Ask Amy Anything
The Nurse Is In
Issue date: 11/2/09 Section: Can You Hear Me Now
If there is one thing I've learned working as a nurse practitioner in reproductive health, it's that there are a whole lot of unanswered questions out there. Perhaps more frightening are the purported answers to many of these questions! Sex can be complicated. Questions arise that people are embarrassed to ask, often simply because they think they should already know the answer. I hope this column will provide a forum for these questions and a resource for honest and factual answers.
What should I do if I miss one or two birth control pills in a row? What about three? More?
Missing a pill every now and again isn't a big deal. If you miss one, simply take it as soon as you remember, even if that means taking two at once the following day. No need for a backup method, just resume regular pill use.
If you miss two pills, do not take three in one day! Instead, double up for two days. For example, if you miss Monday and Tuesday, you'll take Monday's pill along with Wednesday's and Tuesday's pill along with Thursday's.
Missing three or more pills is where you start getting into trouble. You absolutely must use condoms for the first week you're back on the pill. If you have sex without a condom within a week after missing three or more pills you may want to consider Plan B, also known as the morning after pill or emergency contraception. Whether or not you should continue with the pack you're already on or start a new pack depends on which pill you're on and where you are in the pack. The directions that accompany your pill pack should help, but call your doctor or Planned Parenthood if you're unsure. A quick phone call is better than an unintended pregnancy.
FYI, a common and likely side effect of pill miss-age is irregular bleeding (a.k.a. "break-thru-bleeding" or "spotting"). If you find yourself frequently missing pills, you may want to consider changing your method. There are plenty of methods out there that don't require daily maintenance, such as the patch, Nuvaring, Depo-provera, Implanon and IUD. Again, consult your doctor about options that are right for you.
I hate having my pap exams done. Why does my doctor insist that I do it every year?
Plain and simple, cancer screening. Certain strains of HPV, also known as the human papilloma virus, have been linked to cervical cancer in women. During an annual pap your doc checks to make sure everything looks healthy and addresses other health concerns, but more importantly he or she is looking for abnormalities that can lead to cervical cancer. The pap exam itself allows your doctor to take a small sample of your cervical cells. If the cells are abnormal your doc takes a closer look to rule out common, curable causes like yeast infections, bacterial vaginosis or certain STIs.
If he or she finds the cells to be precancerous there are a number of ways to handle it. He or she may just have you come back in a few months or schedule you for an appointment to remove them. The most important thing to keep in mind is that these are PRE-cancerous cells! If caught early, you can avoid cervical cancer. However, women who don't get their annual paps run the risk of having precancerous cells go unmonitored, resulting in cervical cancer. Pap exams may not be the most comfortable thing in the world but it certainly beats the alternative!
And speaking of comfort, always let your doctor know if anything he or she is doing hurts or is uncomfortable. Oftentimes women stay quiet about pain, both with their partners and their doctors. A routine pap exam (assuming you don't have any type of infection) shouldn't be a painful experience. If you're new to pap exams, let your doctor know so he or she can explain the procedure and answer any questions you have before the exam. Talking to women who have had several pap exams may also help reduce your anxiety. Remember that the benefits of having this exam annually far outweigh a few minutes of awkwardness.
***
Nurse Amy is a professional nurse practitioner and is here to answer any and all questions you have about your sexual health. Feel free to send us your questions or post in the form of a comment below using an alias name. Our goal is to have you informed, so ask away!
What should I do if I miss one or two birth control pills in a row? What about three? More?
Missing a pill every now and again isn't a big deal. If you miss one, simply take it as soon as you remember, even if that means taking two at once the following day. No need for a backup method, just resume regular pill use.
If you miss two pills, do not take three in one day! Instead, double up for two days. For example, if you miss Monday and Tuesday, you'll take Monday's pill along with Wednesday's and Tuesday's pill along with Thursday's.
Missing three or more pills is where you start getting into trouble. You absolutely must use condoms for the first week you're back on the pill. If you have sex without a condom within a week after missing three or more pills you may want to consider Plan B, also known as the morning after pill or emergency contraception. Whether or not you should continue with the pack you're already on or start a new pack depends on which pill you're on and where you are in the pack. The directions that accompany your pill pack should help, but call your doctor or Planned Parenthood if you're unsure. A quick phone call is better than an unintended pregnancy.
FYI, a common and likely side effect of pill miss-age is irregular bleeding (a.k.a. "break-thru-bleeding" or "spotting"). If you find yourself frequently missing pills, you may want to consider changing your method. There are plenty of methods out there that don't require daily maintenance, such as the patch, Nuvaring, Depo-provera, Implanon and IUD. Again, consult your doctor about options that are right for you.
I hate having my pap exams done. Why does my doctor insist that I do it every year?
Plain and simple, cancer screening. Certain strains of HPV, also known as the human papilloma virus, have been linked to cervical cancer in women. During an annual pap your doc checks to make sure everything looks healthy and addresses other health concerns, but more importantly he or she is looking for abnormalities that can lead to cervical cancer. The pap exam itself allows your doctor to take a small sample of your cervical cells. If the cells are abnormal your doc takes a closer look to rule out common, curable causes like yeast infections, bacterial vaginosis or certain STIs.
If he or she finds the cells to be precancerous there are a number of ways to handle it. He or she may just have you come back in a few months or schedule you for an appointment to remove them. The most important thing to keep in mind is that these are PRE-cancerous cells! If caught early, you can avoid cervical cancer. However, women who don't get their annual paps run the risk of having precancerous cells go unmonitored, resulting in cervical cancer. Pap exams may not be the most comfortable thing in the world but it certainly beats the alternative!
And speaking of comfort, always let your doctor know if anything he or she is doing hurts or is uncomfortable. Oftentimes women stay quiet about pain, both with their partners and their doctors. A routine pap exam (assuming you don't have any type of infection) shouldn't be a painful experience. If you're new to pap exams, let your doctor know so he or she can explain the procedure and answer any questions you have before the exam. Talking to women who have had several pap exams may also help reduce your anxiety. Remember that the benefits of having this exam annually far outweigh a few minutes of awkwardness.
***
Nurse Amy is a professional nurse practitioner and is here to answer any and all questions you have about your sexual health. Feel free to send us your questions or post in the form of a comment below using an alias name. Our goal is to have you informed, so ask away!
Viewing Comments 1 - 4 of 4
missed periods a cause for concern?
posted 11/12/09 @ 2:18 PM PST
I haven't gotten my period in a little over 6 months (and no, I'm definitely not 6 months pregnant). I know this isn't good, but is it something I should go to a doctor about immediately? I wasn't eating very much last semester, but was getting it then - but when I started eating more, it stopped and hasn't been back since. (Continued…)
Is it worth it?
posted 11/20/09 @ 12:45 PM PST
Dear Amy,
I haven't had a stable boyfriend in years and I haven't had sex in over 3 months but I've been on birth control for 5 years now, so I have 2 questions:
1. (Continued…)
professional essay writers
posted 11/26/09 @ 4:07 AM PST
Thank you for answer the question about pills. I had this problem couple of times and didn't know whom to ask.
Amy
posted 12/16/09 @ 12:40 PM PST
Thank you so much for your questions. Stay tuned for answers in the next issue!
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