To bleed or not to bleed?? How to control your period using the NuvaRing!

Hi Shawna,

I am going on vacation soon and really don’t want to be on my period. I am using the NuvaRing and my best friend told me that if I kept it in, I would skip my period. Is that true?

-Anonymous

Swim-when-You-Are-on-Your-Period-Step-5

Hi,

Great question! Your friend is right!

Although I have written about the ring before, I have not written about how to use it to skip periods (which is totally safe). For those who have never heard of the NuvaRing or still a bit confused about it, check out my previous blog post by clicking here.

NuvaRing 1

It’s actually pretty simple to skip a period using the ring. Instead of taking the ring out after 3 weeks and going ring free for a week, simply leave the ring in for 4 weeks and immediately replace it with a new ring when the 4 weeks is up. This means there will not be a time in which you aren’t wearing a ring. Don’t worry; your ring is still protecting you against pregnancy during the 4th week, just don’t forget to remove it and replace it when the 4th week is up. You can do this just once or continually. And remember, it’s totally safe not to have a period, so using your ring in this way is a great option for people who hate having their periods.

grace-period-300x199
Let me know if you have any other questions!

In happiness & health,

Shawna

Reviewed by Kohar Der Simonian, MD

Stick It Before You Kick It! The 101 on the Birth Control Patch!

Happy 2014!!

This is the first blog of the year! Yay! It’s also the last Friday of the month! Why is that important? Well, I will now only be posting new blogs on the last Friday of the month! I may sneak additional blogs in from time to time but from here on out, you can expect to see a new post at the end of the month. Don’t worry though; you can still contact me by email anytime you have any questions – askshawna@yahoo.com

The first blog of the year is about the birth control patch. I have gotten several emails lately with questions about the patch and so I’m here to tell you all about it! And as always, feel free to comment or email any additional questions you may have.

What is the birth control patch?

T_BC_the-patchThe birth control patch is a small patch that sticks to your skin to prevent pregnancy. Like other methods of birth control, the patch includes a combination of an estrogen (estradiol) and progestogen (progestin) to prevent pregnancy. If used correctly, the patch is a very effective (meaning it works really well) at preventing pregnancy.

How does the birth control patch work?

The patch works by “telling” the ovaries not to release an egg (called ovulation). If no egg is released, there is nothing for sperm to fertilize (the fertilization of an egg by sperm results in pregnancy). However, if the patch is missed or used incorrectly, the ovaries don’t get the message (and may release an egg) making pregnancy possible if there has been recent unprotected sex (sex without a condom).

How to use the patch:

Patch How ToWear the first patch for 7 days. At the end of the 7 days, take off the first patch and apply a new patch in a different location (see below for acceptable patch locations). At the end of those 7 days, take the second patch off and apply a new one in a different location. After the end of those 7 days, take the patch off and DO NOT apply another one. Instead, leave the patch off for 7 days. That’s, 3 weeks on & 1 week off.

It’s during those 7 days of NOT wearing a patch that most women get their period (however, some women may or may not bleed the entire 7 days). Regardless of whether or not you are still bleeding, start a new patch only when the 7 days are complete. No sooner and no later.

Never go more than 7 days without wearing a patch, if you do, you may get pregnant.

Don’t use lotions or makeup on your skin near where the patch is

Don’t put the patch on the same part of your body for 2 weeks in a row – skin may become irritated. Also, don’t wear the path on your legs or breasts.

Some women experience breast tenderness when they first start using the patch. That generally goes away within a few weeks.

Before applying a new patch, think about the clothes you may wear that week and whether or not the patch may be visible.

Why some people love the birth control patch:

What to do if a patch falls off or I make a mistake?  

Issues and mistakes with the patch happen. Although the patch is designed not to come off the skin, it’s definitely possible. Also, sometimes patch users forget when to take off or put on a new patch (if you forget often, you might want to consider switching birth control methods). Knowing what to do if that happens can help prevent an unplanned pregnancy. Read the following for some general instructions on what to do if a patch mistake happens!

If a Patch edge lifts up:

Press down firmly on the Patch with the palm of your hand for 10 seconds, making sure that the whole Patch adheres to your skin. Run your fingers over the entire surface area to smooth out any “wrinkles” around the edges of the Patch.

  • If your Patch does not stick completely, remove it and apply a replacement Patch (no backup method is needed and your Patch Change Day will stay the same). Ask your healthcare professional for a replacement Patch prescription so you always have an extra Patch available.
  • Do not tape or wrap the Patch to your skin or reapply a Patch that is partially adhered to clothing

If your Patch has been off or partially off:

  • For less than 1 Day, try to reapply it. If the Patch does not adhere completely, apply a new patch immediately. (No backup contraception is needed and your Patch Change Day will stay the same)
  • For more than 1 Day or if you are not sure for how long, you may become pregnant. To reduce this risk, apply a new Patch and start a new 4-week cycle. You will now have a new Patch Change Day and must use non-hormonal backup contraception (such as a condoms) for the first week of your new cycle

How to purchase a REPLACEMENT Patch:

  • You can get a replacement Patch at the pharmacy where you filled your prescription
  • You will need a replacement Patch prescription from your healthcare professional
  • Unfortunately, Family Pact does not pay for the replacement patch. You will need to pay for the replacement Patch when you pick it up at the pharmacy.

From the Ortho Evra website:

http://www.orthoevra.com/how-use-loose-fall.html

In happiness & health,

Shawna

Reviewed by Kohar Der Simonian, MD and Andrea Raider, NP

A Pill a Day Will Keep an Unintended Pregnancy Away!

What is the birth control pill?

The birth control pill (also called “the Pill”) is a birth control method that includes a combination of an estrogen (estradiol) and progestogen (progestin) to prevent pregnancy. If taken correctly, the pill is a very effective (meaning it works really well) at preventing pregnancy. Although there a lot of different types of pills, they all work the same way. They vary by brand or by the amount of hormones in them. If you are interested in the pill, talk to your clinician about which one might be the best option for you. And if you’ve tried the pill before and didn’t like it for a reason other than forgetting to take it, talk to your clinician about the other types of pills available.

PrintThere is a pill that is progestin only – called the mini pill. The mini pill has slightly different instructions than what is listed below. If you are using the mini pill, please discuss proper usage instructions with your clinician or pharmacist.

How does the birth control pill work?

The pill works by “telling” the ovaries not to release an egg (called ovulation). If no egg is released, there is nothing for sperm to fertilize (the fertilization of an egg by sperm results in pregnancy). However, if a pill is forgotten or missed the ovaries don’t get the message (and may release an egg) making pregnancy possible if there has been recent unprotected sex (sex without a condom).

ovulation-period-920270

How to use the birth control pill:

The birth control pill is most effective (works the best) when taken every day around the same time of day – the first week is especially important. A typical pill pack has 28 pills – 21 of those pills contain hormones and the other 7 do not. It’s during those 7 non-hormonal pills that most women get their period (however, some women may or may not bleed the entire 7 days). Regardless of whether or not you are still bleeding, start a new pack only when the 7 days of non-hormonal pills are complete. No sooner and no later.

ocp_instructions

*Every pack looks a bit different. Some are round. Some are square. Some are rectangular. Make sure you talk to your clinician or pharmacist about which pills are the active pills (the pills with hormones) and which are the non-active pills (the non-hormonal pills taken during the week in which you can expect your period). Also, not everyone starts their new pack on a Sunday. Whatever day you choose to start, be sure it’s the same day every month (meaning, if you start a new pack on Tuesday, every new pack thereafter will start on a Tuesday).

What to do if a pill or two are missed:

It’s common to forget a pill from time to time (if you forget often, you might want to consider switching birth control methods). Knowing what to do if that happens can help prevent an unplanned pregnancy. Here are some general instructions on what to do if you forget a pill or two.

Forget

Number of Pills Missed

When Pills Missed

What to do …

 “Should I use condoms?

First 1 pill

Beginning of pack 

  • Take a pill as soon as you remember.
  • Take the next pill at the usual time.

(This means you may take two pills in one day.)

Yes, use condoms for 1 week.

 

1 pills

First week of pack

  • Take a pill as soon as you remember.
  • Take the next pill at the usual time.

(This means you may take two pills in one day.) 

Yes, use condoms for 1 week.

2 pills

2nd and 3rd week of pack

  • Take 2 pills 2 days in a row

For example, if you forget pills on Monday & Tuesday, you would take 2 pills on Wednesday & 2 pills on Thursday.

No

3 or more pills

Any time in pack

  • Do not finish pack. Throw away remaining pills.
  • Start next pack.*

*If you use Family Pact, you can only pick up 3 packs of pills every 3 months. If you throw away a pack and start a new one because of missed pills, you will not have enough pills/packs to last until your next refill. If this is the case, please call New Generation Health Center. We have pills on site that we can give to you.

Yes, use condoms for 1st week of new pack.

I know this was A LOT of information. If you have any questions, you are always welcome to comment, send an email to askshawna@yahoo.com, call or make an appointment at New Gen (415.502.8336).

In happiness & health,

Shawna

Reviewed by Kohar Der Simonian, MD

New Faces at New Gen!!!!

I know it’s been longer than usual since my last post and I am so very sorry BUT I promise I have a good reason. All of us here at New Gen have been really busy training 4 new health educators!!!! Two of the new health educators are the new AmeriCorps members and the other two are San Francisco State University Health Education interns. We are so grateful that these four have joined us. They are proving to be great additions to the New Gen team and like all staff, they are extremely comfortable discussing all things related to sex and relationships so don’t hesitate to ask them questions. So without further adieu, here they are!

AmeriCorps:

AlondraCardenasPhotoHola! My name is Alondra and I am a new Health Educator at New Gen. I have plenty of experience working with teens as a tutor and teacher’s assistant. I am very excited to be working here and helping young men and women make the best reproductive health choices for themselves!
I am originally from Mexico, but grew up in the South Bay. My interests include dancing to a variety of music like cumbia and hip-hop, traveling and going to the beach! I also love to eat delicious, home-cooked Mexican food!

My name is Zoe and I’m a Health Educator at New Gen. I’ve worked at other health centers and clinics doing front desk, Zoeadministration, and translating, but this is the first time I’ve had the opportunity to do education and counseling. I love working with adolescents because they’re still very much in the process of figuring out who they are and becoming comfortable with themselves and in their relationships. It’s a great time to start forming habits and practices that will lead to a healthy and happy life!

I grew up in Pittsburgh, PA, but chose the cornfields of Ohio as the backdrop for my college education. After graduation I spent a brief time in rural Guatemala translating for doctors and physical therapists before making the big move to the Bay Area! So far I’m loving the urban life, spending my free time exploring the city and the natural beauty that surrounds it, enjoying free concerts, finding new spots to eat lunch, doing yoga, and trying to learn how to cook! I’m so excited to work for a health center that values and protects the patient’s right to all kinds of reproductive and sexual health services.

SFSU Health Education Interns:

AriannaHello, my name is Arianna, I am currently in San Francisco State’s Health Education program and I am interning at New Gen for my final semester. Ever since high school, I’ve always had an interest in adolescent reproductive health. Growing up in a Catholic school from K-8th grade, I was never introduced to topics of sex, relationships, or reproductive health. It wasn’t until I started going to school at a public high school, that I began learning about sexual health.
It started with a 15 year old me learning about birth control from a guest speaker in my English class. This lesson made me feel empowered to take control over my own body and protect myself and encourage others to do the same. I was “that one friend” in the group who convinced and encouraged everyone to get on some type of birth control. And I was always the first one to call when someone was nervous to go to the school based health center alone. While working as a Health Educator at New Gen, I hope I can be a valuable resource to youth and empower them to take care of their reproductive and overall health and well being. One of my goals is to make sure that youth leave here with the knowledge and skills to make their own informative decisions on their health and relationships with others.

Hi everyone! My name is Elaine. I’m interning at New Gen and loving it. I’m a super senior at San Francisco State University Elaine2with a genuine passion in health and wellness. I love spending time in nature, whether that be hiking, hula-hooping, practicing yoga, searching for stones, or just hanging out with loved ones. I’m a vegetarian and very much enjoy cooking. I’m happily involved with a partner of three years and loving life with him in it! We have a pact to travel to a new place every year we are together. As for me, my life is an open book- no questions are off limits!

So next time you’re in the clinic and you see these lovely faces, say hello!!!! And if you’re interested in learning more about either programs click here – AmeriCorps & SFSH Health Education – they are both fantastic ways to get involved in the health care field. But I must admit I am a little biased, I am a graduate of the SFSU Health Education program.

In happiness & health,

Shawna

P.S. I promise I will try not to lag so much between postings. To help me out, send me your questions at askshawna@yahoo.com

Prescription for Success – The Pharmacy Low Down!

Hi Shawna,

I just finished my last pack of pills – how do I get more?

-Anonymous

Good Question!

Prescription and pharmacy questions are some of the most frequently asked questions we get – it’s about time I blog about it.

Before I begin, let me clarify some terms.

Prescriptions: Medications that require a clinician’s approval.

Over the Counter Medications: Medications, like Tylenol or NyQuil, which can be purchased without a clinician’s approval.

Refill: A refill is more of your medicine that you already have a prescription for. Some medicines are only needed once whereas other medicines are needed over a long period of time – like birth control pills.

Pharmacy: Where medications, both prescriptions and over the counter, are dispensed and/or sold. Walgreens, CVS, and Safeway are some of the most common pharmacies used by NGHC patients.

Pharmacyforme_Vertical

Many places give patients a piece of paper (like the one below) that they must take to a pharmacy in order to get their prescription but here at NGHC we send prescriptions electronically (like an email).

Rx Pad

Picking up your prescription:

Go to the pharmacy counter and let the pharmacist know you are picking up a prescription. Give them your picture ID (if you have one) and your Family Pact Card. It’s okay if you don’t have an ID because they can verify your identity by asking you various questions (like birth date or address). But it’s really important to have your Family Pact card because it’s the reason the medications we prescribed you are free. Without this card, the pharmacist may attempt to charge you for your medication (which can be very expensive). 

*Family Pact does not cover all medications but it does cover the medications we prescribe at NGHC (like birth control and STD treatment). It will not cover the cost of other medication (like acne or asthma medication). If you have any questions about this, ask the person prescribing you the medication or the pharmacist.

FPACT Card

If you have any questions about the medication, be sure to ask the pharmacist. Common questions include:

        Should I eat before I take this medication?

        Should I avoid certain food or alcohol when taking this medication?

        How long should I take this medication for?

        Are there any side effects from taking this medication?

It’s really important that you get all your questions answered. Some medications can have some very bad consequences if taken incorrectly.

If you forget to ask the pharmacist or are too embarrassed, you can call NGHC and ask us. We’d be happy to answer any questions about the medication that we prescribed to you.

Before you leave the pharmacy, check the label on the prescription and make sure everything is correct. If not, let the pharmacist know. The medication will also likely come with a sheet of information about the medication. Make sure you read it, especially if you have never taken the medication.

The picture below shows you how to read a medication label. All medications will have this information.

perscription-drug-label

Refills:

If you are taking a medication more than once, like the birth control pills, you will need refills. For almost every patient we prescribe birth control to, we also give refills. Look at the label and see if you have any refills left. If you do, call the pharmacy BEFORE you run out and ask them to refill the prescription. Be sure to pick it up before you run out.

If the label says you have no refills left, call NGHC and ask for a refill. Whoever takes your call will deliver the message to one of the clinicians so they can send in another prescription for you. It may take a few days for that to happen so make sure you let us know before you are completely out of your medication.

Confidentiality:

All your personal information, including your prescriptions, is confidential. The pharmacy is not allowed to tell anyone, including your parents, about your medications. However, if you use the same pharmacy your family does, we suggest informing the pharmacists that you really do need all your medications confidential. Make sure they have your phone number and know how to contact you if you share your phone number with family.

A few pharmacy tips:

If you use any major pharmacy, like Walgreens or CVS, you can pick up your prescription at any location. You can either walk in or call the location you want to pick them up at and tell them that you normally pick them up elsewhere but that you’d like to get them there. All larger pharmacies are connected and can see where your prescription was sent. Just note, it may take a little longer for your prescription to be ready.

Some major pharmacies have apps that make ordering and refilling super easy. Ask your pharmacy if they have an app.

Walgreens

I hope this answers some of your questions about prescriptions and pharmacies. If you still have questions, let me know (I know this stuff can be a little confusing).

In happiness & health,

Shawna

Reviewed by Kohar Der Simonian, MD

Happy Pride Everyone!!!

New Gen joins in on celebrating LGBTQI Pride!

We are not claiming to be experts on this subject. Like all kinds of people, many LGBTQI people have their own way of explaining what their identity means to them or what their experience may be . This blog is just a brief view into what is a huge and active conversation around the world. If you find yourself wanting to learn more, or want to join in on that conversation, we include some sites to check out at the end of this blog.

This past weekend, June 29-30, was Pride Weekend in San Francisco—a weekend when people from across the country and throughout the Bay Area come together to celebrate the LGBTQI community. According to the SFPride website, this event is “the largest LGBT gathering in the nation.” This is something for all San Franciscans to be proud of!

Identifying with one or more of these terms is totally personal. It is 100% OK if you don’t identify with any of these terms or don’t know which of these you consider yourself right now. It’s also totally normal if how you identify changes over a lifetime. While the identities represented by all these letters may be separate, many of the people in these groups have come together to support each other and work for a common cause of acceptance, equal rights and access to services. Even if we don’t personally identify with any of these letters, many of us have loved ones, friends, coworkers, and neighbors who do. As a clinic, we welcome LGBTQI patients and do our best to make every person comfortable!

 So what do all these letters stand for exactly? They represent different kinds of

Sexualities—Based on sexual attraction and romantic love: homosexual, heterosexual, bisexual, queer.

Gender Expression—Based on how a person wants the world to see them: feminine, masculine, transgender*, androgynous*,   or genderqueer*.

*Some transgender people may identify simply as female or male, while others may identify as trans.

*Androgynous: some people desire to look neither masculine nor feminine.

*Genderqueer: some people desire to look sometimes feminine, sometimes masculine, sometimes both or neither, and not stick to one gender at all times.

Biological sexesBased on sexual anatomy: male, female, intersex.

All three of these identities can and do include more than just appearance — identity is never that simple. As you read on, you’ll see there is a lot of grey in between.

Gingerbread

http://itspronouncedmetrosexual.com/2011/11/breaking-through-the-binary-gender-explained-using-continuums/

L: Lesbian. Women who are attracted to other women.

G: Gay. Someone who is attracted to other people of the same sex. A man who is attracted to other men OR a woman who is attracted to other women.

B: Bisexual. A person who is attracted to people of both sexes.

T: Transgender. A person who identifies as a different gender than the biological sex they were assigned at birth based on their sexual organs. The gender with which someone identifies does not necessarily have to do with their sexual orientation (heterosexual, homosexual, bisexual, queer).

Q: Queer. Some people prefer to call themselves “queer” instead of “gay” or “bisexual” because they feel it is less confining (they may feel attracted to people regardless of gender or not want to think about attraction in terms of two genders or sexes).

I: Intersex. A person who is biologically both sexes. This can mean they have the hormones, genes, and/or anatomy of both a male and female.

It can be a huge leap for someone to open up to friends, family, health care providers, employers or coworkers about any one of these identities. That’s what make events like Pride Weekend so awesome!

Happy Pride Everyone! This past weekend and everyday!

Barbara Haupt

For more information check out:

San Francisco LGBT Community Center – Resources for LGBTQI people an queer education.

LyricActivities, tutoring, recreation, health and sex ed. for GLBTQ youth

SFQueer A Calendar for Queer events and activities in the Bay Area

The Trevor Project 24 hr. suicide prevention and crisis hotline

Transgendered San Francisco Support and social group for the Transgender community.

Intersex Society for North America

National Center for Lesbian Rights

Gonorrhea — Hard to Spell, Easy to Catch!

Okay, this may sound very familiar to the blog about chlamydia and that’s because chlamydia and gonorrhea are very similar.

stdin2

Gonorrhea is a very common sexually transmitted infection in the United States and we see it often here at New Generation Health Center.

What is Gonorrhea?

Gonorrhea is a bacterial infection caused by bacteria called Neisseria gonorrhoeae

How Do People Get Gonorrhea?

Gonorrhea is passed from one person to another through female vaginal fluids and male ejaculatory fluids (cum and pre-cum) of people who are infected. Although it is most commonly passed through sexual intercourse (penis in vagina or penis in anus), it can also be transmitted (passed from one person to another) orally (mouth on penis/vagina/anus). Meaning, it’s possible to get gonorrhea in your vagina, penis, anus, or your mouth, depending on how you have sex. Gonorrhea can also be spread from an untreated mother to her baby during childbirth. However, if a pregnant woman is receiving prenatal care she is tested and treated for any STD’s making this type of transmission far less common.

You can’t catch gonorrhea from a towel, doorknob, or toilet seat.

*Anus is the butthole

What are the Symptoms of Gonorrhea?

Unfortunately, most people don’t experience any symptoms and therefore don’t know they have it. The lack of symptoms is why gonorrhea is such a common infection – it is easily passed unknowingly!

But for those who do have symptoms, they usually go as follows:

For women symptoms may include vaginal discharge; pain and/or burning with urination (peeing); vaginal bleeding between periods; and/or pain during sex. Women with gonorrhea are also at risk of developing serious complications from the infection, even if symptoms are not present or are mild. That’s why it’s super important to get tested regularly.

For men symptoms may include white, yellow, or green discharge from the penis and/or pain with urination (peeing). Sometimes men with gonorrhea can get painful or swollen testicles.

For both men and women, anal infections may not cause any symptoms.  But if symptoms are present it may include discharge, itching, soreness, bleeding, or painful bowl movements (pain when pooping).

Infections in the throat may cause a sore throat but usually cause no symptoms.

TransferFromTo-Circles-375x285

How is Gonorrhea Treated?

Fortunately, gonorrhea is curable. Just 2 pills and an injection (shot) of antibiotics and no bodily fluid exchanges for a week (meaning no sex or sex with a condom) and it’s gone like you never had it. But treating it once doesn’t mean you can’t get it again in the future if you are re-exposed. That’s why it’s important that any partners you have also get tested and/or treated and that you use condoms to protect yourself in the future!

What is the Test for Gonorrhea?

Sterile Urine Cup

EASY!  Pee in a cup!!! That’s all we ask you to do here at NGHC anyway. Other clinics may take a swab (use a big Q-Tip) of the vagina, penis, or anus. The sample (pee or swab) is then sent to a lab where it takes about a week to process and get the results.

*If someone is on the receiving end of anal sex (meaning a penis is being put into their butt) a swab will be used to test instead of urine.  

We recommend that sexually active teens and young adults test for gonorrhea at least once a year. More if they have more than one partner or are having unprotected sex (sex without a condom).

Routine testing is important (even if no symptoms are present) because if gonorrhea is left untreated it can lead to a more serious infection that can cause infertility (not being able to get pregnant) in the future.

rectal-cultureHow Do You Prevent Gonorrhea?

Play Safe

Luckily, this is also easy! Use condoms. Condoms prevent the sharing of fluids. No exposure to fluids = no gonorrhea! Also, talk to your partner(s) about their STD status. If they haven’t been tested recently, you may want to wait to have sex.

Get tested! Use Condoms!

Check out San Francisco City Clinic for more information!

In happiness & health,

Shawna

Reviewed by Kohar Der Simonia, MD