period after becoming sexually active...why?

[magentakitty]

So... I'm a 25 y/o female, and was technically a virgin on my wedding night a little over 2 months ago... we had played around and had oral sex, but waited to have penetrative intercourse. I have noticed my periods have gotten much less crampy since i've been sexually active. Before, I'd have at least a day of my cycle i'd be drugging myself on advil and feel like someone was twisting my uterus. The last 2 months it's just some pressure. Similar heaviness of flow though. I wonder why this is. I wonder if it's that I opened up a bit. My gyno told me that I was smaller than average (in fact too small to get a female barrier like a diaphragm which is what I wanted to use for BC- I use fertility awareness + a male barrier since the female one won't work now). I wonder if the sex has opened me up a bit down there so that my periods are easier and I can shed my lining without as much work from my body. Not complaining... We don't abstain during sex, so maybe it's having orgasms that relax me... whatever it is, it's great, but I just wonder why!

[Heather]

So, I first want to deconstruct a couple ideas it seems like you have because they're not sound, and so I can't really answer the questions you're asking based on them, since what they're based on isn't sound.

If the back of your vaginal canal (that'd be the issue with a diaphragm) is, in fact, smaller than the smallest size available of them, that won't have anything to do with your periods or menstrual flow.

(Just FYI -- I'm a bit of a longtime cervical barrier evangelist, so this just happens to me one area of my obscure geekdom -- the smallest diaphragm size is 60mm, so in the event this OB/GYN didn't even try a fitting to know that, didn't need to use a pediatric speculum, and you're also having no issues at all with intercourse, you might want to seek out a second opinion, since the language you're reporting them having used strikes me as iffy in a few ways, especially without a fitting even attempted or any pain or major obstacles to intercourse.

If they had said something like that you have a shallow vaginal shelf -- a "smaller-than-average" vagina isn't actually a thing, since the vaginal canal doesn't have a static size, but variations in topography like that can make it difficult for the device to be stable or be something that isn't a headache for you to get in and out -- that'd be one thing, but the terms used, assuming they were't just saying only what they thought you would understand, rather than explaining what the actual situation is, make me go hmm. I'm saying something since it sounds like you really wanted this method, so if there isn't actually a real reason you can't use one, I figured you'd want to know so you could seek out a second opinion. And in the event there is an issue like a shallow vaginal shelf or problems with vaginal tone that would make a diaphragm not doable for you, know a cervical cap is another cervical barrier method that should work just fine, presuming you have no cervical problems.)

The lining shed during a period is shed from the uterus, not the vagina, the vagina is just the canal it comes through. And variations when it comes to the vagina -- with the exception of something like an imperforate hymen at the front of it, which would not let any flow out at all -- don't have anything to do with cramps or flow. Cramps also often have as much to do with our endocrine systems -- the changes of hormones that happen when we have periods -- as they do with muscle tension, and intercourse doesn't have any bearing on those hormonal shifts.

What's much more likely is either that a) like the majority of people entering into or in their 20s, periods will tend to become less crampy or otherwise painful than they were in the teens.

Intercourse also doesn't actually change the vaginal canal in any permanent way. It may be, however, that if you're only just now exploring any kind of vaginal entry -- alone or with partners -- that you've been learning how to relax those muscles, which includes the muscles in your whole pelvic area. And certainly, had you been holding those muscles more tensely in the past, that could make some difference with cramps. But that's not because of intercourse doing something permanent, were that the case, it'd be about you learning to use those muscles a bit differently because you have been with intercourse. (I know that may sound like only semantics, but it's really not, and it's important we always help people let go of common ideas that aren't based in fact, intercourse changing the vagina or body being a big one.)

Too, in the event that this kind of sexual activity has turned out to be something you've really enjoyed, especially if it's also meant more orgasm for you, orgasm does tend to have a relaxing effect on the uterus and the muscles around it. Again, though, that's not really a have-orgasms-be-forever-more-relaxed thing so much as a having-orgasms-frequently-thus-frequently-being-more-relaxed thing.

Also, if this relationship and marriage are turning out to be a happy place in your life, and are reducing stress, that certainly can make a difference with cramps.

[magentakitty]

Wow, Heather, thank you for your response. You sound like such a wealth of knowledge!! Maybe you can answer some of my questions since you brought up many good points.

First of all, I too was puzzled about the whole structural thing! Before I was married, I rarely ever wore tampons. My husband had fingered me a few times, closer to the wedding, but I didn’t explore much in terms of vaginal entry. I actually played around w/ myself a bit, but until my husband and I started playing around, I never orgasmed. I think I had my first orgasm, maybe around last summer? Also, before we were married, we both had a spiritual/religious conviction that we wanted to be as abstinent as possible (and similarly I had never gone beyond kissing before w/ anyone else). We slipped up and pushed our boundaries because it was hard to wait, but I never fully enjoyed or let myself go since I was going against what I/we believed was right. Also we would only do it every few weeks or so. We now have sex several times a week and we feel very free to explore and enjoy and it involves lots of orgasming. So it could be several things, but I’m not complaining!

In terms of structure I’m very very curious about what you were talking about. Before our wedding, I went to the gyno to get fitted for a diaphragm. They told me that I was too small (tried fitting me for the smallest size and yes they used a pediatric speculum)… they couldn’t fit it in! I think I was relaxing!! She told me (yes I asked cause I thought it’s not normal) that I’m structurally normal, just smaller, but it was likely cause I was a virgin and didn’t use tampons. So I didn’t buy it either! I then went to a midwife for a second opinion, as I am very holistic minded, and they tend to be that way. (Also they gyno tried to steer me toward hormonal BC methods which I am against, more on that later… I thought that they midwife would be more collaborative and supportive of my wanting to use a barrier). She took more time to examine me and fit me. I have a feeling that wasn’t a pediatric speculum, because it hurt. I had also worn tampons for the month or two between the gyno visit and the midwife visit to try to stretch a bit. It took her a lot of time but her and her student did shove it in, but it barely fit, and she worried it might not stay in properly and might not be the best as a contraceptive. I really wish I asked more questions because I am the type to like to know what is happening in my body. But she told me that my cervix is smaller than average (from what I understand this doesn’t change til childbirth), plus I’m tight, so it might not be a good option for me. They told me to start w/ condoms and then after a few months I could come back to try to see if I could use it. I am really confused. I wonder if something IS wrong w/ my cervix, because of this, and because I do fertility awareness, where I chart my temps and cervical fluid and prevent accordingly, and I can’t check my cervix because I can’t feel it! At least I have one, but wouldn’t they have told me if it was structurally abnormal? It’s odd. Any thoughts? Oh and I have had a bit of pain w/ intercourse, but my hubby goes slow, makes sure I’m very turned on and he will usually not enter me until I have orgasmed from manual or oral because for some reason I get much wetter and looser after that. Sometimes certain positions, or if he goes too fast or hard, and esp if I’m not ready it really hurts and I’ll scream, but it’s not a happy scream. Luckily I married someone who is very patient and is willing to go slow enough to make it a good experience. When open enough, and properly lubricated, it feels amazing! And he is a pretty average size. Both the gyno and the midwife said it might hurt, so it’s a happy surprise that I had little pain. I am also very very comfortable w/ my husband and relaxed, so that helps too.

I did lots of research w/ my husband and we decided that the diaphragm would be best. We know that it has a 10% failure rate or something which is higher than hormonal methods or the copper IUD, but we want to have kids in a few years, so in the chance it happened, we’d be a bit unprepared but blessed (plus I have non classical congenital adrenal hyperplasia, very mild version so my cycles are regular… long story but I found out by accident, so I know that we may have fertility struggles in the future). I had amenorrhea for other reasons for a few years because of disordered eating and excess exercise and the doc put me on the pill and I had bad side effects, so I know I can’t do hormones cause I feel bad. And we believe life happens at conception, so copper IUD prevents implantation, not always conception, so that’s not an option for us… We don’t want anything long term or hormonal esp w/ my endocrine issues and because we want a baby in a few years. So it’s diaphragm or condoms. And of course I hate making my husband wear condoms. He’s had some issues w/ delayed ejaculation, so I don’t think it’s helping. He doesn't mind, and doesn't complain, but in my non fertile days, it's happier for him. I hear that diaphragms hinder female sensation less than condoms do male sensation. I am surprised you are a guru for female barriers, as many don’t use them anymore! I’m curious why you advocate for them? What are the pros? Do you know of any cons? I too thought they sounded like the best option to use during my fertile time.

Thanks so much for your lengthy response!!!

[Heather]

My pleasure.

It sounds like the midwife you've been seeing is your better choice with this healthcare: they just seem to have actually done more investigating, and it also sounds like they respected your desire to use barrier methods a bit better.

Since it sounds like two providers have told you there does seem to be some issue or another that currently wouldn't make a diaphragm (and it sounds like the midwife is also saying a cervical cap) work, it sounds like, for now, anyway, those options are just out. Per your additional concerns and questions, I'd suggest following up with those with the midwife. Without being a person who's been able to examine you, they're just not questions I'll be able to answer well for you.

However, CAH is probably part -- if not all -- of the picture here as that can play a part in genital structure issues and variations, particularly with the vaginal opening (which is typically much smaller at birth than most, just like the clitoris is typically larger). Any genital surgeries that may have been performed to correct that when you were very young, if they were, could also be at play here if there were complications or they weren't done properly (though my understanding is that while infant surgery to reduce the size of the clitoris is common for infants diagnosed with CAH, vaginoplasties to increase the vaginal opening are not, and those are most commonly suggested in puberty). I don't know if you have a healthcare provider to address CAH for you, but if not, you may also consider seeking one out to discuss potential vaginal issues with them.

Again, being a virgin or not -- or using tampons -- has no bearing on the size of the vaginal opening or the anatomy of the vagina inside (like I said, that first OB/GYN sounds iffy if they are saying things like that when they should know better, like perhaps they haven't kept up with their continuing education if they're older, were asleep at the wheel in anatomy class, haven't studied things like intersex conditions, etc.).

Just FYI, condoms really don't have to have a big impact (and sometimes very little impact) on the sensation of the wearer so long as a) they're using the thinnest types available (which are just as effective), b) are putting a couple drops of lubricant inside before putting them on, and c) don't have it in their heads that condoms reduce their sensation (it really is often a mind-over-matter thing in a pretty substantial way). Too, you two might want to try the female condom, if you have already done all of those things for a while but he still finds male condoms are an issue for him: they are non-latex, so conduct body heat a bit better, and they're only as tight around the penis as the vaginal canal is, since they're not on the penis itself. I'd also suggest you perhaps see if you can't do an attitude adjustment of your own: I'm sure you're not "making" your husband wear condoms, but rather, that of the methods available for you both that you both feel good about, that's what you two are agreeing to use together. If you think about them as this giant drag and some big sacrifice you're asking him to make, that can rub off on both of you, really.

If you'd like more help than that changing things around with

I'm not going to pipe up about your beliefs around conception, so I'll just sidestep those bits. It's simply that from someone who is at work from a place of science, people's beliefs that stand counter to that...well, I can't get behind them, but I also want to be respectful of your right to have them for yourself. (That said, the copper IUD often will prevent pregnancy before an egg can be fertilized and implant: it's thought that the copper interferes with sperm motility so they won't usually even be getting to that stage of the game.)

Just to make sure you do have all the options open to you you can and may want to, because one pill wasn't a fit for you doesn't mean all pills or hormonal methods will be the same way. It's actually common for people to find they have to try a brand or two, or more than one type, of hormonal method before they find a good fit. So, if you would want to consider something like the pill, patch, ring, implant or injection, I wouldn't assume because one brand of pill was a bad fit for you all brands, or all those options, will be: probably not.

Cervical barriers are one of the oldest forms of contraception, one of the most affordable, least invasive and most easily reversible. Many don't use them anymore because a) they have become much harder to access, b) fewer providers are training in on fitting them, and c) they don't create the kind of profits for companies that other methods do. That lack of popularity also has something to do, no doubt, with the learning curve, but really, it's not about them being crummy methods: they're perfectly excellent ones! They also tend to get a bad rap mostly based on ignorance, thus my stepping up to bat for them when someone comes in with questions.

There are some cons though: they are associated with a higher risk of UTIs, for instance, and because they need to be used with spermicide, that can be an allergy issue for some. They also do have a fairly steep learning curve (though with more people using menstrual cups, that's probably less of an issue, and a new form of diaphragm is coming unto the market that looks a bit easier to insert than the dome types). Plus, they are less effective than many other methods.

P.S. The size of the cervix doesn't change with childbirth, only the size and shape of the opening of the cervix.

[magentakitty]

I really appreciate your knowledgeable, thought out response! I will be back later to answer when I have a few spare moments

[Heather]

Whatever works for you!

[magentakitty]

Ok… a few minutes to write… wow… first of all I can tell you are quite knowledgeable about all of this stuff.

I definitely agree about the midwife. They put me at ease and took a lot of time to talk to me and reassure me. If I go back, I’ll ask. I hope nothing too serious is wrong, but it sounded like it was just small. Hopefully it won’t prevent a vaginal delivery in the future (if we are so blessed to have a child).

In terms of CAH (no one knows about CAH, I’m surprised you have heard about it), there are two types; classical and non classical. Non classical is much more mild. What you describe sounds like classical. In classical they often have genital abnormalities. Non classical often presents a lot like PCOS and results in excess androgen symptoms and sometimes infertility. This is the type I have. I would have never known because my cycles are quite regular (now), but w/ my endocrine issues w/ my periods very sporatic and sometimes absent for several years, I had lots of endocrine assessments and monitoring. My levels were mysterious. I was very thin. I struggled w/ disordered eating and was a runner. As would be expected my estrogen levels were quite low for a while. I had related symptoms. But what was puzzling was my testosterone was also very high. So docs alternated between a PCOS and hypothalamic amenorrhea dx. My structures are pretty normal (no one ever said anything, no surgery). I present as very feminine. Anyhow. This all started at age 15. Disordered eating was only as a teen and was underweight then, but I gained some and my weight stayed at the low end of normal for years. Still had no cycle. Then at age 22-23ish I read about hypothalamic amenorrhea, put on 15 lbs, ditched the scale, and started eating more fat and my cycles returned and were regular for the 1st time in years. I thought I was normal and might just have mild PCOS if anything, but requested a progesterone reading to see if I was ovulating since i read you can have anovulatory cycles and still bleed and wanted to know if I was really cycling. They ordered the wrong test 17-OH progesterone by mistake, not the P that spikes after ovulation. It turns out that is the test that is indicative of CAH and I found an adrenal specialist, since my levels were alarmingly high, and I have it (genetically confirmed by a 22 hydroxylase deficiency). So now my estrogen is normal, my testosterone is high… I know I have NCAH, but my only symptom is excessive hair growth on my face. Also we are worried about genetic issues for our children (as genetically, a parent w/ non classic CAH can have a kid w/ classical CAH, which is BAD, so we have to get DH tested before we even think of TTC)… but my mom has PCOS dx and based on the fact that I have CAH, she likely has it too (had complicated pregnancies and a few month preterm births each time). Perhaps a mild form of CAH could cause a cervical abnormality, but my endo seemed to not be alarmed by my structure (my clit seems maybe slightly larger than average, but they didn’t mention that), but endos don’t do pelvic exams, and midwives don’t understand CAH.

Unfortunately my endo told me that if we want to get pregnant we should treat the CAH because it increases fertility issues and pregnancy issues. Also, I should go to a specialized OBGYN who knows about adrenals (for a pregnancy situation of course), not a midwife as the endo feels that based on my NCAH there might be complications (i guess my natural midwife dream birth is not happening). At least I know so I can treat it and might be able to have a family in the future (as many people w/ this have happy families, and it could save us heartache but it’s still not the best).

Especially given it would be a high risk situation, w/ possible genetic issues for our child, and we haven’t sorted this out yet (hubby hasn't been tested; if he is a carrier we are at risk of having a child w/ classical CAH and need to seek genetic counseling), plus we are not in a great financial situation (just finished grad school, just starting career, no money, we both have loans), it would be a terrible time to get pregnant. We want to be parents so much in a few years, but the thought of it happening soon (unlikely, but people w/ mild CAH can get pregnant naturally and there are just often complications if untreated). That’s why we are preventing pretty strictly. We like FAM plus barrier (we do FAM very carefully, and take no risks and I know my cycles well- I’ve actually been charting long before we were using it for contraception- over a year; so I know my cycles and patterns well). Next time I go for an exam, I will ask again about what is truly going on w/ me structurally and if they will ever be ok. We were actually thinking about using condom+diaphragm during fertile times as we wanted extra protection. We aren’t too worried, but again, there are lots of problems if it failed. I agree about the condoms… it’s no big deal, and it makes days when we don’t wear them extra special. We are very much on the same page in terms of contraception and family planning and our desire to wait 2-3 years and feeling that we very much want kids, but based on many factors the timing now would be awful so we are as careful as possible, but he understands too that I prefer no hormones.

Thanks again! This site seems like it has great info.

[Heather]

Just reading now, but I had mistakenly thought you said you had classical CAH: sorry for my misread!

[Heather]

Okay, now I feel all filled in. That's a lot of personal information to share with a stranger, so I appreciate your trust.

It does sound to me like if you could get a GYN referral to someone who is well-versed in CAH, that would be ideal. Whether or not the vaginal opening/topography issues are due to it -- but I would suspect they probably are, given the timing of things and what certainly sounds like some other impacts you've had with it -- since those are so common with classical CAH, that kind of provider would likely be well-versed in that issue. So, you'd pretty much win either way, especially since if you have pregnancy in mind down the road, you'll want that kind of specialist anyhow.

FAM and a barrier can totally be an excellent combination of methods (on a personal note, when I had male partners in my twenties, that was what I used myself), for sure. And I get being very cautious, but truth be told, when used properly, condoms are highly effective, so becoming pregnant while using them properly isn't at all likely. However, if you do want to be extra-protected during fertile times, what you could do instead is just skip intercourse during those times, saving intercourse -- with condoms, if, again, you want the most protection you can get with this scenario -- for other times.

So, for now, perhaps you'd benefit by just making sure you're using really great condoms -- and with plenty of lube, and that little bit on the inside, to increase his sensation -- and perhaps experimenting with them some. I'd also add that Plan B is a progestin-only medication (no estrogen, and also only a use-per-incident, so what happened with you and the BCPs probably wouldn't here), and in study, it has only been found to work by either suppressing ovulation and thickening cervical mucus. The possibility it may interfere with implantation remains only theoretical. So, if the worst happened here and you were using condoms during a fertile time, and one slipped off or broke, that may be a possible option for you that might still fit within your belief system.

[magentakitty]

You seem knowledgeable so I thought you might have a few tidbits of info I haven’t heard before… Thanks again.

The problem with docs is they want to treat treat treat, and w/ barely any symptoms I have decided to wait to treat till we are TTC although my endo was recommending low dose steroids (given I’m pretty antimedication in most situations). Since I’m not having any awful complications, and condoms are working fine (and we can still do FAM w/out finding my cervix), next time I have an exam, I’ll likely start looking for someone who I could use in the future. I’m slightly nervous about something being slightly odd in my anatomy after having a few kind of weird exams… for years I was told I didn’t need an internal exam since I wasn’t having sex (seems like weird reasoning since there could be issues anyway and things to know about for the future) so these have been some of my first internal exams.

We trust condoms. You read 90 ish% effective, so I trust that. The 1 issue I have w/ FAM, is there are times when it’s iffy within a few days when O occurred if symptoms and temps don't line up right away… If it wasn’t for the uncertainty of our genetics and possible high risk scenario, we’d be slightly open to an unplanned pregnancy, but we are being super careful till we know for sure cause if we are at very high risk for genetic issues we may not want biological kids. genetic testing takes a long time to come back and I actually just got my official dx a few months ago, so we are still figuring all of this out and sorting through what it means.

One question… why do you recommend lube? And what do you recommend? Is it for him or for me? We sometimes use coconut oil for a bit extra moisture, but I read this is a no no for condoms so on our condom days… we don’t use anything (we had a water based one we used our first few times, but it wasn't that great and didn't do much). W/ enough foreplay I usually get wet enough. Do you think lube would increase his sensation, because he sometimes has issues w/ delayed ejaculation.

Oh and thanks for the info about plan B… basically does it just make your body think you have ovulated already, so it can’t release the egg it was about to release if you took it pre O? Just out of curiousity, if someone took it post O, and the egg was implanted, would it just be an increased dose of progesterone, and nothing would change (since P is high post O anyway)… if conception occurred the egg would still implant and pregnancy would occur… If no conception occurred, a normal period would follow? Just trying to picture how it works. Hopefully we won’t be needing to think about taking that… just curious.

[Karyn]

Lube does a couple of things. It helps keep condoms from breaking, because even if you produce quite a lot of natural lubrication, it tends not to hold up to condoms so well, and a drier condom = more friction = increased risk of breakage. It can also help with sensation, like Heather said: putting a drop inside the tip of the condom before it's rolled on can make things a lot more comfortable for the person wearing the condom. There are a ton of different kinds of water-based lube, so if you didn't like the first one you used, it's well worth trying another kind. We have a couple articles on lube - because we are seriously big fans - that you can check out too:
Lube 101: A Slick Little primer
Lubricant (Not Diamonds) Is A Girl's Best Friend

Per Plan B, it has been proven to prevent fertilization from happening, in two ways: by preventing ovulation and by thickening cervical mucus to make it harder for sperm to reach any egg that is present. If a fertilized egg has already implanted, Plan B won't do anything. Does that make sense? (I must admit I'm having a bit of trouble parsing your question because 'conception', medically speaking, is the whole process of fertilization AND implantation, not just fertilization.)