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FAQs

General Women's Health

Are silicone-based lubricants absorbed through the vagina? Can they be harmful?

Silicone-based lubricants are an alternative to water-based lubricants. Unlike oil-based lubricants, they are safe to use with latex and polyurethane condoms. They are not recommended for silicone sex toys.

This synthetic product retains its lubricant properties longer than water-based lubricants, thus is preferred by some people. As it is not water-soluble, it can be more difficult to wash off.

Silicone-based lubricants are not absorbed through the skin epithelial layer of the vagina. Other than potential skin sensitivities, it does not carry any known health risks.

At what part of my cycle can I get pregnant most easily?

A woman can get pregnant at any time of the month. Some women have even become pregnant from having sex during their period! The easiest time to get pregnant though is when you ovulate. This happens once a month when your body releases an egg from one of your ovaries. However, not all women ovulate at the same time of the month. Most women ovulate about 2 weeks before their period starts.

The days before, during, and just after ovulation are the easiest time of the month to get pregnant.

Sperm can live in your body for 5-7 days. If you have sex a week before you ovulate, the sperm may still be able to fertilize the egg, resulting in pregnancy.

The egg can survive for 1-2 days after ovulation. If you have sex on the days right after you ovulate, you could become pregnant.

It may be difficult to know exactly when you ovulate and unfortunately there is no perfect test for this. For a young woman whose periods are just getting started or who has irregular periods it is very, very difficult to know when she has ovulated. For this reason it is important to always use some form of birth control if you don't want to get pregnant, regardless of where you are in your cycle.

If you have unprotected sex (no matter at what point in your cycle) but you do not want to get pregnant, talk to your health care provider about emergency contraception, or go to www.not-2-late.com.

Can a tampon go beyond the vagina and get lost in the body? Can a tampon get stuck inside?

No, a tampon cannot get lost inside your body. The opening at the end of your vagina (the cervix) is much too small for a tampon to fit through. The tampon is held in place by the walls of your vagina until you pull on the cord to remove it. If you feel definite resistance when you pull on the withdrawal cord, try to relax. You may want to leave the tampon in a little longer as it may not have absorbed enough menstrual fluid to become soft and pliable. It may be too early to remove it, if it's been in place less than 4 hours.

A tampon cannot get "stuck" inside you. The vagina is a potential space that can expand, and the tampon can get lodged near the back. It will stay there until you find it. Sometimes the string may become twisted behind the tampon, or pushed way back in the vagina, making it difficult to reach. When this happens, it takes some time for the vagina to relax and change position so that the tampon will return to its usual place, or at least a place where it can be reached. Try to "fish around" for the tampon or string with a clean finger. If you're not able to find it, ask your partner to try.

If neither you nor your partner can find the tampon, see your health care provider (as a last resort, you can go to the emergency room). It is important to do this not only for peace of mind, but because the tampon will begin to smell bad and because there may be a small risk of infection (including toxic shock syndrome) if the tampon is left in for too long.

Can a yeast infection make you sterile?

No, a yeast infection will not affect your fertility or make you sterile.

A yeast infection is not considered a sexually transmitted infection. It is caused when certain internal or external factors change the normal environment of the vagina and trigger an overgrowth of microscopic fungi called Candida albicans. These are the most likely fungi to cause yeast infections as well as infections in other moist areas of the body, such as the mouth (thrush), skin folds and fingernail beds.

Factors that increase the risk of yeast infections include:
Certain medications (antibiotics, steroids)


  • Menstruation

  • Pregnancy

  • Diabetes



Damp bathing suits, sweaty workout clothes, toilet seats, tampons, and spermicides do not cause yeast infections.

Some sexually transmitted infections are associated with infertility. Both chlamydia and gonorrhea may lead to pelvic inflammatory disease (PID) and this may damage the fallopian tubes, ovaries and uterus, including the cervix. These infections can cause scarring that may lead to infertility. Up to 40 percent of women who have untreated chlamydia develop PID and 20 percent of women with one episode of PID become infertile. Therefore it is very important that you protect yourself against sexually transmitted infections by using condoms every time you have intercourse.

Can any procedures performed during childbirth, such as an episiotomy or epidural, have long-term effects on your sex life?

An episiotomy can occasionally result in a scar that is tender and therefore makes intercourse uncomfortable or even painful. It is impossible to predict which episiotomies will result in a painful scar. The size or the location do not seem to matter. Most of these can be successfully treated with minor surgery, although there is a risk that the surgery can cause another painful scar.

Can stress influence irregularity of a menstrual cycle?

Yes, stress can definitely affect the timing of menstrual cycles. Some women can miss several months in a row with extreme stresses (like relationship breakup, loss of a loved one, school exams, etc). Physical stress can also cause skipped periods. Physical stress may include exercising for several hours every day, losing or gaining more than 10 lbs in a short period of time, or not getting enough calories to support the nutritional needs of both herself and a potential baby.

Can stress influence irregularity of a menstrual cycle?

Yes, stress can definitely affect the timing of menstrual cycles. Some women can miss several months in a row with extreme stresses (like relationship breakup, loss of a loved one, school exams, etc). Physical stress can also cause skipped periods. Physical stress may include exercising for several hours every day, losing or gaining more than 10 lbs in a short period of time, or not getting enough calories to support the nutritional needs of both herself and a potential baby.

Can you still have your period if you're pregnant?

The short answer is no. Your period is the (usually) monthly sloughing of the lining of the uterus. During the early part of your cycle, the lining grows in response to increasing hormones. After ovulation, the lining matures and prepares itself for implantation of the fertilized egg (blastocyst). When conception does not occur, the drop in hormones causes the shedding of the uterine lining (your menses).

In pregnancy, some women experience some spotting at the time of implantation, approximately 6-7 days after fertilization. So if fertilization happens at mid-cycle, and the implantation is a week later, spotting could happen at the time a woman is expecting her period. The implantation bleeding is usually light and short in duration.

Any other bleeding in pregnancy would not be considered normal. Medical attention should be sought.

How can I ensure that I am still fertile when I am older?

An important point to help preserve one's fertility is to prevent acquiring STIs by using condoms. A woman who contracts chlamydia or gonorrhea can develop an infection in her tubes that will leave them permanently scarred. This could prevent egg and sperm from meeting, or increase her risk of having a tubal pregnancy (when the fertilized egg gets caught in the tubes and does not reach the uterus).

A woman's ability to conceive begins to decrease by age 35, and becomes very low by age 42. Miscarriage rates also increase as maternal age increases.

Previous use of the oral contraceptive pill and/or the contraceptive patch does not affect a woman's future fertility.

After use of Depo Provera, it may take up to 1 year to return to regular cycles, with the monthly release of an egg. However, long-term fertility is unaffected by this progestin contraceptive.

How can I find a gynecologist in my area? None of my friends go to one and my family (and family doctor) lives far away.

You can access the web pages for the College of Physicians and Surgeons relevant to the province where you live. On that webpage you can access a doctor search for any specialty in any city. To see a specialist, you usually need to get a referral from your family physician. Ask your family doctor to refer you to a gynecologist in your area. You can give them a name that you found or they can find someone for you.

How late does a period have to be in order for a pregnancy test to be positive?

The pregnancy tests that are available at the drugstores are very sensitive. By the time a woman has missed her period, if she is pregnant, it will be positive. If she has a delayed period for another reason, it will be negative. If a woman misses two periods in a row, she should consider redoing a pregnancy test and/or seeing a doctor for a more sensitive blood test to rule out pregnancy.

I am 17 years old, and due to a combination of dieting and excessive exercise, I havent had my period for 6 months. Is it dangerous to not have a period for so long? My doctor suggested going on the birth control pill, but Im not sure. Is there anything natural I can do to regain my periods?

When a woman is not taking in enough calories to meet her energy needs, the body seems to recognize that there would not be enough energy to nourish a developing baby and thus stops ovulation. In other words, when there is an imbalance between the calories consumed and the energy needed, this stress acts on the hypothalamus in your brain to temporarily shut off your reproductive hormones. The result is that you do not ovulate (release an egg) which means that you dont have a period.

A woman in this situation usually has low levels of estrogen too. This often happens when a woman eats too little, exercises too much, or is too thin. Sometimes this takes place in athletes who train very hard and is often seen in gymnasts, figure skaters, and dancers. It also happens in women with an eating disorder like anorexia nervosa.

Anorexia nervosa is a disorder where a person has a distorted body image so that they think they need to lose weight, even though they are sometimes already dangerously thin. This is a serious condition with health effects like depression and suicide, electrolyte imbalances, heart rhythm problems and in extreme cases can lead to death! It can be treated with counseling and sometimes medication.

The main long-term effect of low estrogen is loss of bone mass, leading to osteoporosis. In a teen-age woman whose bones are still increasing their strength, this is especially a concern.

The lack of periods is not the problem, but what is causing it. You should see your doctor to look for other causes of not having a period. If it is too much exercise/too little food, the natural way to get back your period would be to either reduce your exercise level or increase the calories you take in to meet the demands on your body. It may help to gain some weight because a woman needs a certain percentage of body fat in order to ovulate and menstruate. You should think hard about your motivation for dieting and exercising so much. Could you have an eating disorder? This is something you should bring up with your doctor.

The birth control pill is one option. It does not correct the underlying problem, but it gives you a regular period, keeps the uterine lining thin, and acts as supplemental estrogen to help your bones. It also gives you reliable birth control (if you need it), among other non-contraceptive benefits.

I had a friend that was diagnosed with Toxic Shock Syndrome. What is it?

Toxic shock syndrome (TSS) is the bodys response to a toxin produced by a bacterium called Staphylococcus aureus. We all have bacteria throughout our bodies, and in fact we need them to have our bodies function properly. Up to 50% of people will carry this particular strain of bacteria at any given time. Most of the time, it does not cause us any harm, and many of us have natural resistance to the toxin it produces. However, if you have a break in your skin (like a cut from shaving, a surgical wound, or an abrasion in your vagina from using a tampon) and your immune system does not respond, an infection can develop from this bacteria. This is very rare, but can be life threatening.

Once the bacteria enter the wound and multiply, they begin to release the toxin. This toxin can cause a high fever, rash, muscle pains, vomiting and diarrhea, and leave you feeling generally unwell (like a severe bout of the flu that does not go away). As time passes, it can cause the blood pressure to drop dangerously, and the kidneys can fail. There are some people who die from this infection.

Although a Staph aureus infection can be caused by several factors, it became more known to the general public because of its association with tampon use. In the 1970s and 1980s, reports describe a number of women who developed Toxic Shock Syndrome (TSS). They all had their period at the time and many were using a particular super-absorbent tampon that is no longer available. When tampons are used for a prolonged time, they can irritate the surface of the vaginal skin, creating microscopic breaks in the skin that allow bacteria to enter your system. The bacteria then produce the toxin that makes you sick. We now know that this infection can be caused from other sites of damage to the skin, and can also happen in men.

The best way to avoid getting this infection is to keep your hands clean. These bacteria live on the skin and can be passed from person to person through contact. Also, use tampons with the lowest absorbency that will handle your menstrual flow and change them often (at least every 4-6 hours). Wash your hands well before inserting a tampon. Consider alternating tampons with sanitary pads to allow the vaginal skin to heal. If you develop symptoms that suggest TSS during your period, even if you are not using tampons, you should see your health care provider right away.

I have a discharge in my underwear all the time. Is that normal?

It is very common for women to have a vaginal discharge, but it can be bothersome or concerning for some women. Under the influence of estrogen, the vagina and cervix secrete mucous which results in a discharge. This is completely normal, and starts when a girl begins to go through puberty. A normal discharge is usually clear, white or pale yellow, but can vary widely between individuals, as well as changing throughout a womans lifetime with her menstrual cycle, with pregnancy, after having a baby, or on different hormonal medications.

When women notice a discharge, they often worry about infection. If the discharge suddenly increases in amount, becomes yellow-green, has a foul odour, or if you are experiencing fever, chills or abdominal pain, you should see your health care provider, who will examine you and take swabs to rule out infections. If you have been sexually active, a sexually transmitted infection such as gonorrhea, chlamydia, or trichomonas is a possibility. Women who have never had sex can still get a yeast infection, or an imbalance of the normal vaginal bacteria (called bacterial vaginosis). If you think it may be a yeast infection, but have never had one before, it is a good idea to see a professional the first time to be diagnosed correctly before trying an over-the-counter treatment.

Even if an infection has been ruled out, vaginal discharge can be embarrassing or annoying for some women. If there is a lot of discharge, this can contribute to odour, itching and irritation in the genital area. Having a bath (not just a shower) every day in plain water can help keep the vulva clean. Other simple measures can include wearing cotton underwear during the day, going without underwear at night, and avoiding thongs and pantyliners.

I have a lot of pain during my periods. Is this normal?

Pain during your period is called dysmenorrhea, and it is extremely common. It is usually associated with cycles that release an egg (ovulatory cycles). When young women first start to get their periods, they may not release an egg every month so their periods may not be as painful.

When your period starts (menstruation), chemicals called prostaglandins are released which cause your uterus to contract. The endometrial lining (the lining of your uterus), which has become thick, is shed from the uterus through the cervix during these contractions. Typically, these contractions are the most painful during the first day or two of your period, and then gradually get better. However, some women have pain throughout their entire period. Painful periods may also be accompanied by other symptoms, such as nausea, vomiting, dizziness, diarrhea, and headaches.

This pain may sometimes be treated with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, that help decrease the amount of prostaglandins your body releases. These drugs work best if you take them before the pain gets very bad. If you have a predictable cycle, you can start taking the medication the day before your period starts. Most of the time, you will only need to take the medication for a day or two to get over the worst of the symptoms. Some women find exercise or a hot shower or bath can also help to ease the pain. If this does not work, and you need more help with pain control, please see your health care provider for more information.

There are other, less common, causes for painful periods. These include endometriosis, problems with the development of the female reproductive tract resulting in a partial or complete blockage of menstrual tissue, and untreated pelvic infections. Again, if you have monthly pain that is not responding to basic treatment such as over-the-counter medications, please see your health care provider for help.

I have not started my period yet. What is that going to be like?

The first period can be a bit different for everyone, but it will always involve some kind of bleeding from your vagina. This bleeding may be a small amount of brown or bloody liquid containing slippery mucus, or it may be more like fresh blood. Sometimes, if the blood sits for a while in the vagina, it will appear clotted (lumpy). This is normal.

During your first period, you may feel cramps in your stomach area or lower back, or you may not have any cramping or pain at all for your first few cycles. Painful periods are usually related to the release of an egg a few weeks earlier (see the previous FAQ), and this might not happen for the first few cycles after you start your period.

You may notice some changes before your period comes. You (or your friends!) may notice that you have been moody or grumpy for the week before your period starts. During this time, your breasts may also feel tender or your stomach area may feel bloated. All of these changes are normal, and are caused by special chemicals in your body called hormones. These symptoms will normally go away once your period starts.

I have uneven breasts. What options are there besides surgery?

Women frequently have a difference in the size of their breasts. At puberty one breast may grow faster than the other. Inequalities often even out after completion of pubertal changes.

Hormonal treatments are not effective in correcting breast asymmetry. Mild to moderate inequalities could be modified by using bras with gel supports, added to the smaller breast side. Corrective surgery can be sought for significant asymmetries, if a woman so desires.

Breast size however can change over the course of a woman's life. Adolescent breasts are mainly formed of glandular tissue. This tissue slowly changes, and by menopause is mostly replaced by fat.

In a typical cycle, breasts retain water, and can feel firmer in the time leading up to menstruation. Breast pain and water retention improves during menses.

Early pregnancy will see growth of the glandular tissue, which will differentiate and begin secreting milk as the pregnancy progresses. Overall, breast size will increase.

Changes in weight are also reflected in fluctuating breast size as breasts are partially formed of fat.

If one breast starts to feel different from the other, changes its contour, or seems to be suddenly larger, a breast examination should be performed to detect any lumps or masses.

I have vaginal discharge. Is it normal?

A certain amount of vaginal discharge is normal. It is a result of the hormones that are produced by your body. Normal vaginal discharge does not have a strong odour and is usually clear, white, or slightly yellow. If you find that the discharge is smelly, has changed color, or is itchy or irritating to your skin, see a healthcare provider.

I think I might have forgotten a tampon inside me a few months ago, but I've used tampons since then. What are the symptoms of toxic shock syndrome?

First of all, if you think you might have a tampon left inside, "a few months" is way too long to wait!

Toxic Shock Syndrome is a very rare but potentially serious condition caused by toxins released from the common (and usually friendly) skin bacteria Staphylococcus aureus. Staph aureus infections can occur in other circumstances, but when a foreign body like a tampon is left in the vagina for days, these bacteria can multiply, especially in the presence of nutrient-rich blood, and release their toxins, causing the syndrome.

The symptoms of toxic shock syndrome include a high fever, a diffuse rash that can include peeling skin when more severe, feeling unwell, nausea, vomiting or diarrhea, fast heart rate, dizziness or fainting from low blood pressure, and confusion. If severe and not treated, this can progress to shock, organ damage or even death.

Again, this syndrome is very rare (about 1 in 100,000 women) but you will notice that all tampon boxes have warnings about it. To reduce your risk, do not leave your tampon in for more than 8 hours, use the minimum absorbency needed for your flow, and always remember to remove the last tampon at the end of your period.

When you have a "lost" tampon, try not to panic. Your vagina is a closed space. The tampon cannot move anywhere else; it is either inside your vagina within reach, or it has already fallen out. Try to get it yourself by reaching into your vagina with clean fingers to see if you can pull it out or feel it. If you can't, but suspect it is still there, you should see a health care professional within a day or two for help.

I'm bleeding in between my periods! Is this OK?

For the first few years after starting their periods, many girls have irregular cycles. This can mean bleeding every 2-3 weeks or 2-3 months. The cause for this is anovulation (not releasing an egg), which is very common while the hormone system that regulates periods reaches full maturity.

If you are using birth control, such as the birth control pill, the patch, the ring, an IUD, or an injectable contraceptive, bleeding between your periods (breakthrough bleeding) is common in the first few months. Usually this problem will resolve on its own after three to six cycles. Long-term pill users may also have breakthrough bleeding if they miss pills or take them at irregular times. Women who smoke cigarettes are also more likely to experience spotting in between periods.

Occasionally, sexually active women may experience spotting as a symptom of a sexually transmitted infection like chlamydia and gonorrhea. Using condoms properly, each and every time, greatly lowers the risk of getting these infections.

If you are pregnant, or think you might be pregnant, it is very important to see your health care provider to find out the cause of the bleeding. Several complications of pregnancy can cause irregular bleeding, including miscarriage or ectopic pregnancy (a serious condition in which the baby develops outside the uterus, usually in a fallopian tube).

If I have not had my period in 3 months, is that bad?

The most common reason for sexually active women to miss 3 periods in a row is pregnancy. It is very important to have a pregnancy test to determine if you are pregnant. If the test is negative, there are several reasons why you have missed periods. It may be caused by a recent substantial weight loss or gain, a particularly large amount of stress in your life, or eating too little and exercising too much.

It can also be due to hormonal conditions like polycystic ovarian syndrome (PCOS). If you have been on the birth control pill for a long time, menstrual periods can get lighter and lighter until they actually stop. This is not a problem (in fact many women enjoy this relief from menstrual bleeding); however, it is still prudent to get a pregnancy test to be sure. If your periods have recently stopped you should see your health care provider to have this checked out.

If you use a tampon will it hurt less the first time you have sex?

Using a tampon is a good way to learn more about your own anatomy and if you are able to insert and remove it easily it makes it more likely that you have adequate room and no partial blockage of the vaginal opening by a remnant of the hymen. The tampon itself does not really stretch the vagina or create more space, but if you have been able to successfully use a tampon, you will probably not have pain with your first sexual intercourse.

If your mother has small boobs will you have small boobs too?

No. There is only a small genetic (inherited) component to breast size. However, there is no absolute connection. It is common within one family to see sisters with very different breast sizes.

In between my periods, I have a lot of itching "down there". Is this a yeast infection? What do I do about it?

It is possible that this is a yeast infection. Typical yeast infection symptoms are thick, white discharge (kind of like cottage cheese), lots of itching, and the skin can look quite red and irritated. If you have consistent itching like this, it is a good idea to see your doctor to be tested for yeast. There are many other things that can make your vagina and external skin itch, and yeast creams may not fix the symptoms or can make them worse. Once the yeast infection is confirmed, it is usually easily treated by an over-the-counter treatment (typically a cream or tablet that is inserted in the vagina).
Women who have confirmed recurrences of yeast infection in the week before menstruation each month can often get relief by taking a single tablet of a prescription medication each month about the time the infections have been recurring.

Is it normal for labia to be two different sizes? One is bigger than the other.

Yes, it is normal for a woman to have labia that are different sizes. Sometimes, one can be quite a bit larger and can even be irritated by rubbing against clothes and underwear. A gynecologist is trained to examine this part of your body and can recommend treatment if needed.

Is it normal to have breasts that are different in size?

Yes it is normal to have breasts that are different in size. It is not something to worry about. In fact, very few women have breasts that are identical in size. The difference between each breast, or even each nipple, can be slight, or more obvious, especially after puberty. Breast size and shape are unique for each woman.

As you get older, your breasts may become more "even" in size. Throughout a woman's lifetime, breast size and shape change in response to changes in hormone levels. While menstruating, breasts become fuller and more tender. When a woman is pregnant or is breastfeeding, her breasts generally become much larger. During menopause, breasts may become more lumpy. Taking hormonal contraceptives or gaining or losing weight also alters the size of the breast. Knowing that your breasts will go through normal changes may make you feel more comfortable.

Since there are many individual differences in breast size and shape, it is important to know what is "normal" for you. Becoming familiar with your breasts will help you to notice any changes in your breast tissue that may be a cause for concern. If you detect anything different from the usual, see your health care provider.

Is it true you can get a disease from a tampon?

About 10 years ago, high-absorbency tampons were developed so that women with heavy flow would not have to change tampons as often. Unfortunately it was discovered that when high-absorbency tampons were left in place too long, a local infection could develop from a bacteria called staphylococcus. This bacteria is not carried on the tampon but is normally present on everyone's skin. The staphylococcus could produce a toxic substance that entered the blood stream and made the tampon user sick - a condition called toxic shock syndrome. The symptoms were high fever, a red rash (like a sunburn), vomiting, diarrhea, muscle aches, and feeling generally unwell. Tampons have been redesigned so that this is very rarely seen as long as the tampon is changed at least every 4-8 hours. If you ever experience these symptoms while using tampons, you should remove your tampon and see a doctor immediately to get checked. Don't be embarrassed to tell the doctor that you have been using tampons. If she or he doesn't know this, they might just think you have the flu.

Is there a "standard size" for a vagina?

The length of the vagina is variable. The depth from the vaginal opening to the tip of the cervix can range anywhere from three to seven inches when a woman is not in a sexually aroused state. The vagina does have the capacity to expand which it does during childbirth and during sexual arousal. When a woman is sexually aroused blood flows to the genital area causing the upper two-thirds of the vagina to lengthen by forcing the cervix and uterus to ascend. Sometimes during vaginal intercourse the penis may come in contact with the cervix. If this is uncomfortable for the woman, changes in position or depth of thrusting may be required.

Is there any new treatment for recurrent yeast infections?

Recurrent vulvovaginal candidiasis (yeast infections) affects 5-8% of pre-menopausal women.

The diagnosis is made with four or more culture proven episodes of infection per year.

Risks include: antibiotic use, oral contraceptive use, diabetes, sexual activity, douching, HIV infection, lupus, use of immunosuppressive drugs (e.g. steroids), and hormone replacement therapy.

A recent study looked at using oral fluconazole 150mg weekly for 6 months versus placebo, after both groups were initially treated with fluconazole every 3 days for 3 doses.

The cure rate was statistically higher in the fluconazole group at the end of treatment, and at the 6 month follow-up.

However the relapse rate was also higher at follow up in the treatment group.

Sobel, JD, Hillier, S, Smoleski, L, et al., 42nd Interscience Conference on Antimicrobial Agents and Chemotherapy, San Diego, CA 2002; Abstract LB-8

A small study found less recurrence over 3 months in women using Depo Provera.

Dennerstein, GJ, Depo-Provera in the treatment of
vulvovaginal candidiasis. J Reprod Med 1986; 31: 801-3

Other treatments include: managing/changing risk factors, yeast-free diet, eating yogurt with active lactobacilli, and the application of gentian violet.

Is there any safe way to enlarge your breasts?

Breasts are formed of fat and fibrous tissue with glands that enlarge during pregnancy to allow for breast feeding the baby. If a girl gains weight, her breasts might get larger. Exercise can enlarge the look of the breasts not by adding fat to breast tissue but by enlarging the muscles (pectoral) beneath the breasts. There are no other effective non-surgical alternatives for breast enlargement. Surgical breast enlargement involves placing a prosthesis- an artificial device containing saltwater or silicone - into the space between the breast tissue and the underlying muscle through a small incision under the nipple or in the armpit.

My biggest wish right now is for my period to be normal, but I don't know what I can do to get it that way! I am sixteen years old and have been having my period for more than a year. I cannot predict my period, despite the fact that I keep a record. My period usually happens once every fourteen days. What is wrong with me? It used to scare me in my first year but now it just annoys me.

It is not uncommon for some girls to have irregular menses for the first year or so after they start their period. However, if this does not improve, a visit to your health-care provider would be a good idea. There are some health conditions that are associated with irregular periods and should be ruled out. Your health-care provider will have some options to regulate your cycle if you wish.

My boyfriend's penis just won't fit in. Is anything wrong?

During sexual intercourse, the penis enters the vaginal opening. This can be occasionally difficult if a woman is not aroused, as the opening is neither relaxed nor well lubricated.

If intercourse has previously been painful, or if a woman is apprehensive, there may be an involuntary spasm of the muscles around the vagina called "vaginismus". Women describe the feeling during intercourse as burning, or tearing. They may feel that they are "too small" or their partner "too big". Often these women have the same sensation during insertion of any other object including fingers and tampons.

Initial steps in overcoming this problem could include:


  • Being comfortable with your partner, and sure of your decision to have intercourse


  • Wait until you are aroused prior to attempting penetration


  • Communicate with your partner. Until this problem is solved, there are other ways of having sex without penetration!


  • If vaginismus may be the problem, try exercises to relax your pelvic muscles called Kegel exercises.


    • Though it may feel difficult or embarrassing, talk to your physician or health care provider. They may be able to reassure you and offer suggestions. There are a number of simple strategies to eliminate the problem of vaginismus, and restore a healthy sexual relationship.

    My wife is 48 and has not had a period in four months and has been off birth control for 6 months. Can she still get pregnant?

    There is still a chance of pregnancy before a woman is menopausal, but it isn't high. Ovulation and menses may be irregular in the few years leading up to menopause. By definition, a woman is menopausal once she has gone 12 months without a period. There are many excellent contraceptive options for women at this stage of life to ensure that accidental pregnancy does not occur. For most non smokers, hormonal methods of contraception such as the pill, patch and ring are still safe and effective. Barrier methods like the condom, diaphragm and intrauterine devices are also excellent choices for this age group. As women enter menopause, hormonal methods can reduce symptoms like unwanted hot flashes, and can regulate and reduce menstrual flow.

    The whole exterior area of my labia has what looks like white "granules" under the surface of the skin. Is this normal?

    The white "granules" you describe are most likely plugged skin ducts. They are very common on the labia and are normal. If you have an itchy or smelly discharge as well, consider seeing your health care provider to rule out a sexually transmitted infection.

    This is the fourth month that Ive developed a yeast infection with my period. Ive treated them with an over-the-counter yeast treatment but they still come back. Is there anything I can do? (I am on the birth control pill).

    Firstly, it is important to establish that they truly are yeast infections. Some women have a different vaginal discharge just before their period, and if this discharge is itchy or irritating, it may be perceived as a yeast infection. You should see your doctor when you have the symptoms to be sure.

    Recurrent yeast infections can be seen if the immune system isnt working properly due to medical conditions like diabetes or when using certain medications like corticosteroids (used to treat asthma and other conditions). Overweight women get more yeast infections, presumably due to the increased moisture from sweat in the groin folds. The infection can also recur (or never really go away) if the yeast species is resistant to the treatment used. Your doctor can look for yeast under the microscope to confirm the diagnosis and can culture the yeast with a vaginal swab if the organism is resistant to treatment.

    Some women do get cyclic yeast infections based on hormonal changes in the vagina. In this case, your options would include:


    • Continue to treat the yeast infection each month


    • Get the yeast infection pill (fluconazole) from your doctor and take it each month in the week before your period to prevent a yeast infection


    • Change your pill, go off the pill, or try another birth control method to change the hormonal environment in your vagina


    • Treating the vagina with boric acid or gentian violet can sometimes help with difficult cases.

    What are the signs and symptoms of pregnancy?

    The usual early signs of pregnancy are a missed period or a period that is not like your normal period; breast tenderness, swelling or tingling; frequent urination; nausea or vomiting; fatigue; changes in appetite (either increased or decreased); and mood changes. Missing a period does not become a reliable sign of pregnancy until it is more than 10 days late (and your periods are normally regular). Some women experience a small amount of bloody discharge just after conception, called "implantation bleeding", and may mistake this for a period.

    Other signs of pregnancy include enlargement of the abdomen as pregnancy progresses, softening of the cervix, and a bluish discolouration of the vaginal mucosa.

    If you were not using a reliable form of birth control or were not using it properly or consistently and your period is more than 10 days late, you should consider performing a pregnancy test. A blood test or a urine test can be performed to diagnose pregnancy. The blood test must be ordered by your doctor, however urine pregnancy testing kits are available in most drugstores.

    What are the symptoms of a yeast infection?

    A yeast infection is a common type of vaginal infection caused mainly by an overgrowth of a fungus called Candida albicans. Candida albicans is often present in the vagina without causing any symptoms

    Yeast cells are normally present in the vagina but can overgrow if the vaginal environment is disturbed. If the normal pH balance of the vagina changes, the yeast cells can multiply resulting in a vaginal yeast infection.

    Certain factors may increase the risk of developing a yeast infection. These include: pregnancy; certain medications (steroids, antibiotics); some medical conditions (diabetes, immune disorders); tight synthetic clothing; sexual activity with a partner who has a yeast infection.

    The most common signs of yeast infection are severe itching, burning, and irritation of the vagina. The inner and outer lips of the vagina may be swollen or inflamed.

    There is usually a thick, odourless, cottage cheese-like discharge.

    Intercourse and urination may be painful due to inflammation of the urethra.

    If you have never had a yeast infection before, don't try to diagnose or treat it yourself. The only way to know for sure is to see your doctor. If you have had a yeast infection before, you might recognize its symptoms: itching, burning, and a thick, white vaginal discharge that resembles cottage cheese.

    Treatment: Yeast infections can usually be treated with over the counter antifungal medications available in the drug store/pharmacy (a prescription is not required). These creams or suppositories are inserted into the vagina. Alternatively, your doctor may prescribe a medication for you that you take by mouth.

    It is important to get a professional diagnosis. Failure to correctly diagnose and treat a vaginal infection could have long term health effects. Vaginal discharge that is not white and does not resemble cottage cheese may indicate that you have something other than a yeast infection. If this is the case, consult your doctor.

    What causes the pain with my period? What can I do about it?

    Cramps with a woman's period are common, and are caused by chemicals called "prostaglandins" that are released as the uterine lining is shed. Prostaglandins cause the muscle of the uterus to tighten, causing little "contractions" which are often perceived by the woman as painful. Many women get mild cramps which are tolerable, and which can be treated by hot baths, hot water bottles or exercise, or by taking an over-the-counter medication such as ibuprofen (Advil or Motrin).


    Ibuprofen is an example of a non-steroidal anti-inflammatory medication ("NSAID"). This type of medication prevents prostaglandins from forming, and thus reduces the cramping. If an over-the-counter NSAID is not strong enough, ask your doctor for a prescription. Some examples of NSAIDS available by prescription only include naproxen, mefenamic acid, celecoxib, and ketorolac. If taking it as you need it is not working, try taking your anti-inflammatory at the first sign of pain, or just before your period even starts, and take it regularly according to directions for the first 2 or 3 days of your period. The medication can work even better if you start to take it before the prostaglandins have had a chance to form, rather than waiting until the pain is severe.

    Hormonal contraceptives like the combined oral contraceptive pill or patch, Depo-Provera injections, or the Mirena intrauterine system are also used to treat painful periods due to various causes. These work by stopping ovulation and/or reducing the amount or frequency of bleeding.

    Severely painful periods are not necessarily normal, and can be treated. A visit to your health care professional may be helpful to help figure out why you are having the pain and what type of treatment would work best for you. A woman should not have to "suffer through" pain that interferes with her life. Some other causes of painful periods include fibroids (benign uterine tumours), endometriosis and adenomyosis (benign conditions where small patches of the uterine lining grow outside of the uterus or into the uterine muscle, respectively). Pain that occurs at other times in the month may also be due to these, or could be from ovarian cysts, or bladder or intestinal conditions, among other things.

    Talk to your doctor if you are concerned, or if the pain is severe.

    What is a menstrual cup?

    Some women use a device called a menstrual cup during their menses. There are two menstrual cups available, the Keeper and the DivaCup . The Keeper is a rubber cup (and so cannot be used by women with latex allergies), while the DivaCup is made from silicone.

    The cup is inserted into the vagina during menses. It holds one ounce (30 ml) of menstrual fluid. Unlike tampons, the menstrual cup is non-absorbent and simply collects the menstrual flow. Depending on the amount of menstrual flow, the cup should be emptied at least 2-3 times per 24 hour day, washed and reinserted. It can be worn up to 12 hours at a time. For removal, pull on the stem until the base of the cup is reached. The contents can then be emptied in the toilet, the cup washed with hot water and soap, rinsed and re-inserted. The cup can also be sterilized by boiling it in water for 2-5 minutes.

    The keeper cup is marketed as "The DivaCup" and is made in Canada. It is available in 2 models: one for women under the age of 30, who have never delivered a child, and model 2 (slightly larger) for women over 30 years old, or who have had a child.

    As the cup is reusable, it provides women with an environmentally friendly alternative to tampons or pads.

    It has been approved for use by Health Canada since 2002. It is available in some health food or environmental stores, or through order.

    What is a pelvic exam? When do I need to go for one?

    For many women, pelvic exams can be pretty stressful. Some women will even delay visits to the doctor for years to avoid them. This might be because of a fear of the unknown or bad news, or maybe just a fear of discomfort and embarrassment. If you are dreading your next pelvic exam, hopefully this answer can help dispel some of the bad vibes.

    A pelvic exam is made up of two parts: taking a look at the cervix (and doing swabs for infection and a Pap smear) and feeling the uterus and ovaries. Because the walls of the vagina normally sits closed (kind of like a tube sock), an instrument called a speculum is used to gently hold the vagina open so the person doing the exam can see the cervix. For some women, this part of the exam is uncomfortable. Taking deep breaths and relaxing your muscles will help. It also helps to let the examiner know how your previous experiences with the exam have gone.

    The cervix is the opening to the uterus. If you are sexually active, a swab may be taken from the cervix to check for infections like chlamydia and gonorrhea. A Pap smear checks for signs of pre-cancerous changes in the cervix. Most cervical cancers are started from a type of virus called human papillomavirus, or HPV, which is the same family of viruses that can cause genital warts.

    Once you are sexually active, a pap smear should be done every year to monitor the cervix for these changes. This is done using a small wooden or plastic spatula (kind of like a Popsicle stick) that is wiped on the surface of the cervix to remove cells. The cells are placed on a slide and examined by specially trained people. This part of the exam should take 2-3 minutes at most and is usually not uncomfortable.

    The speculum is removed at this time. The examiner will then place one hand on your lower abdomen and one or two gloved fingers into your vagina. By putting pressure between their hands, the examiner can feel for the uterus and ovaries. If there are abnormalities in the size or shape of these organs, they can usually be detected this way. This takes about 30 seconds. Thats it!

    This exam should be done every year once you become sexually active. If you have not had sex yet, this exam is usually done around the age of 18. This exam is very important. Not only can it provide early detection of disease, but it also gives you an opportunity to ask questions and get answers about your reproductive organs and sexuality.

    What is the best douche to use?

    A douche is a liquid, which some women use to clean the vagina. In fact, the vagina keeps itself clean, and douching is nor really necessary. So the answer to "what is the best douche to use" is none!

    The vagina contains a variety of bacteria. It may sound strange, but the balance of bacteria in the vagina is an important part of keeping it healthy. If one bacteria or yeast takes over, you can develop an infection like bacterial vaginosis or a yeast infection. Douches can destroy the balance of bacteria in the vagina which may result in an infection. Douches can also irritate the vagina, possibly putting you at higher risk of other sexually transmitted infections.

    If you notice an unpleasant odour or discharge, you should see your health care provider to be checked for an infection, instead of trying to douche and cover it up.

    You should never douche before visiting your doctor, even for your routine check up and especially before your Pap smear. It will make your test results unreliable.

    What is toxic shock syndrome? Do tampons cause it? What are the symptoms? Is it treatable?

    Toxic shock syndrome (TSS) is a rare but serious infection caused by a bacterial toxin. It may be caused by different bacteria but is usually due to streptococci and staphylococci.

    The number of reported TSS cases has decreased a lot in recent years. About half the cases of TSS reported today are associated with tampon use during menstruation, usually in young women. TSS also occurs in children, men, and non-menstruating women.

    Studies have shown that using the super plus tampons and leaving tampons in the vagina for long amounts of time increase the risk of developing TSS.. Tampons made with rayon do not appear to have a higher risk of TSS than cotton tampons of similar absorbency.

    TSS symptoms appear quickly and are often severe. Not all cases are exactly alike, and you may not have all the symptoms. Symptoms include a sudden high fever, vomiting, diarrhea, fainting, aching muscles, dizziness, or a sunburn like rash. Later, the skin on the palms of your hands and soles of your feet may flake or peel. A first episode may be so mild that you don't connect the symptoms with TSS, but the next time, the symptoms may be severe. Once you've had TSS, you're more likely to get it than someone who never has had it.

    TSS is usually treated with antibiotics, and drugs to lower temperature, and large amounts of fluids to keep your blood pressure up. Antibiotics are given to help prevent recurrence. Patients often are hospitalized and severe cases require intensive care. With proper treatment, patients generally recover within three weeks.

    While TSS is rare, it's an important health concern for menstruating women. It is important to know how to prevent it and how to recognize its symptoms. This will help to reduce its dangers and continue to keep its incidence low. Early diagnosis and speedy treatment are crucial to avoiding the most serious effects of TSS.

    What sorts of testing is done at an annual exam (for women)? Is it just to pick up cancer or STIs too?

    Many women go faithfully for their annual exam without knowing exactly why they are important!

    One reason is to review your health history and any medications, in case there have been any changes. This is a good time to review your birth control method, to be sure it is still working well for you. Your doctor may ask about your periods, mood, or any sexual concerns, and review other habits that can influence your health such as smoking, alcohol or drugs. Your doctor may check your blood pressure, or perform a breast exam to check for any lumps. You may be sent for blood tests such as thyroid, sugar or cholesterol tests, depending on your age and situation. Women over 50 are sent for mammograms (breast x-rays) every two years to screen for breast cancer.

    With regard to the pelvic exam, the purpose is to do a Pap test, screen for sexually transmitted infections if needed, and to make sure your reproductive organs are normal and healthy. The Pap test is designed to pick up pre-cancerous changes in the cervix so that they can be treated if necessary, to prevent development of cervical cancer. A speculum is used to hold your vaginal walls apart so your cervix (the entrance to the uterus or womb) can be seen at the top of the vagina. A sample of cells is brushed from your cervix, spread onto a glass slide and sent to a laboratory where specially trained technicians carefully examine the cells under a microscope to see if there are any abnormal or pre-cancerous cells there. The Pap test has been proven effective at preventing cervical cancer, if women get tested every one to two years.

    At the same time, cervical secretions can also be sampled with a Q-tip to look for gonorrhea or chlamydia, two common STIs that often have no symptoms in women. Many health care professionals check for these infections as a routine, but you can ask for them to be done if you would like to be sure. There is no test to screen for herpes or genital warts, but if there are sores or warts seen, these can be sampled to confirm the diagnosis. Other infections like HIV, Hepatitis B and syphilis are diagnosed with a blood test; ask your doctor if you would like to be tested.

    The final part of the pelvic exam is the "bimanual" exam where the position, shape and size of your uterus and ovaries are felt with 2 fingers in your vagina and the other hand on your lower abdomen, to ensure that they are normal.

    Why do ectopic pregnancies occur more frequently following a tubal ligation?

    Women who conceive after tubal ligation have an increased risk of tubal pregnancy because of tubal distortion resulting from the procedure. Ectopic pregnancies are usually secondary to utero-peritoneal fistula after unipolar electrocoagulation, inadequate coagulation or recanalization after bipolar procedures, or recanalization or fistula formation after Pomeroy, tubal ring or clip procedures.

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