Sex Education for your kids

Dear Yuliya,
At what age should I first talk to my kids about sex? Masturbation? Should I wait for them to bring it up or should I bring it up with them? I remember when my dad gave me the SEX TALK, he trapped me in a car so I couldn't run away and we did family type errands while having the most awkward conversation ever!

First of all, if you are a parent and you are contemplating having the "sex talk" with your child under similar circumstances - DON'T do it. You'll just give them a horror story to tell their friends when they're older. I know it can be embarrassing to talk about sex, and I know it's particularly tricky with your child, but remember that this is important and not something that you can expect a school to provide anymore. Try to pluck up your courage and talk to your child at home, maybe even in his/her room so that they feel comfortable. But, first things first.

Parents should be prepared to answer all sorts of question from their kids. I know I asked my Mom about babies when I was about 6. She was very honest with me and explained all the mechanics calmly. This is important. Don't get freaked out. Children will be curious from an early age. Give things their proper name - don't use "pee-pee" or "down there." It may lead to a couple of embarrassing outbursts in front of relatives, but it's nothing to be ashamed of. Answer all questions that you can in age-appropriate language. Don't feel the need to elaborate too much. Often a child will be satisfied with a fairly surface explanation. If you can bring yourself to do it, talk about masturbation. Children often manipulate their own genitals at an early age. It's normal! If sex is difficult for you to talk about, consider getting a book for your child to read. Something like Where Did I Come From may be useful. I've also heard good things about It's Perfectly Normal.

If your child is already well on the way to puberty and you haven't had a talk with him/her yet, you may consider pointing them in the direction of Scarlateen - an excellent sex education site. Of course, it's always OK to want to talk to your child yourself. Feel free to arm yourself with any knowledge you may want to impart and sit your child down for a talk. Allow questions. Be open and honest. Don't get embarrassed, you are doing a good thing! Try to cover many important things like pregnancy, STI's, sexual assault, but also talk about good things like masturbation, healthy relationships, consent, sexual identity, etc. Have more than one talk - there's a lot of ground to cover! Also, take an interest in what kind of education the child's school is providing (if any). It may be comprehensive sex ed, it may be abstinence-only sex ed, or there may be nothing. Check on the materials and coursework provided and make sure your teenager gets all the correct information. Try to prepare him/her for making good decisions about sex and sexuality later in life. And try not to freak out too much about your child growing up. It's inevitable!

Missing BC pills

Dear Yuliya
I'm a lady in a committed monogamous relationship with a gentlemen. We have both been tested for everything possible and no longer use condoms. I take Orthotricyclen every night at around the same hour as directed. However, I forgot to take my pill two nights in a row! Durrr! We have not had sex for maybe 4 or 5 days, however, so all I want to know is how long I should wait?
I do not want TEH BABIES!

Dear I do not want TEH BABIES,
Take your next pill as soon as is possible, along with yesterday's pill. Do not take more than 2 pills at a time. Throw away the other one you missed. Then, it depends on which week of your pills you are on. Most people seem to recommend waiting for 7 days, and if you are on the third week of the cycle, to skip the week of placebo pills and just continue on to the next pack. I'd wait until your period, just in case. If you are in your third week when you forget some pills, then go ahead and start the next pack instead of the placebo, but be warned that with a tri-phasic birth control pill you will likely have breakthrough bleeding. I'd recommend waiting until you're a week into your next pack to start penis-in-vagina sex.

This question actually brings me to one of my favorite things to talk about, though - the many fun things you can do that do not involve penis-in-vagina! Intimacy is many many things and there seems to be somewhat of an over-emphasis on PIV. Some people even call PIV the only "real" sex. You and your partner can enjoy each others' sexuality without it, when something like a missed birth control pill throws you off. There is oral sex, anal sex (if you are into that sort of thing), manual stimulation, mutual masturbation, heck even regular masturbation next to each other, sex toys, and whatever else your imagination may come up with! This might be a good time to just explore each other and come up with new erogenous zones. This is a time for play!

PCOS and some remedies

Question: What can you tell me about Polycystic Ovary Syndrome (PCOS) treatments, specifically natural or alternative treatments?

First, a definition. PCOS is an endocrine disorder that affects 5-10% of women - the most common hormonal disorder in women of reproductive age. It is characterized by infrequent and irregular menstruation or no menstruation, an excess of androgen activity, and/or polycystic ovaries. There are various reasons why an ovary will produce an excess of androgen and this leads to some of the symptoms of this disease like irregular menstruation, infertility, central obesity, hirsutism, acne, etc. A polycystic ovary is one in which the egg follicle does not fully mature to be released and instead forms a cyst.

Diagnosing this disorder is a complicated task. There are various tests that may be done - a sonogram, testosterone screening, a biochemical screen and lipid profile, or a glucose tolerance test. It is important to note that not all women with PCOS will have ovaries that are polycystic, nor do all ovarian cysts mean that women have PCOS. Make sure to ask your doctor a lot of questions about the tests done or that will be done. Make sure you trust your doctor, as per my previous post. You may or may not want a second opinion.

Treatments options: Since this disorder is often linked with insulin imbalance, a low-carbohydrate diet and plenty of exercise is thought to be beneficial. It may also be useful to take an insulin lowering medication. When restoration of ovulation is a concern, a doctor may prescribe Metformin. Oral contraceptives or cyclic progestins may help with certain symptoms and with restoring menstruation. There are also ways to restore fertility through surgery once pregnancy becomes desired.

As far as natural and alternative treatments, diet and exercise seems to be your best bet. A diet in which most of your carbohydrates come from fruit, vegetables and whole grains is important. These help to maintain a steady blood sugar and insulin level. There are a few sites that provide support and information for women with PCOS - here is a good one. To help plan low-carb meals, there is a variety of cookbooks available that came with current Atkins and South Beach trends. Ask your doctor to recommend a nutritionist to talk to who has dealt with patients with PCOS before. Good luck!

Choosing a doctor

Doctors are important people. They receive a huge amount of schooling and at times it may seem like they know everything and can make everything better. They are our best hopes against the fear of disease and death. They help us maintain our health and happiness. A good doctor is a joy. Not all doctors are good doctors. It is very important to remember that.

There are certain things that you should expect from your doctor. Courtesy and respect, knowledge and the ability to answer questions are just some of the things you should get on your visits. Sometimes you will go to a new doctor and not get some or all of these things. Please remember that you have the freedom and the right to seek another doctor. It can be difficult with certain insurances or in sparsely populated areas, but there is usually at least some choice. Doctors, while great and noble, are not gods. They can be wrong or they can be disrespectful. If your doctor is so intimidating or annoying that you can't bring yourself to come back for much needed care, then that doctor has failed you. Find someone else. Ask around. I've found that it can be useful to ask at your job, since it is likely that your co-workers will have the same insurance. Or you could ask one of the doctors you go to who you like. Don't get stuck with someone who treats you badly in any way.

A little bit about why I'm doing this

I think sex is an unqualified good. Now that doesn't mean that you have to have it all the time, or ever if that's your choice, but sex and sexuality are not just composed of the physical. Knowing one's desires, knowing how to take care of one's body and one's partner(s), being able to talk honestly about fundamental functions of both mind and body - that will lead us to a brighter future. I know it seems kind of grandiose, but we really must learn and talk about these things.

Communication and knowledge are the building blocks of healthy sexuality. They will lead to fewer diseases, more pleasure, more respect. Yes some people will be hateful and mean. They will look upon anything different as a moral failing. But they are and will continue to be in the minority. I am in the business of providing the means and the ways of communication and knowledge, and I hope I can educate some whose views are different, and all who come with an open mind.

I've always thought that education is one of the most important jobs out there. For sex there should certainly be mystery between partners, but there should not be a veil of secrecy drawn over a basic part of life. There are fewer comprehensive sexuality education classes out there. People need information. It needs to be accurate and free from judgment. I am not a moral authority. I am only someone who wants to teach and talk and work toward a better world. Ask me and I will do all I can.

First question!

Some friends have been kind enough to start me off with a round of questions. I'm picking this one to be the first to answer because it's easy and useful for everyone to know.

Q: What is a natural organic cure for yeast infections? I don't like teh pills!

There are actually a great number of resources for this on the Internet, which is a wonderful thing. But first, a little about yeast infections.

A yeast infection can be caused by various things but is basically the result of vaginal acidity becoming lower than it should be and the yeast that lives there naturally (Candida albicans) taking over. Causes include antibiotics, birth control pills, pregnancy, douching, and diabetes. The symptoms include itching and burning of the vulva, a cottage cheese-like discharge, and swelling. However, other infections share the same symptoms, so I would definitely recommend going to a doctor the first time to get it diagnosed under a microscope.

Once you know that what you have is a yeast infection, there are a few things you can do that don't require pills. Easiest and most common recommendation is yogurt - completely unsweetened and with live cultures - apply to a non-applicator tampon and insert, or apply directly to the vulva. Apparently teatree oil is also a good one to apply to a tampon. Just remember that a dry tampon may be uncomfortable to insert during an itchy time. Another interesting one I came across is garlic. Peel the dry papery cover off a clove, wrap it in cheesecloth and insert, making sure a bit of string is sticking out. Make sure you are wearing clean cotton underwear and clothing that's not too tight - this will cut down irritation.

A note: Men can get yeast infections too. They may not have symptoms or may have similar ones - itching and burning and a discharge. The important thing to note is that couples can pass yeast infections from one to the other, so please note if you are having recurring infections whether your partner may have one too. Men will need to treat yeast infections with a prescription, or a topical application of Monistat cream. Again, go to your doctor first.

If you don't mind having "teh pills," a handy trick is to ask your gynecologist for a prescription of something like Diflucan, the one pill treatment, with a few refills and simply take when necessary.

First order of business

First thing I will do is recommend that every woman age 26 or younger go and get the HPV vaccine, Gardasil. If you have a daughter or a niece or know someone between the ages of 9 and 26, I recommend you talk to them about getting this vaccine. It will protect women against 4 types of the Human Papilloma virus - these types cause 70% of cervical cancer and 90% of genital warts. It works best if one has been vaccinated before first sexual contact. The Merck site recommends that it be done before exposure to the virus, but in practical terms that means what I said - before first sexual contact. The rates of HPV infection are extremely high, particularly among teens, and it's not a disease that necessarily shows symptoms.

Not all insurance companies will cover this vaccine, I'm sure. I know for a fact that some do, so please call yours and find out. The cost of Gardasil is $360 for 3 injections over 6 months, so it may be possible to afford without insurance, but is a serious expenditure. It also seems that some doctors' offices will ask for out-of-pocket payment to be reimbursed after the insurance company pays them. If your insurance company let you know that you are covered, I would recommend that you try to get the vaccine even with this method. The CDC has a good comprehensive site about Gardasil and some low-cost alternatives for children. Merck also seems to have a vaccine patient assistance program.

Now get out there and find out!