Your Reproductive Health Matters: Tips for a Healthy Future

Sexual health and reproductive health are intertwined. Looking after your reproductive health can support more pleasurable sexual experiences, but it goes beyond just sex or even fertility.

Safe sex, sexually transmitted diseases and infections (STDs and STIs), consent, abuse, nutrition and mental health all fall under the umbrella of reproductive health.

What is reproductive health?

"Reproductive care can generally be categorized into two domains: prevention and intervention," said Tameca N. Harris-Jackson, Ph.D., a sex and relationship therapist and the founder of Hope & Serenity Health Services in Altamonte Springs, Florida.

Prevention

"Experiencing pain with sex, erectile dysfunction (ED) or other challenges often result in people seeking care for their reproductive health," Harris-Jackson said.

However, for many, signs of problems may never appear—or when they do, it may be at the later stage of an illness.

"Establishing a routine screening schedule, such as annual exams around your birthday, can be beneficial to preventative care," she said.

Annual reproductive health checks are essential, allowing healthcare providers to assess changes between visits and making it easier to recognize any concerns that may need to be addressed.

Breast and cervical exams, prostate exams and rectal exams are recommended at certain ages. Other factors are important, too, and may dictate that these exams take place earlier and more frequently, such as a person's race, ethnicity or family history.

In addition, sexually active people should consider undergoing routine testing for STIs.

"When detected early enough, depending upon the diagnosis, treatments for reproductive health concerns may be more cost-effective, less invasive and have better long-term outcomes for success, resulting in fewer barriers to sexual pleasure," Harris-Jackson said.

Interventions

"People often choose to avoid seeking reproductive health treatment for various reasons," Harris-Jackson said.

The cost or lack of insurance; access to quality health care; not feeling heard, seen or valued as a patient; and prejudice, discrimination and other disparities in treatment are all valid and documented reasons people may not seek treatment for their reproductive health.

However, failure to seek treatment may exacerbate symptoms and result in long-term and perhaps irrevocable damage.

Seeking treatment can feel scary or overwhelming. However, receiving treatment can mean the difference between experiencing long-term complications or pleasure.

"Inclusive healthcare providers operate from an ethos that healthcare should be equal and equitable for all," Harris-Jackson said. "Searching for inclusive providers in one's area can be helpful to address some barriers, such as cost and discriminatory practices. While many people associate an organization like Planned Parenthood with abortions only, there are a variety of health and wellness services available at reduced rates, including primary care, STI testing and transgender care services."

There are also clinics in local areas or available via telehealth that provide low-cost or no-cost services.

How to use condoms and practice safe sex

"The only form of contraception that protects you from sexually transmitted infections is the condom," said Deborah Lee, M.B., Ch.B., a sexual and reproductive health specialist at DrFox Pharmacy, an online doctor and pharmacy service in the United Kingdom.

About 57 percent of women worldwide are using some form of birth control, but sexually active women are at risk of both unplanned pregnancies and STIs, a 2018 report suggested.

"It's important for women to use safe and reliable contraception so they can control their fertility," she said. "But none of these methods offer STI protection, apart from the male and female condom."

Condoms must be used carefully and consistently for every episode of intercourse until a person is in a long-term monogamous relationship—and even then, it's not a bad idea to continue using them.

Lee provided some useful information people need to know about condoms:

• The male condom is applied to the penis before it penetrates the vagina, mouth or anus. It covers the penile mucosa and prevents bacterial-infected semen or particles from viral shedding (e.g., human immunodeficiency virus (HIV)) from entering the genital, oral or gastrointestinal (GI) tracts. It also prevents transmission of STIs that spread from skin-to-skin contact, such as herpes (HSV), syphilis and the human papillomavirus (HPV).
• Female condoms—often called internal condoms—give a woman an opportunity to protect herself if, for any reason, a man will not use a condom. They are about as effective as the male condom at preventing pregnancy, with a typical use failure rate of around 20 percent in 12 months. They are also effective at STI protection, latex-free and can even increase sexual pleasure. Never use a male condom at the same time as a female condom.

"Young people are still being encouraged to 'Double Dutch.' This means using a reliable method of contraception plus a condom in order to prevent both unplanned pregnancy and STIs," Lee said.

This is because compliance with different methods of contraception is often poor. Roughly 39 percent of women ages 21 to 29 had forgotten to take at least one contraceptive pill in the past month, according to a 2019 study.

"The use of a condom at the same time as any other method of contraception gives added contraceptive safety, as well as providing STI protection," she said.

Condoms used alone are not completely reliable methods of contraception, however, with a one-year typical use failure rate of about 13 percent, according to 2018 research carried out and reported by the Guttmacher Institute in 2020.

"There can be sperm in pre-ejaculatory fluid, and a condom can slip off or burst inside the vagina," Lee said. "If a couple has sex more than once in the same sex session, there can be sperm left over in the male urethra. Condoms should be used for each and every episode of sexual intercourse and should never be reused."

Condoms work well without the need for a spermicide. Spermicides provide a physical barrier to the transfer of organisms, although the spermicide nonoxynol-9 has been shown to increase the risk of STI transmission, which is why spermicides are no longer regularly added to condoms.

"There is also a risk of allergy to the spermicide," Lee noted.

Reproductive health, STDs and STIs

Condoms offer protection from sexually transmitted diseases and infections, but you still need to undergo regular STI screening if you are sexually active. And yes, this applies even if you use condoms.

The Centers for Disease Control and Prevention (CDC) recommends the following screening checks:

• Every adult should be tested for HIV once a year between the ages of 13 and 64.
• All sexually active women ages 25 and younger should have a chlamydia and gonorrhea test once a year. Women older than 25 should be tested if they have had a recent change of partner or have a partner who has been diagnosed with chlamydia or gonorrhea.
• All pregnant women should be tested for syphilis, HIV, and hepatitis B and C. Those with risk factors should be tested for chlamydia and gonorrhea early in pregnancy.
• Sexually active gay and bisexual men should be tested once a year for syphilis, chlamydia and gonorrhea. They should also have an HIV test every year or more often if they have had frequent new sexual partners. Those with HIV should be tested once a year for hepatitis C.
• Intravenous drug users and their partners, or anyone having sex with those partners, should have an HIV test at least once a year.
• Anyone who has oral or anal sex is advised to have their throat and rectum tested.

You can find the ZIP code of your nearest testing center on the CDC website.

HPV is the most common sexually transmitted infection in the United States. It can lead to several serious reproductive problems, including cervical, vaginal and vulvar cancers in women, as well as penile and anal cancers in men. The HPV vaccine prevents the spread of the virus and is recommended for all people before they become sexually active.

HPV vaccination is available for preteens ages 11 or 12, but it can be given to those as young as 9, according to the CDC. It is generally not worthwhile giving the vaccination to those ages 26 and older, but if a person is at risk and vulnerable, the HPV vaccination can be given up to people up to age 45.

Reproductive health: pleasure, autonomy, respect and consent

Feeling safe and understood are crucial elements of a pleasurable sexual experience.

"Taking away or not honoring one's reproductive autonomy and consent not only impacts pleasure but can have a significant impact on one's reproductive health," Harris-Jackson said. "When we believe people will respect our decisions, we are more likely to make decisions that protect us and others, such as the use of contraceptives or barriers and other methods to protect us from STIs."

Conversely, when our consent is not honored, our voices are not heard and our choices are not respected, we are more likely to engage in behaviors that place us and others at greater risk.

These can include not seeking medical support for pregnancies for fear of being reported, deported, jailed or fined; engaging in sexual activity under the influence of substances to decrease fears of being forced, coerced or manipulated; and being dishonest about our own STI status due fear of shame, disrespect and assault.

"It is important to note that, for all of these issues, changes or improvements are not solely up to individuals," Harris-Jackson said. "Systemic changes are needed to increase feelings of safety and enhance efficacy in caring for reproductive health. This includes changes at federal and state levels to ensure constituents are heard, rights are protected and people are safe."

Individuals can also take action, including the following:

• Seek mental health support to assist with feelings of low self-worth or self-efficacy related to using our voices for self-advocacy.
• Contact local crisis centers or intimate partner violence agencies if you're feeling unsafe in partnerships.
• Contact political representatives to advocate for rights related to reproductive autonomy.
• Access and share resources with others to help inform and empower, such as the National Coalition for Sexual Health's Guide called Take Charge of Your Sexual Health and A Guide to Sexual Concerns and Pleasure.

What are the best nutrition, exercise and diet recommendations for reproductive health?

"There are limited studies to date that provide definitive evidence regarding various lifestyle factors like nutrition, exercise, diet, and hygiene and their effect on reproductive health and fertility," said Austin Johnson, M.D., an OB-GYN and a clinical fellow in reproductive endocrinology and infertility at UW Heath in Seattle.

The strongest studies are randomized controlled trials; however, these studies are few. Most reported literature comprises observational studies that, while helpful and suggestive of potential relationships between exposures and outcomes, are not the strongest form of evidence.

"We do know, however, that certain lifestyle factors, such as obesity, do have well-established impacts on reproductive health and fertility," Johnson said. He provided two examples:

1. Being overweight (a body mass index of 25 to 29.9 or obese with a BMI of greater than 30) can result in dysfunctional ovulation as a result of excessive estrogen, thereby decreasing fertility and the ability to conceive spontaneously.
2. Obesity during pregnancy increases the risks of pregnancy complications, such as hypertensive disorders of pregnancy (gestational hypertension or preeclampsia) or gestational diabetes.

"As our diet and exercise choices largely influence our weight, optimizing nutrition and physical activity is the best way to achieve a healthy weight and, in turn, reduce the negative impacts of abnormal weight on reproductive health," Johnson said. "General recommendations should be followed regarding routine exercise to maintain a healthy weight. Similar to diet, no specific exercise regimens have been proven to increase fertility."

It is a well-established fact, however, that ovulatory disorders and subsequent sub/infertility may arise in underweight women (BMI less than 18.5) as a result of excessive exercise or decreased caloric intake.

"This is known as functional hypothalamic amenorrhea—sometimes referred to as 'female athlete triad'—and is typically a reversible cause of subfertility or infertility with lifestyle changes and weight gain," Johnson said.

Before receiving this diagnosis, Johnson recommended that patients be fully evaluated for other potential causes of subfertility or infertility.

What is the relationship between reproductive health and mental health?

Difficulties conceiving or the loss of a pregnancy can influence the stress, anxiety and depression experienced by many patients.

"While difficulties with reproduction may feel isolating, patients should know they are not alone," Johnson said. "On average, only 20 percent to 30 percent of patients become pregnant in one cycle, with approximately 80 percent becoming pregnant by six months and 85 percent by 12 months."

Despite these statistics, many patients can feel discouraged when struggling with their reproductive health.

Natural and assisted fertility require emotional, physiologic and financial investments, making undesired outcomes or losses related to reproduction more impactful on mental health. Patients with underlying depression or anxiety outside of pregnancy are at increased risk of worsening symptoms before, during and after pregnancy (postpartum depression or postpartum psychosis), according to Johnson.

"It is, therefore, essential that in both patients with and without a mental health diagnosis, mental health be prioritized and optimized prior to attempting to conceive," he said.