Looking After Your Reproductive Sexual Health

Your reproductive sexual health affects more than just sex and fertility, and vice versa, more things go into reproductive health than sex and fertility. Consider the life stage you're in and preexisting conditions that might cause issues.

"Reproductive health implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so," stated the World Health Organization.

Let's break down all the factors and people that help you look after your reproductive sexual health, and provide strategies for the key challenges you may face.

Kecia Gaither, M.D., M.P.H., board-certified in OB-GYN and maternal-fetal medicine, serves as the director of perinatal services/maternal-fetal medicine at NYC Health + Hospitals/Lincoln in the Bronx, New York. Gaither said there are several types of clinicians you can turn to in the United States for reproductive health support:

• OB-GYN (obstetric gynecologist). A physician who specializes in pregnancy and female reproductive health.
• Urologist. A physician who specializes in both male and female urinary tracts, including managing disorders of the kidneys, ureters, bladder, prostate and male reproductive organs.
• Nurse practitioners. As nurses with graduate training, they can serve as primary care providers and prescribe medications.
• Physician assistants work in collaboration with a physician.
• Certified nurse midwives, with training in gynecologic and family planning services, act as primary healthcare providers to women of all ages.

More specifically trained professionals may include:

• Reproductive endocrinologists. Also referred to as REs, they are OB-GYNs who diagnose and treat endocrine disorders that are either directly or indirectly related to reproduction.
• Andrologists. These are urologists who focus 100 percent on the diagnosis and treatment of conditions affecting male fertility and sexuality.
• Reproductive immunologists study the interactions between the immune system and the reproductive system, in particular, the role of the immune system concerning recurrent pregnancy loss and repeated in vitro fertilization (IVF) failures.
• Reproductive surgeons. These are gynecologists and urologists who specialize in reproductive surgery. They are experts in the conservative treatment of reproductive organs in men and women.

Your reproductive health should be something you focus on for your entire adult life, although your specific concerns may change as you enter different life stages.

For men and women, the top five reproductive issues to be aware of are:

1. Sexually transmitted infections and diseases (STIs and STDs)

Common STIs and STDs include chlamydia, genital warts, gonorrhea, syphilis and HIV. (This topic is covered in greater detail in the first article in this series.)

Erica Montes, M.D., a board-certified OB-GYN in Phoenix, the founder of the Modern Mujer health site and a spokesperson for the global healthcare company Organon, stressed the importance of getting screened for STIs, especially if you are at risk, because they can lead to severe health and fertility issues in the future.

Risk factors include:

• Having unprotected sex (vaginal, anal or oral)
• Being young (ages 18 to 24)
• Having sexual contact with multiple partners
• Mixing alcohol, recreational drugs and sexual activity
• Injecting drugs
• Being forced into sexual activity
• Having sex with a partner who engages in sexual activity with other partners
• Having a history of STIs or STDs

2. Fertility problems

"Around 19 percent of American women of reproductive age currently find they cannot get pregnant within 12 months of trying," explained Deborah Lee, M.B.Ch.B., a sexual and reproductive health specialist at Dr Fox Pharmacy, an online doctor and pharmacy service in the United Kingdom.

Infertility results from issues on either the female or male side of the partnership, or both. Recently established estimates indicate that:

• 30 percent of infertility cases are attributed solely to females.
• 30 percent are attributed solely to males.
• 30 percent are due to a combination of issues in both partners.
• 10 percent of cases have an unknown cause.

3. Sexual dysfunction

"It's very common for women to come to the sexual health clinic with problems of sexual dysfunction," Lee said.

These problems might include a lack of sexual desire, arousal difficulties, inability to orgasm and painful sex. The same applies to men, who also might experience erectile dysfunction (ED), premature ejaculation, delayed or inhibited ejaculation, and dry orgasm.

Your healthcare provider can help treat all different types of sexual dysfunctions. Don't be nervous to reach out for support, as these are common issues they've undoubtedly dealt with before.

4. Unplanned pregnancy

"Around 45 percent of pregnancies in the U.S. are unintended, of which around 40 percent end in abortion and 60 percent result in a live birth," Lee said.

In the U.S., information about abortion isn't always clear and availability very much depends on your location. Your healthcare provider is able to give you precise information about your choices, and many organizations can support you through whatever action you decide to take.

5. Sexual assault

"Every 68 seconds, a woman somewhere in America is sexually abused or assaulted," Lee said. "That's a staggering statistic."

Other staggering statistics include:

• About a quarter (24.8 percent) of men in the U.S. experience some form of contact sexual violence in their lifetime.
• 81 percent of women and 43 percent of men report experiencing some form of sexual harassment and/or assault in their lifetime.
• An estimated 734,630 people were sexually assaulted (including threatened, attempted or completed rape) in 2018 in the U.S.

If you've been sexually assaulted, raped or harassed, it's essential to remember it's not your fault. All types of sexual violence are a crime. Make sure you get support from friends and family, and don't hesitate to get professional help.

Although many reproductive conditions can afflict women, Lee highlighted the ones most prevalent and significant in her experience:

Menstrual problems

One in 5 women in the U.S. complain of heavy periods every year. Periods may be so heavy and painful they necessitate time off from work or school. Other common problems are irregular periods, bleeding in between periods, missed periods and having no periods at all. Some women suffer from troublesome menstrual migraines.

Gynecological problems: PCOS and endometriosis

Polycystic ovary syndrome (PCOS) is said to affect 6 percent to 12 percent of American women of reproductive age, which translates to as many as 5 million adults. PCOS is an endocrine disorder associated with anovulation, infertility, obesity and hirsutism. Over a lifetime, around half of all women with PCOS develop diabetes. It is linked to raised cholesterol, heart disease, high blood pressure and an increased risk of uterine cancer. Women with PCOS are also more likely to develop gestational diabetes during pregnancy.

Endometriosis affects about 11 percent of American women ages 15 to 44, which is more than 6.5 million adults. In this condition, tissue similar to the endometrium (the uterine lining) grows outside the uterus in the pelvic tissues. The endometrium grows and develops each month along with the ovarian cycle, and if no pregnancy occurs, it bleeds internally at the same time as the monthly period, causing excruciating pelvic pain. Scar tissue then develops around the fallopian tubes and the pelvic sidewalls, resulting in abdominal pain, painful sex and eventual infertility.

Menopause and postmenopause

Women experience menopause on average at age 51, although there is a wide range from ages 45 to 55 or older. Women produce far less estrogen 10 years before their last menstrual period, which is why women in their 40s often experience symptoms such as fatigue, menstrual irregularity or a change in periods, vaginal dryness and other perimenopausal symptoms.

The term perimenopause literally means "around menopause" and refers to the time leading up to the moment of menopause and then postmenopause. Eighty percent of perimenopausal women get hot flashes and night sweats in the run-up to menopause. There is no need to suffer in silence, as your healthcare provider has all kinds of advice and suggestions. Many options exist to ease these symptoms, including hormone replacement therapy (HRT), now often referred to as menopausal hormone therapy (MHT).

Postmenopausal women have a variety of sexual health needs. They may need topical estrogen for vaginal dryness. They may have incontinence problems that could require gynecological surgery or medication. They may have lower bone mineral density and need treatment to prevent the progression of osteoporosis and fractures. Older women are more at risk of gynecological malignancies, so any abnormal bleeding or discharge, abdominal pain or swelling must be promptly reported to the doctor.

Juliet Owen-Nuttall, a fertility expert in the United Kingdom and co-founder of the Facebook page, the Non Invasive Method, makes a crucial point: "You have more control over your reproductive health and fertility than you realize.

"You don't have to put up with menstruation problems or brush your fertility concerns aside. It's essential to educate yourself, take control of your reproductive health and get an understanding of what's going on," she added.

While men's contribution to the reproductive process might not be as time-consuming, there are still some important reproductive health problems that they need to be aware of:

Balanitis

Affecting 3 percent to 11 percent of men in their lifetime, balanitis presents as an inflammation of the head of the penis. Causes include poor personal hygiene, use of irritants, drug allergies, obesity, trauma, allergic reactions and other more specific health conditions. If left untreated, it can lead to a significant infection and more serious issues.

Benign prostatic hyperplasia (BPH)

A nonmalignant enlargement of the prostate gland, benign prostatic hyperplasia (BPH) affects about half of all men ages 51 to 60 and up to 90 percent of men older than 80. As the prostate gland swells, the urethra becomes constricted, causing urinary symptoms. Several medical and lifestyle treatment options are available to reduce symptoms and improve your overall quality of life.

Peyronie's disease

This disease occurs when scar tissue builds up inside the penis, creating curvature in erections. Peyronie's disease most commonly affects men older than 40. About 1 in 100 men in the U.S. have been diagnosed with this condition. Depending on the severity of the symptoms, penile injections and surgeries can help.

Justin Houman, M.D., a urologist and men's health specialist at Tower Urology in Los Angeles, noted that men's reproductive health comes down to four factors:

• Anatomical issues, mainly varicoceles, that can impact sperm count and quality. For instance, a family medical history of undescended testicles can cause fertility issues later in life.
• Hormone issues. Low intratesticular testosterone can negatively impact sperm count and quality.
• Genetic issues. Klinefelter syndrome and Y chromosome microdeletions can cause low or no sperm count.
• Lifestyle. Smoking, excessive drinking, marijuana, saunas, steam rooms and jacuzzis can all impact sperm quality and counts.

For men and women, it's vital to be aware of reproductive cancers such as ovarian, cervical, prostate and testicular.

Cervical cancer. The American College of Obstetricians and Gynecologists (ACOG) recommends starting Pap tests at age 21, regardless of when you first start having sex. You should then continue to have Pap tests every three years.

Breast cancer. For most women with average risk, ACOG recommends screening for breast cancer every one to two years, starting at age 40 and no later than age 50.

"We really want women to start breast screening annually from age 40. But depending on your family history, you may need to be screened more frequently or sooner," Montes said.

Before age 40, doctors recommend you get to know your breasts well so you notice any lumps or changes, and carry out a monthly breast self-examination.

Prostate cancer. The American Cancer Society (ACS) recommends that men should make an informed decision with their healthcare provider about being screened for prostate cancer at the following ages:

• Age 50 for men at average risk
• Age 45 for men at high risk
• Age 40 for men at very high risk

Colorectal cancer. For men and women, colorectal cancer screening should begin at age 45 for people with no risk factors. The ACS recommends that if you are in good health and have a life expectancy of more than 10 years, you should continue regular colorectal cancer screening up to age 75.

Montes encouraged women to ask their healthcare provider as many questions as possible about contraception, potentially including:

• What types of contraception are available?
• What's going to be the most effective method for me to prevent unintended pregnancy?
• What are the side effects?
• How often do I need to use or take it?
• How do I use or take it?
• How accessible is it? Do I need a doctor's prescription?
• How affordable is it?
• What factors might prevent it from being effective?

"It's vital for women to realize that it is so important to ask these questions and that there are all kinds of contraceptive options," Montes explained. "We have the short-acting options, which include the pill, the patch, the ring, the vaginal ring and the shot, and then the long-acting reversible contraceptive options, which include the intrauterine device and the arm implant."

In all, there are about 18 types of contraception to protect against unwanted pregnancy. Rather than listing them all here, please follow this link to a special guide.

"I want to make sure that everyone's thinking about contraception, especially because right now, unintended pregnancies disproportionately affect women between ages 18 to 24," Montes stated.

With so many options available, there's a method of contraception to suit you and your lifestyle. Your healthcare provider is a useful source of information, but so, too, are friends, family members and colleagues you trust. Everything from great experiences to horror stories can inform your choice.

We would be remiss not to mention the elephant in the room. The U.S. Supreme Court overturned Roe v. Wade on June 24, 2022, marking the end of a woman's constitutional right to an abortion. Depending on where you live, you may already have concerns about accessing the medical treatment you need. If you're struggling to find reproductive health support, please check the recommended website links at the bottom of this article.

Even without legal changes, sexual health services in general are notoriously underfunded and undersupported.

"Policymakers often fail to realize that spending money on sexual health services is actually good value for money," Lee explained. "Sexual and reproductive services are often neglected when resources are scarce."

Sexual health services involve challenges including poor clinic attendance, a lack of available face-to-face appointments (especially since the COVID-19 pandemic) and the increasingly high costs of contraceptives, Lee said.

"Sexual and reproductive health is never seen as a priority and rarely gets the attention and the funding it deserves," she added. "In a 2021 Guttmacher policy review, the authors [Zara Ahmed and Sophia Sadinsky] stressed the need for new service delivery methods, such as outreach clinics, patient call centers and expanding services to less specialized providers. They also called for a new vision of sexual and reproductive health under the Biden administration."

Even if we do say so ourselves, Giddy, the world's largest sexual health platform, does have a wealth of free information on your reproductive needs. If you're looking to explore further, here are five great websites full of advice and resources on reproductive health, contraception, pregnancy and abortion. This is not an exhaustive list by any means, but they're all great places to start:

• Find My Method: You'll find information on 18 different contraceptive methods along with guides to safer sex. Contraceptive information from around the world is provided.
• How to Use the Abortion Pill: This website discusses various abortion-inducing medications and provides information about abortion care in different countries. Online courses are provided specifically for professional stakeholders within the medical abortion profession.
• Planned Parenthood: This organization offers information on all things related to sexual reproductive health, including contraception, pregnancy, abortion, gender identity, consent and sexual assault.
• Safe2Choose: Connecting women with abortion information, care and counseling, this site is focused on providing the information you need to make safe and informed choices.
• What's Next for Her: This is a place to find reliable educational information about contraception and advice on how to have that conversation with your physician.