Sexually transmitted infections

Catdoor

There seems to be an awful lot of unprotected sex going on. Recurring lapses in judgment. That little voice that says “wear a condom” was silenced by what? Alcohol (the usual suspect). The heat of the moment. Sometimes just embarrassment.

An irksome patient: Uses withdrawal as her form of birth control and comes to my office desperate for STI screening. Both situations could be remedied by using condoms. I tell her, first and foremost: USE A CONDOM (in this voice, too). IT’S IMPORTANT. Then the questions start. Here are the most common ones

Marsupial super reproduction skills

The LA Zoo is full of educational surprises. Did you know that the tammar wallaby can mate and become pregnant again within just a few hours of giving birth?

This little fact begs the questions: after a human female gives birth, when can she mate and become pregnant again?

I usually give my patients the go ahead to resume sexual activity at their 4 week post partum (post delivery) check. It’s probably safe to resume sexual intercourse as early as 2 weeks after the baby is born if: you had a vaginal delivery, and you didn’t have a large tear, with need for sutures, during delivery. For a cesarean delivery, it’s probably best to wait about 4 weeks.

In terms of “mating” aka baby making? Physiologically, a woman may ovulate as soon as 25 days after delivery. If you ovulate, you can get pregnant.

So you need to discuss birth control options with your doctor before you have sex post delivery, unless you want to make like a tammar wallaby. A human embryo won’t pause for 12 months to give a newborn time to develop though. Humans haven’t evolved enough for that.

Coital cephalgia. What is it and do you have it?

Sometimes I love medical jargon.
My phrase for the day: coital cephalgia.
Translation: sexual headache.

Yes, this is an actual diagnosis. It is headaches specifically associated with sexual excitement. Any sort of sexual excitement counts, including masturbation and oral sex.

Two distinct types have been described:

1. Preorgasmic: dull headaches, usually at the back of the head / base of the skull. The severity of the pain increases with sexual excitement. The headache usually lasts about 30 minutes to 1 hour.

2. Orgasmic: sudden “explosive” headaches that occur immediately prior to, or at the moment, of orgasm. Severe throbbing pain follows, usually in the entire head. These headaches can last even longer.

Sexual headaches are rare. Our medical literature show 1% of the population gets them, and men are more commonly affected than women (so I guess this may be more of a gentleman parts blog post).

These kinds of headaches are probably under reported. If I weren’t a doctor and I got headaches with sex, I don’t think I would go see a doctor about it. Also, some doctors (I don’t know any in particular, but it can definitely happen) dismiss problems that sound made up. Yes, saying you get headaches only with sex sounds like an outdated joke on TV.

But they are real! And they can be scary.

The explosive kind of headache should be evaluated further. “Worst headache of my life” can mean a brain bleed or something else very serious. Once your doctor has proved to him/herself, and you, that nothing life threatening is going on, you can start finding a way to prevent and treat these horrible headaches.

The predispositions to these headaches is poorly understood (except having sex, of course). Associations have been made with some medications / substances (birth control pills, cannabis, pseudoephedrine) and some medical problems (sinus problems, glaucoma, low blood sugar, lung problems).

These kinds of headaches often disappear without treatment. If they continue, treatment is usually prescription medication. Some medications can be taken on an as needed basis (for those with low frequency sex, or daily for prophylaxis (for the more randy of you).

Bottom line: If you get these headaches, don’t feel like it’s all in your head (intentional pun. I had to).

 

 

Sources:

Up to Date online. Primary headaches associated with sexual activity.

Redelman, Margaret. “What if the ‘sexual headache’ is not a joke?. BJMP 2010;3(1):304