is most effective. Be aware that tests become more accurate as you get closer to the date of your expected period. They are most effective once you have already missed your period. Most home pregnancy tests work 99 out of 100 times if used after a missed period.

If the pregnancy test is positive, that means you’re pregnant. If you’ve taken a home pregnancy test, it’s important to visit a healthcare provider to receive prenatal care. A negative result could mean that you are not pregnant or that you used the pregnancy test too early. Wait until a day or two after your missed period and take another pregnancy test to be sure.

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Sexual Transmitted Infection testing and treatment

Viruses, bacteria, or parasites transmitted through vaginal or anal sex can cause sexually transmitted infections. There are many kinds of sexually transmitted infections and they are very common — more than half of us will get one at some time in our lives. They very often do not cause any symptoms.

The good news is you can protect yourself and your partner from STIs. Practice safer sex by using a condom, which allows you to reduce your risk of getting sexually transmitted infections. If you’ve done anything that puts you at risk of infection, getting tested allows you to get any treatments you may need.

Because many infections do not cause symptoms in their early stages, sexually active women should consider being screened for STIs annually; because early diagnosis and treatment are important to prevent complications, it is essential that you see a healthcare provider at the first sign of a sexually transmitted disease. Symptoms vary depending on the type of infection:

  • sores, bumps, ulcers, or blisters on the vulva, anus, or mouth (excluding cold sores or other common mouth sores)
  • soft, flesh-colored warts around the genital area and/or anus
  • pelvic pain, including pain during penetrating sex
  • an unusual vaginal discharge or smell
  • burning or itching around the vagina or anus
  • bleeding from the vagina that is not your regular period
  • swelling, soreness and/or redness in the throat (if you’ve taken part in oral sex)
  • nausea, dark urine, yellowing of the skin and/or whites of the eyes

Chlamydia [kluh-MID-ee-uh]:
It is the most common sexually transmitted bacterial infection in the United States. It is spread by vaginal and anal sex but rarely by oral sex. Chlamydia is NOT passed through casual contact. About three million American women and men become infected with chlamydia every year. It is especially common among women and men under 25. Three out of four women and half of men with chlamydia have NO symptoms. Because chlamydia has few or no symptoms, it can sometimes go untreated for a long time. If chlamydia is not treated, it can become a serious threat to your health. In women, chlamydia can infect the fallopian tubes, ovaries, or uterus and is called pelvic inflammatory disease (PID). Up to one out of five women who do not get treatment will develop PID, which may affect a woman’s ability to get pregnant. In men, if chlamydia is not treated it can result in a condition called epididymitis, which can lead to sterility. Testing and treatment for chlamydia significantly reduces the risk for PID. If you do get symptoms, they may begin in as little as 5-10 days after you get infected. Center for Disease Control and Prevention has an informative fact sheet.

Using latex condoms or dental dams or choosing not to have sex may prevent chlamydia.

Antibiotics cure chlamydia.

Gonorrhea [gon-o-RHEE-a]:
It is a bacterial infection that is passed during sexual contact and is spread by vaginal, anal, or oral sex. It can infect the penis, vagina, cervix, anus, urethra, or throat. Sometimes it is called “the clap” or “the drip”. About 600,000 women and men in the U.S. become infected every year. Four out of five women and one out of ten men with gonorrhea have NO symptoms. Gonorrhea is easily treated, but it can be a serious health risk if not treated. During pregnancy, untreated gonorrhea can cause premature labor and stillbirth and it can be passed from mother to baby during birth. In women, gonorrhea can infect the fallopian tubes, ovaries, or uterus, and is called pelvic inflammatory disease (PID). Up to one out of five women who do not get treatment will develop pelvic inflammatory disease (PID). If PID is not treated, it may affect a woman’s ability to get pregnant. In men, if gonorrhea is not treated, it can result in a condition called epididymitis. If epididymitis is not treated, it can lead to infertility. If you do get symptoms, they may begin in as little as 1-14 days after you get infected. Center for Disease Control and Prevention has an informative fact sheet.

Using latex condoms or dental dams or choosing not to have sex may prevent gonorrhea.

Antibiotics cure gonorrhea.

Hepatitis B:
Hepatitis B is a viral infection of the liver and is spread through semen, vaginal fluids, blood, and urine from vaginal, anal, or oral sex, or by using infected needles to inject drugs. About 46,000 women, men, and children in the U.S. become infected with HBV every year. Most of these infections occur among people ages 20-49. One out of two adults with Hepatitis B have no symptoms. When symptoms do occur, they usually appear between six weeks and six months after infection.

The symptoms of Hepatitis B are different from other sexually transmitted diseases. The ones most likely to happen first include:

  • extreme tiredness
  • tenderness and pain in the lower abdomen
  • loss of appetite
  • nausea, vomiting
  • pain in the joints
  • headache
  • fever
  • hives

Later Hepatitis B symptoms include:

  • more severe abdominal pain
  • dark urine
  • pale-colored bowel movements
  • yellowing of the skin and eyes

Although there is NO cure for Hepatitis B, most cases resolve themselves within 4-8 weeks, and nine out of ten adults recover completely. However, about 1 in 20 people with HBV as adults will be “carriers” and have long-term infection. Long-term infections can lead to sever liver damage – including cirrhosis and liver cancer. About one out of five people with long-term HBV infection die from the infection. There are about one and a quarter million HBV carriers in the U.S.

If you are exposed to the semen, vaginal fluids, blood, or urine of someone with HBV and you have not already received the HBV vaccine, see your health care provider right away. You can reduce your risk of infection by getting treatment within 14 days of being exposed.

Get the hepatitis B vaccine to prevent infection.

Using latex condoms, dental dams, or choosing not to have sex may prevent hepatitis B.

Don’t “shoot” drugs, especially with unclean needles.

Anti-viral drugs can help treat long-term infections, but pregnant women cannot use these medications.

Herpes:
Herpes is a very common infection that is caused by two different but closely related viruses: Herpes Simplex type 1 (HSV-1) and Herpes Simplex type 2 (HSV-2). Touching, kissing, and sexual contact, including vaginal, anal, or oral sex spread herpes. Brief skin-to-skin contract is all that is needed to pass the virus. Once infected, the virus remains in the body for life and can produce symptoms that come and go. Infections in or near the mouth (cold sores) are most often caused by HSV-1; infections in or near the genital area are most often caused by HSV-2. Up to eight out of ten American adults are infected with HSV-1, while one in four are infected with HSV-2. Millions of adults have no symptoms. When there are initial symptoms, they usually appear from 2 – 20 days after infection. It is most contagious when sores are open, moist, or leaking fluid – until the scabs heal and fall off. But it can also spread when there are no symptoms. The initial herpes sores usually heal in 10–14 days, but the virus stays in the body and can flare up and cause sores again.

Stop having vaginal, anal, or oral sex even with a condom during an active outbreak to prevent the spread of HSV-2.

Use condoms between outbreaks, don’t touch the sores, and use herpes treatments.

Wash your hands frequently with soap and water.

There are medications available to help manage infection. Pain relievers such as aspirin, acetaminophen, or ibuprofen may help relieve discomfort and fever.

Genital warts:
Genital warts are a small growth on the skin of the mouth, genital area, and around the anus. Types 6 and 11 Human Papilloma virus (HPV) cause genital warts. They are passed from one person to another by skin-to-skin contact usually during vaginal, anal, or oral sex. Between 500,000 and 1 million people get genital warts every year. Genital warts usually develop six weeks to six months after infection. Although you may find genital warts unpleasant or uncomfortable, they are not dangerous.

Get the HPV vaccine to protect against types 6 and 11 HPV infections.

Stop having vaginal, anal, or oral sex until you have talked to a healthcare provider.

Using latex condoms, dental dams, or choosing not to have sex may reduce the risk of infection. 

Stop smoking!

Genital warts often disappear on their own, but they can be treated with medications or removed by various treatments.

Syphilis [siff-l-lis]:
Syphilis is a sexually transmitted bacterial infection. It can infect the vagina, anus, urethra, or penis, as well as the lips and mouth. It can be a serious health risk if not treated. Syphilis is spread by direct contact with chancres (a primary sore or ulcer) through vaginal, oral, and anal sex. The liquid that oozes from the chancre is very contagious and can even spread from a woman to her fetus during pregnancy. If untreated, the risk of stillbirth or serious birth defects is high. About 36,000 U.S. men and women become infected with syphilis every year. There are several stages of syphilis, and symptoms vary with each stage:

Primary Stage: A painless sore or open, wet ulcer, which is called a chancre, appears and there may just be one chancre or a few. Chancres usually appear about three weeks after infection, but may take up to 90 days. Without treatment, they last 3–6 weeks. Chancres can appear on the genitals, in the vagina, on the cervix, lips, mouth, breasts, or anus. Swollen glands may also occur during the primary phase.

Secondary Stage: Other symptoms often appear 3–6 weeks after the sores appear and may come and go for up to two years. They include body rashes that last 2–6 weeks, often on the palms of the hands and the soles of the feet. There are many other symptoms, including mild fever, fatigue, sore throat, hair loss, weight loss, and swollen glands.

Late Stage: One out of three people who have syphilis that is not treated suffer serious damage to the nervous system, heart, brain, or other organs, and death may result. This can occur 1–20 years after the start of infection.

Stop having vaginal, anal, or oral sex until treatment is finished.

Using latex condoms or dental dams or choosing not to have sex may prevent syphilis.

Antibiotics cure syphilis if taken during the primary stage.

Comparison table of symptoms of common sexually transmitted diseases:

STI Table 1

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Colposcopy and cryotherapy

Colposcopy is a procedure that can help prevent cervical cancer. If you have a Pap test with abnormal results, your healthcare provider can do a colposcopy. Colposcopy can be used to find abnormal cervical cells (though sometimes abnormal cervical cells may heal without treatment) and may develop into cancer. Treatments for abnormal cells are highly effective at preventing cervical cancer. Two common types of treatment are cryotherapy and LEEP.

1. Cryotherapy is the local use of low temperatures in medical treatments. Cryo means cold and is used to treat abnormal cervical cells by applying a very cold chemical to the cervix to freeze the cells. This allows new, normal cells to grow back in the same place. It is a safe procedure and most women do not have any serious side effects after cryotherapy. Most women feel mild cramping during cryotherapy and may feel a cold sensation in their vagina; while a few women have no discomfort at all. Cryotherapy takes about 5 minutes.

2. LEEP stands for Loop Electrosurgical Excision Procedure. It is used to remove abnormal cervical cells by cutting them away using a thin wire loop that carries an electrical current. It is a safe procedure and is usually NOT painful – although some women feel mild discomfort or cramping. A LEEP procedure takes about 10 minutes.

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Infertility services

Some women have a hard time getting pregnant or staying pregnant. Infertility is diagnosed when a woman tries to get pregnant for a year without success. More than 1 out of 10 couples experience infertility, which is not exclusive to women, as men can have fertility problems as well. It is estimated that:

  • 1 out of 3 times, infertility is due to a problem with a man’s infertility
  • 1 out of 3 times, infertility is due to a problem with a woman’s infertility
  • 1 out of 3 times, infertility is due to a problem with both the man and woman’s infertility

There are many reasons why a woman might be infertile:

  • Age is one of the most important factors: At 30-34 about 1 in 7 women fail to get pregnant; at 35-39 about 1 in 5 women fail to get pregnant; at 40-44 about 1 in 4 women fail to get pregnant
  • Hormonal problems may mean that the egg is not released from the ovary
  • Blocked fallopian tubes prevent sperm from reaching the egg
  • Shape of the uterus makes it hard for a fertilized egg to implant
  • Endometriosis
  • Sexually transmitted infection

There are many reasons why a man might be infertile:

  • Too few sperm
  • Abnormal sperm

Diagnosis of infertility may take several months. Testing usually begins with a healthcare provider doing a pelvic exam and blood may be taken to measure hormone levels. A healthcare provider may ask you to try to track your ovulation patterns by taking your temperature (body temperature rises slightly after ovulation), checking your cervical mucus (cervical mucus thickens after ovulation), or using a home ovulation test. A sample of semen may be sent to a lab for examination.

There are many treatments for infertility:

  • Most women begin treatment with medications. These are intended to treat hormone and ovulation problems.
  • Minor surgery is performed if one or both fallopian tubes are blocked.

There are two treatments that help egg and sperm unite:

  • Intrauterine insemination: Semen is collected from a man, healthy sperm are separated, and a healthcare provider puts these healthy sperm directly into the woman’s uterus around the time when the egg is released from the ovary.
  • In vitro fertilization: A woman takes medication to make several eggs mature in the ovary at the same time. A healthcare provider removes these eggs from the ovary. Healthy sperm that has been collected from a man is put together with the eggs in a lab. After some eggs have been fertilized, one or more of them is put into the woman’s uterus. Pregnancy happens if one or more of them implant into the wall of the uterus.

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Mid-life and post-menopausal care

Menopause is the time when a woman has her last period. This happens when her ovaries stop releasing eggs. For some women it happens all at once, but for others it is a gradual process. If you have not had a period for more than one year, are not pregnant, or do not have another illness, you have most likely reached menopause. Typically, a woman reaches menopause in her 50s. The gradual change leading up to menopause is called perimenopause. During perimenopause hormone levels are changing causing your period to change from month to month, and in some months to skip your period entirely. The most common menopause symptoms are hot flashes, night sweats, and sleeping problems; these may last only 3-5 years. About 1 out of 10 women have few, if any, symptoms of menopause.

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Natural family planning

Fertility awareness methods are ways to track ovulation – the release of an egg from the ovary – in order to prevent pregnancy. This method works by keeping sperm out of the vagina during the days near ovulation, when a woman is most likely to become pregnant. In order to know when you are most likely to get pregnant, you have to become familiar with your menstrual cycle. For pregnancy to happen, the woman’s egg and man’s sperm must join. There are days when this can happen; other days when it cannot happen.

A woman’s fertile days depend on the life span of the egg and the sperm. Her eggs live for about one day after it is released from the ovary. Sperm can live inside her body for about five days. A woman has a chance of her egg joining a sperm about seven days of every menstrual cycle:

  • the five days before ovulation
  • the day of ovulation
  • a day or two after ovulation

This contraceptive method relies on knowing when ovulation occurs. Test kits that attempt to predict ovulation are available for home use, unfortunately they are not reliable for preventing pregnancy.

There are several methods you can use to predict when you will ovulate:

  • Temperature Method: you will take your temperature before you get out of bed in the morning every day for several months. Body temperature increases the day after ovulation.
  • Cervical Mucus Method: you will check the changes in your cervical mucus every day of your cycle. Cervical mucus becomes thicker the day after ovulation.
  • Calendar Method: you will chart your cycles on a calendar.
  • Standard Days Method: you will track your cycle for several months to be sure that your cycle is always between 26 and 32 days long. Never longer or shorter. Day 1 of your cycle is the day that your period begins. Then, you will not have unprotected vaginal sex on days 8–19 of each cycle.

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Male sterilization (vasectomy)

Sterilization is one of the few birth control methods available to men and is meant to be permanent. There are several types of methods used:

  • Incision method: Usually, a local anesthetic is injected into the pelvic area. Then, the doctor makes a small cut on each side of the scrotum to reach each vas deferens — the tubes that carry sperm. Each vas deferens is blocked and in most procedures, a small section of each vas deferens is removed. The ends may be tied off or blocked with surgical clips or they may be closed using an instrument with an electrical current.
  • No-incision method: With the no-incision (“no-scalpel”) method, the skin of the scrotum is not cut. One tiny puncture is made to reach both vas deferens. Each vas deferens is then tied off, cauterized, or blocked. The tiny puncture heals quickly, no stitches are needed, and no scarring takes place.

Male Sterilization 1Male Sterilization 2

Recovery is very quick and most men lose little or no time from work, though a few need a day or two to rest. You will have to avoid strenuous work or exercise for about a week. For most men, sexual activity can begin again within one week of the surgery. But remember, after the procedure, it takes about three months to clear all sperm out of your system. Use another form of birth control for vaginal intercourse until a semen analysis shows there are no sperm in your seminal fluid.

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Mammogram

Mammograms are not covered by publicly funded family planning centers.

The goal of breast cancer screenings, such as breast self-exams or mammograms, is to help find breast cancer in its earliest, most treatable stage. A screening mammogram is an x-ray exam of the breast on a woman who has no symptoms. A mammogram uses low-dose X-rays to examine the breast. The U.S. Preventive Services Task Force recommends screening mammograms every 1-2 years for women aged 50 and older and every year for women aged 40 and older. There is no fixed age at which women should stop getting mammograms. Mammograms for older women should be based on the woman’s health and whether or not she has other serious illnesses. Age alone should not be the reason to stop having regular mammograms. As long as a woman is in good health and would be a candidate for treatment if she developed breast cancer, she should continue to have screening mammograms.

When you go for a mammogram, you will be asked to undress from the waist up and a cover-up or wrap will be provided for you. When you have your mammogram, a technician (most are women) will compress or squeeze your breast between 2 plates attached to the mammogram machine — a plastic plate (on top) and an x-ray plate (on the bottom). The technician compresses your breast to keep it from moving and to make it thinner. These measures reduce x-ray exposure and blurring, and make the image sharper. Although the compression can be uncomfortable and even painful for a few women, it only lasts for a few seconds and is needed to produce a good mammogram image. Because deodorant, talcum powder, or lotion may show up on the x-ray as calcium spots, women are told not to use them on the day of their exam. The entire procedure for a mammogram takes about 20 minutes.

Mammogram

Mammograms produce a black and white x-ray picture or digital image of the breast tissue. A doctor, most often a radiologist, will read the x-rays and determine the results. Before you leave, ask how long it will take to get the results and how you will get them – by mail or by telephone.

Source: American Cancer Society, www.cancer.org

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Click here for a list of useful links to resources on women’s health issues.

For teen specific sexual health.

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