Vulvodynia

Vulvodynia is chronic pain or discomfort around the opening of your vagina (vulva) for which there's no identifiable cause and which lasts at least three months. The pain, burning or irritation associated with vulvodynia can make you so uncomfortable that sitting for long periods or having sex becomes unthinkable. The condition can last for months to years.

Symptoms

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  Vulva

The main vulvodynia symptom is pain in your genital area, which can be characterized as:

• Burning
• Soreness
• Stinging
• Rawness
• Painful intercourse (dyspareunia)
• Throbbing
• Itching

Your pain might be constant or occasional. It might occur only when the sensitive area is touched (provoked). You might feel the pain in your entire vulvar area (generalized), or the pain might be localized to a certain area, such as the opening of your vagina (vestibule).

Vulvar tissue might look slightly inflamed or swollen. More often, your vulva appears normal.

A similar condition, vestibulodynia, causes pain only when pressure is applied to the area surrounding the entrance to your vagina.

Causes

Doctors don't know what causes vulvodynia, but possible contributing factors include:

• Injury to or irritation of the nerves surrounding your vulvar region
• Past vaginal infections
• Allergies or sensitive skin
• Hormonal changes
• Muscle spasm or weakness in the pelvic floor, which supports the uterus, bladder and bowel

Complications

Because it can be painful and frustrating and can keep you from wanting sex, vulvodynia can cause emotional problems. For example, fear of having sex can cause spasms in the muscles around your vagina (vaginismus). Other complications might include:

• Anxiety
• Depression
• Sleep disturbances
• Sexual dysfunction
• Altered body image
• Relationship problems
• Decreased quality of life

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Cervical Mucus Method for Natural Family Planning

Overview

The cervical mucus method, also called the Billings Ovulation Method, is a type of natural family planning also known as fertility awareness-based methods.

The cervical mucus method is based on careful observation of mucus patterns during the course of your menstrual cycle. Before ovulation, cervical secretions change — creating an environment that helps sperm travel through the cervix, uterus and fallopian tubes to the egg. By recognizing the changing characteristics of your cervical mucus, you can predict when you'll ovulate, which can help you determine when you're most likely to conceive.

If you're hoping to get pregnant, you can use the cervical mucus method to determine the best days to have sex. Similarly, if you're hoping to avoid pregnancy, you can use the cervical mucus method to determine which days to avoid unprotected sex.

Using the cervical mucus method for birth control requires motivation and diligence. If you don't want to conceive, you and your partner must avoid having sex or use a barrier method of contraception during your fertile days each month.

Why it's done

The cervical mucus method can be used as a way to identify fertile times to help you gauge the best days to have or avoid unprotected sex. Tracking your cervical mucus for either fertility or contraception is inexpensive and doesn't have any side effects. Some women choose to use the cervical mucus method for religious reasons.

The cervical mucus method is sometimes combined with another method of natural family planning, such as tracking basal body temperature. This is sometimes referred to as the symptothermal method.

Risks

Using the cervical mucus method to promote fertility doesn't pose any risks.

Likewise, using the cervical mucus method for birth control doesn't pose any direct risks, but it doesn't offer protection from sexually transmitted infections. In addition, the risk of unintended pregnancy with the cervical mucus method is somewhat higher than with other methods of birth control.

It's estimated that as many as 23 out of 100 women practicing the cervical mucus method for birth control will get pregnant in the first year of typical use. But, with correct use, the pregnancy rate may be as low as 3 out of 100 women a year using the cervical mucus method for birth control.

Formal training is usually required to master the cervical mucus method. This method also necessitates ongoing, rigorous daily monitoring. In addition, abstinence — or use of another type of contraception — is typically needed for 10 to 17 days of each cycle.

How you prepare

To use the cervical mucus method, it's important to understand how cervical secretions change during a typical menstrual cycle. Generally, you'll have:

• No noticeable cervical secretions for three to four days after your period ends
• Scanty, cloudy and sticky secretions for the next three to five days
• Abundant, clear and wet secretions for the next three to four days — the period before and during ovulation
• No noticeable cervical secretions for 11 to 14 days until your next period begins

Although the specific length of these phases may vary, contact your health care provider if your cervical secretions don't follow this general pattern. You may have an infection that requires medical attention.

If you want to use the cervical mucus method for birth control, consult your health care provider first if:

• You recently had your first period, gave birth, or stopped taking birth control pills or other hormonal contraceptives
• You're breast-feeding
• You're approaching menopause
• You have a condition that disrupts regular ovulation, such as polycystic ovary syndrome

Your health care provider may discourage use of the cervical mucus method if you have persistent reproductive tract infections.

What you can expect

To use the cervical mucus method:

• Record your cervical secretions for several cycles. Starting the day after your menstrual bleeding stops, observe and record your cervical secretions on a daily chart. To avoid confusing cervical secretions with semen or normal sexual lubrication, avoid sex or use a barrier method of contraception during your first cycle. Also avoid douching, which can wash out cervical secretions and make it difficult to notice changes.
• Check your cervical secretions before and after urinating. Wipe — front to back — with toilet tissue. Record the color (yellow, white, clear or cloudy), consistency (thick, sticky or stretchy) and feel (dry, wet or slippery) of your secretions. Also note sensations of dryness, moistness or wetness in your vulva.
• Plan sex carefully during fertile days. You're most fertile when your cervical secretions are abundant, clear, stretchy, wet and slippery — much like a raw egg white. If you're hoping to get pregnant, this is the time to have sex. Ovulation most likely occurs during or one day after your last day of this type of cervical secretion — known as your peak day.
  If you're hoping to avoid pregnancy, unprotected sex is off-limits from the day your cervical secretions begin until four days after your peak day. If you have sex before your cervical secretions begin, you may want to avoid sex the next day and night so that you don't confuse semen and arousal fluids with cervical secretions.
  Some health care providers also recommend avoiding unprotected sex or using a barrier method of contraception during your period because it's difficult to detect cervical secretions when they're mixed with menstrual blood.

Interpreting and charting cervical secretions can be challenging. Most women need more than one instructional session to recognize the pattern of secretions in a typical menstrual cycle. Consult your health care provider with any questions or concerns.

Healthy sperm: Improving your fertility

Healthy sperm aren't always a given. Understand how lifestyle factors can affect your sperm and what you can do to improve your fertility.

If you and your partner are planning a pregnancy, you might be wondering about the health of your sperm. Understand the factors that can affect male fertility — then consider steps to help your sperm achieve your goal.

What determines sperm health?

Sperm health depends on various factors, including quantity, movement and structure:

• Quantity. You're most likely to be fertile if your ejaculate — the semen discharged in a single ejaculation — contains at least 15 million sperm per milliliter. Too little sperm in an ejaculation might make it more difficult to get pregnant because there are fewer candidates available to fertilize the egg.
• Movement. To reach and fertilize an egg, sperm must move — wriggling and swimming through a woman's cervix, uterus and fallopian tubes. This is known as motility. You're most likely to be fertile if at least 40 percent of your sperm are moving.
• Structure (morphology). Normal sperm have oval heads and long tails, which work together to propel them. While not as important a factor as sperm quantity or movement, the more sperm you have with a normal shape and structure, the more likely you are to be fertile.

What causes male fertility problems?

Various medical issues can contribute to male fertility problems, including:

• A problem in the hypothalamus or the pituitary gland — parts of the brain that signal the testicles to produce testosterone and sperm (secondary hypogonadism)
• Testicular disease
• Sperm transport disorders

Age can also play a role. The ability of sperm to move and the proportion of normal sperm tend to decrease with age, affecting fertility, especially after age 50.

Male reproductive system

What's the best way to produce healthy sperm?

You can take simple steps to increase your chances of producing healthy sperm. For example:

• Maintain a healthy weight. Some research suggests that increasing body mass index (BMI) is linked with decreasing sperm count and sperm movement.
• Eat a healthy diet. Choose plenty of fruits and vegetables, which are rich in antioxidants — and might help improve sperm health.
• Prevent sexually transmitted infections (STIs). Sexually transmitted infections — such as chlamydia and gonorrhea — can cause infertility in men. To protect yourself, limit your number of sexual partners and use a condom each time you have sex — or stay in a mutually monogamous relationship with a partner who isn't infected.
• Manage stress. Stress can decrease sexual function and interfere with the hormones needed to produce sperm.
• Get moving. Moderate physical activity can increase levels of powerful antioxidant enzymes, which can help protect sperm.

What's off-limits?

Sperm can be especially vulnerable to environmental factors, such as exposure to excessive heat or toxic chemicals. To protect your fertility:

• Don't smoke. Men who smoke cigarettes are more likely to have low sperm counts. If you smoke, ask your doctor to help you quit.
• Limit alcohol. Heavy drinking can lead to reduced testosterone production, impotence and decreased sperm production. If you drink alcohol, do so in moderation.
• Avoid lubricants during sex. While further research is needed on the effects of lubricants on fertility, consider avoiding lubricants during intercourse. If necessary, consider using baby oil, canola oil, egg white or a fertility-friendly lubricant, such as Pre-Seed.
• Talk to your doctor about medications. Calcium channel blockers, tricyclic antidepressants, anti-androgens and other medications can contribute to fertility issues. Anabolic steroids can have the same effect.
• Watch out for toxins. Exposure to pesticides, lead and other toxins can affect sperm quantity and quality. If you must work with toxins, do so safely. For example, wear protective clothing and equipment, and avoid skin contact with chemicals.
• Stay cool. Increased scrotal temperature can hamper sperm production. Although the benefits have not been fully proved, wearing loose-fitting underwear, reducing sitting, avoiding saunas and hot tubs, and limiting scrotum exposure to warm objects, such as a laptop, might enhance sperm quality.

Chemotherapy and radiation therapy for cancer can impair sperm production and cause infertility that might be permanent. Ask your doctor about the possibility of retrieving and storing sperm before treatment.

When is it time to seek help?

Adopting healthy lifestyle practices to promote your fertility — and avoiding things that can damage it — can improve your chances of conceiving. If you and your partner haven't gotten pregnant after a year of unprotected sex, however, you might consider being evaluated for infertility. A fertility specialist also might be able to identify the cause of the problem and provide treatments that place you and your partner on the road to parenthood.