Types of HRT 

Hormone replacement therapy (HRT) replaces female hormones that a woman’s body is no longer producing, due to the menopause.

These hormones are:

• oestrogen – which is taken from either plants or the urine of pregnant horses

• progesterone – HRT uses a synthetic version of progesterone called progestogen, which is easier for the body to absorb

Choosing the right HRT for you

Finding the right type of HRT can be tricky.

A low dose of HRT hormones is usually recommended to begin with. It is best to start with the lowest effective dose, to minimise side effects. If necessary, you can increase your dose at a later stage.

Persevere with HRT and wait a few months to see if it works well for you. If not, you can try a different type or increase the dose. Talk to your GP about any problems you have with HRT.

While there are more than 50 different preparations of HRT, the three main types are discussed below.

Oestrogen-only HRT

Oestrogen-only HRT is usually recommended for women who have had their womb removed during a hysterectomy. There is no need to take progestogen because there is no risk of womb (uterus) cancer, sometimes called endometrial cancer.

Cyclical HRT

Cyclical HRT, also known as sequential HRT, is often recommended for women who have menopausal symptoms but still have their periods.

There are two types of cyclical HRT:

• monthly HRT – where you take oestrogen every day and progestogen at the end of your menstrual cycle for 12-14 days

• three-monthly HRT – where you take oestrogen every day and progestogen for 12-14 days, every 13 weeks

Monthly HRT is usually recommended for women having regular periods.

Three-monthly HRT is usually recommended for women experiencing irregular periods. You should have a period every three months.

It is useful to maintain regular periods so you know when your periods naturally stop and when you are likely to progress to the last stage of the menopause.

In some cases, a woman using cyclical HRT may continue having periods after the menopause (when she is post-menopausal).

Continuous combined HRT

Continuous combined HRT is usually recommended for women who are post-menopausal. A woman is usually said to be post-menopausal if she has not had a period for a year.

As the name suggests, continuous HRT involves taking oestrogen and progestogen every day without a break.

Contraception, pregnancy and HRT

Oestrogen used in HRT is different from oestrogen used in the contraceptive pill, and is not as powerful.

This means it's possible to become pregnant if you are taking HRT to control menopausal symptoms. In some cases, a woman can be fertile for up to two years after her last period if she is under 50, or for a year if she is over 50.

If you don't want to get pregnant, you can use a non-hormonal method of contraception, such as a condom or diaphragm.

An alternative is the IUS (intrauterine system), which is also licensed for heavy periods and as the progestogen part of HRT. You will need to add oestrogen as either a tablet, gel or patch.

Page last reviewed: 18/08/2014

Next review due: 18/08/2016

Source: NHS Choices, UK

Uterine fibroids fact sheet

• What are fibroids?

• Why should women know about fibroids?

• Who gets fibroids?

• Where can fibroids grow?

• What are the symptoms of fibroids?

• What causes fibroids?

• Can fibroids turn into cancer?

• What if I become pregnant and have fibroids?

• How do I know for sure that I have fibroids?

• What questions should I ask my doctor if I have fibroids?

• How are fibroids treated?

• What new treatments are available for uterine fibroids?

• More information on uterine fibroids

What are fibroids?

Fibroids are muscular tumors that grow in the wall of the uterus (womb). Another medical term for fibroids is "leiomyoma" (leye-oh-meye-OH-muh) or just "myoma". Fibroids are almost always benign (not cancerous). Fibroids can grow as a single tumor, or there can be many of them in the uterus. They can be as small as an apple seed or as big as a grapefruit. In unusual cases they can become very large.

 

Why should women know about fibroids?

About 20 percent to 80 percent of women develop fibroids by the time they reach age 50. Fibroids are most common in women in their 40s and early 50s. Not all women with fibroids have symptoms. Women who do have symptoms often find fibroids hard to live with. Some have pain and heavy menstrual bleeding. Fibroids also can put pressure on the bladder, causing frequent urination, or the rectum, causing rectal pressure. Should the fibroids get very large, they can cause the abdomen (stomach area) to enlarge, making a woman look pregnant.

Who gets fibroids?

There are factors that can increase a woman's risk of developing fibroids.

• Age. Fibroids become more common as women age, especially during the 30s and 40s through menopause. After menopause, fibroids usually shrink.

• Family history. Having a family member with fibroids increases your risk. If a woman's mother had fibroids, her risk of having them is about three times higher than average.

• Ethnic origin. African-American women are more likely to develop fibroids than white women.

• Obesity. Women who are overweight are at higher risk for fibroids. For very heavy women, the risk is two to three times greater than average.

• Eating habits. Eating a lot of red meat (e.g., beef) and ham is linked with a higher risk of fibroids. Eating plenty of green vegetables seems to protect women from developing fibroids.

Where can fibroids grow?

Most fibroids grow in the wall of the uterus. Doctors put them into three groups based on where they grow:

• Submucosal (sub-myoo-KOH-zuhl) fibroids grow into the uterine cavity.

• Intramural (ihn-truh-MYOOR-uhl) fibroids grow within the wall of the uterus.

• Subserosal (sub-suh-ROH-zuhl) fibroids grow on the outside of the uterus.

Some fibroids grow on stalks that grow out from the surface of the uterus or into the cavity of the uterus. They might look like mushrooms. These are called pedunculated (pih-DUHN-kyoo-lay-ted) fibroids.

What are the symptoms of fibroids?

Most fibroids do not cause any symptoms, but some women with fibroids can have:

• Heavy bleeding (which can be heavy enough to cause anemia) or painful periods

• Feeling of fullness in the pelvic area (lower stomach area)

• Enlargement of the lower abdomen

• Frequent urination

• Pain during sex

• Lower back pain

• Complications during pregnancy and labor, including a six-time greater risk of cesarean section

• Reproductive problems, such as infertility, which is very rare

What causes fibroids?

No one knows for sure what causes fibroids. Researchers think that more than one factor could play a role. These factors could be:

• Hormonal (affected by estrogen and progesterone levels)

• Genetic (runs in families)

Because no one knows for sure what causes fibroids, we also don't know what causes them to grow or shrink. We do know that they are under hormonal control — both estrogen and progesterone. They grow rapidly during pregnancy, when hormone levels are high. They shrink when anti-hormone medication is used. They also stop growing or shrink once a woman reaches menopause.

Can fibroids turn into cancer?

Fibroids are almost always benign (not cancerous). Rarely (less than one in 1,000) a cancerous fibroid will occur. This is called leiomyosarcoma (leye-oh-meye-oh-sar-KOH-muh). Doctors think that these cancers do not arise from an already-existing fibroid. Having fibroids does not increase the risk of developing a cancerous fibroid. Having fibroids also does not increase a woman's chances of getting other forms of cancer in the uterus.

What if I become pregnant and have fibroids?

Women who have fibroids are more likely to have problems during pregnancy and delivery. This doesn't mean there will be problems. Most women with fibroids have normal pregnancies. The most common problems seen in women with fibroids are:

• Cesarean section. The risk of needing a c-section is six times greater for women with fibroids.

• Baby is breech. The baby is not positioned well for vaginal delivery.

• Labor fails to progress.

• Placental abruption. The placenta breaks away from the wall of the uterus before delivery. When this happens, the fetus does not get enough oxygen.

• Preterm delivery.

Talk to your obstetrician if you have fibroids and become pregnant. All obstetricians have experience dealing with fibroids and pregnancy. Most women who have fibroids and become pregnant do not need to see an OB who deals with high-risk pregnancies.

How do I know for sure that I have fibroids?

Your doctor may find that you have fibroids when you see her or him for a regular pelvic exam to check your uterus, ovaries, and vagina. The doctor can feel the fibroid with her or his fingers during an ordinary pelvic exam, as a (usually painless) lump or mass on the uterus. Often, a doctor will describe how small or how large the fibroids are by comparing their size to the size your uterus would be if you were pregnant. For example, you may be told that your fibroids have made your uterus the size it would be if you were 16 weeks pregnant. Or the fibroid might be compared to fruits, nuts, or a ball, such as a grape or an orange, an acorn or a walnut, or a golf ball or a volleyball.

Your doctor can do imaging tests to confirm that you have fibroids. These are tests that create a "picture" of the inside of your body without surgery. These tests might include:

• Ultrasound – Uses sound waves to produce the picture. The ultrasound probe can be placed on the abdomen or it can be placed inside the vagina to make the picture.

• Magnetic resonance imaging (MRI) – Uses magnets and radio waves to produce the picture

• X-rays – Uses a form of radiation to see into the body and produce the picture

• Cat scan (CT) – Takes many X-ray pictures of the body from different angles for a more complete image

• Hysterosalpingogram (hiss-tur-oh-sal-PIN-juh-gram) (HSG) or sonohysterogram (soh-noh-HISS-tur-oh-gram) – An HSG involves injecting x-ray dye into the uterus and taking x-ray pictures. A sonohysterogram involves injecting water into the uterus and making ultrasound pictures.

You might also need surgery to know for sure if you have fibroids. There are two types of surgery to do this:

• Laparoscopy (lap-ar-OSS-koh-pee) – The doctor inserts a long, thin scope into a tiny incision made in or near the navel. The scope has a bright light and a camera. This allows the doctor to view the uterus and other organs on a monitor during the procedure. Pictures also can be made.

• Hysteroscopy (hiss-tur-OSS-koh-pee) – The doctor passes a long, thin scope with a light through the vagina and cervix into the uterus. No incision is needed. The doctor can look inside the uterus for fibroids and other problems, such as polyps. A camera also can be used with the scope.

What questions should I ask my doctor if I have fibroids?

• How many fibroids do I have?

• What size is my fibroid(s)?

• Where is my fibroid(s) located (outer surface, inner surface, or in the wall of the uterus)?

• Can I expect the fibroid(s) to grow larger?

• How rapidly have they grown (if they were known about already)?

• How will I know if the fibroid(s) is growing larger?

• What problems can the fibroid(s) cause?

• What tests or imaging studies are best for keeping track of the growth of my fibroids?

• What are my treatment options if my fibroid(s) becomes a problem?

• What are your views on treating fibroids with a hysterectomy versus other types of treatments?

A second opinion is always a good idea if your doctor has not answered your questions completely or does not seem to be meeting your needs.

How are fibroids treated?

Most women with fibroids do not have any symptoms. For women who do have symptoms, there are treatments that can help. Talk with your doctor about the best way to treat your fibroids. She or he will consider many things before helping you choose a treatment. Some of these things include:

• Whether or not you are having symptoms from the fibroids

• If you might want to become pregnant in the future

• The size of the fibroids

• The location of the fibroids

• Your age and how close to menopause you might be

If you have fibroids but do not have any symptoms, you may not need treatment. Your doctor will check during your regular exams to see if they have grown.

Medications
If you have fibroids and have mild symptoms, your doctor may suggest taking medication. Over-the-counter drugs such as ibuprofen or acetaminophen can be used for mild pain. If you have heavy bleeding during your period, taking an iron supplement can keep you from getting anemia or correct it if you already are anemic.

Several drugs commonly used for birth control can be prescribed to help control symptoms of fibroids. Low-dose birth control pills do not make fibroids grow and can help control heavy bleeding. The same is true of progesterone-like injections (e.g., Depo-Provera®). An IUD (intrauterine device) called Mirena® contains a small amount of progesterone-like medication, which can be used to control heavy bleeding as well as for birth control.

Other drugs used to treat fibroids are "gonadotropin releasing hormone agonists" (GnRHa). The one most commonly used is Lupron®. These drugs, given by injection, nasal spray, or implanted, can shrink your fibroids. Sometimes they are used before surgery to make fibroids easier to remove. Side effects of GnRHas can include hot flashes, depression, not being able to sleep, decreased sex drive, and joint pain. Most women tolerate GnRHas quite well. Most women do not get a period when taking GnRHas. This can be a big relief to women who have heavy bleeding. It also allows women with anemia to recover to a normal blood count. GnRHas can cause bone thinning, so their use is generally limited to six months or less. These drugs also are very expensive, and some insurance companies will cover only some or none of the cost. GnRHas offer temporary relief from the symptoms of fibroids; once you stop taking the drugs, the fibroids often grow back quickly.

Surgery
If you have fibroids with moderate or severe symptoms, surgery may be the best way to treat them. Here are the options:

• Myomectomy (meye-oh-MEK-tuh-mee) – Surgery to remove fibroids without taking out the healthy tissue of the uterus. It is best for women who wish to have children after treatment for their fibroids or who wish to keep their uterus for other reasons. You can become pregnant after myomectomy. But if your fibroids were imbedded deeply in the uterus, you might need a cesarean section to deliver. Myomectomy can be performed in many ways. It can be major surgery (involving cutting into the abdomen) or performed with laparoscopy or hysteroscopy. The type of surgery that can be done depends on the type, size, and location of the fibroids. After myomectomy new fibroids can grow and cause trouble later. All of the possible risks of surgery are true for myomectomy. The risks depend on how extensive the surgery is.

• Hysterectomy (hiss-tur-EK-tuh-mee) – Surgery to remove the uterus. This surgery is the only sure way to cure uterine fibroids. Fibroids are the most common reason that hysterectomy is performed. This surgery is used when a woman's fibroids are large, if she has heavy bleeding, is either near or past menopause, or does not want children. If the fibroids are large, a woman may need a hysterectomy that involves cutting into the abdomen to remove the uterus. If the fibroids are smaller, the doctor may be able to reach the uterus through the vagina, instead of making a cut in the abdomen. In some cases hysterectomy can be performed through the laparoscope. Removal of the ovaries and the cervix at the time of hysterectomy is usually optional. Women whose ovaries are not removed do not go into menopause at the time of hysterectomy. Hysterectomy is a major surgery. Although hysterectomy is usually quite safe, it does carry a significant risk of complications. Recovery from hysterectomy usually takes several weeks.

• Endometrial Ablation (en-doh-MEE-tree-uhl uh-BLAY-shuhn) – The lining of the uterus is removed or destroyed to control very heavy bleeding. This can be done with laser, wire loops, boiling water, electric current, microwaves, freezing, and other methods. This procedure usually is considered minor surgery. It can be done on an outpatient basis or even in a doctor's office. Complications can occur, but are uncommon with most of the methods. Most people recover quickly. About half of women who have this procedure have no more menstrual bleeding. About three in 10 women have much lighter bleeding. But, a woman cannot have children after this surgery.

• Myolysis (meye-OL-uh-siss) – A needle is inserted into the fibroids, usually guided by laparoscopy, and electric current or freezing is used to destroy the fibroids.

• Uterine Fibroid Embolization (UFE), or Uterine Artery Embolization (UAE) – A thin tube is thread into the blood vessels that supply blood to the fibroid. Then, tiny plastic or gel particles are injected into the blood vessels. This blocks the blood supply to the fibroid, causing it to shrink. UFE can be an outpatient or inpatient procedure. Complications, including early menopause, are uncommon but can occur. Studies suggest fibroids are not likely to grow back after UFE, but more long-term research is needed. Not all fibroids can be treated with UFE. The best candidates for UFE are women who:

  • Have fibroids that are causing heavy bleeding

  • Have fibroids that are causing pain or pressing on the bladder or rectum

  • Don't want to have a hysterectomy

  • Don't want to have children in the future

What new treatments are available for uterine fibroids?

The following methods are not yet standard treatments, so your doctor may not offer them or health insurance may not cover them.

• Radiofrequency ablation uses heat to destroy fibroid tissue without harming surrounding normal uterine tissue. The fibroids remain inside the uterus but shrink in size. Most women go home the same day and can return to normal activities within a few days.

• Anti-hormonal drugs may provide symptom relief without bone-thinning side effects.

More information on uterine fibroids

For more information about uterine fibroids, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

• American College of Obstetricians and Gynecologists
  Phone: 202-638-5577

• Center for Uterine Fibroids
  Phone: 800-722-5520

• National Institute of Child Health and Human Development, NIH, HHS
  Phone: 800-370-2943 (TDD: 888-320-6942)

Content last updated: January 15, 2015.

Source: Office on Women;s Health, HHS

Introduction 

Pelvic inflammatory disease (PID) is an infection of the female upper genital tract, including the womb, fallopian tubes and ovaries.

PID is a common condition, although it is not clear how many women are affected in the UK because it doesn't always have any obvious symptoms.

PID mostly affects sexually active women from the age of 15 to 24.

Symptoms of pelvic inflammatory disease

PID can be difficult to recognise if the symptoms are mild, and some women don’t have any symptoms.

Most women have mild symptoms that may include one or more of the following:

• pain around the pelvis or lower abdomen (tummy)

• discomfort or pain during sex that is felt deep inside the pelvis

• pain during urination

• bleeding between periods and after sex

• heavy or painful periods

• unusual vaginal discharge, especially if it is yellow or green

A few women become very ill with:

• severe lower abdominal pain

• a high temperature (fever)

• nausea and vomiting

When to seek medical advice

It’s important to visit your GP or a sexual health clinic if you experience any of the above symptoms. If you have severe pain you should seek urgent medical attention from your GP or local emergency department. Delaying treatment for PID or having repeated episodes of PID can increase your risk of serious and long-term complications (see below).

There is no simple test to diagnose PID. Diagnosis is based on your symptoms and the finding of tenderness on a vaginal (internal) examination. Swabs will be taken from your vagina and cervix (the neck of the womb), but negative swabs do not exclude PID. 

Read more about diagnosing PID.

Causes of pelvic inflammatory disease

Most cases of PID are caused by a bacterial infection that has spread from the vagina or the cervix to the reproductive organs higher up.

Many different types of bacteria can cause PID. In about one in every four cases it is caused by a sexually transmitted infection (STI) such as chlamydia or gonorrhoea. In many other cases it is caused by bacteria that normally live in the vagina.

Read more about the causes of PID.

How pelvic inflammatory disease is treated

If diagnosed at an early stage, PID can be treated with a course of antibiotics, which usually lasts for 14 days. You will be given a mixture of antibiotics to cover the most likely infections, and often an injection as well as tablets.

It is important to complete the whole course and avoid having sexual intercourse during this time to help ensure the infection clears.

Your recent sexual partners will also need to be tested and treated to stop the infection recurring or being spread to others.

Read more about treating PID.

Complications of pelvic inflammatory disease

The fallopian tubes can become scarred and narrowed if they are affected by PID. This can make it difficult for eggs to pass from the ovaries into the womb, which can increase your chances of having an ectopic pregnancy (a pregnancy in the fallopian tubes instead of the womb) in the future, and can make some women infertile.

It's estimated that around one in every 10 women with PID becomes infertile as a result of the condition, with the highest risk in women who have had delayed treatment or repeated episodes of PID. However, most women who are treated for PID will still be able to get pregnant without any problems.

Read more about the complications of PID.

Preventing pelvic inflammatory disease

You can help reduce your risk of PID by always using condoms with a new sexual partner until they have had a sexual health check. Chlamydia is very common in young men, and most do not have any symptoms.

If you are worried you may have an STI, visit your local GUM or sexual health clinic for advice. Find your local sexual health clinic.

If you need an invasive gynaecological procedure, such as insertion of a coil or an abortion, make sure that you have a check-up beforehand.

Read more advice about STIs. 

Introduction 

Chlamydia is one of the most common sexually transmitted infections (STIs) in the UK.

It’s passed on from one person to another through unprotected sex (sex without a condom).

In 2012, 206,912 people tested positive for chlamydia in England. 64% of people diagnosed with chlamydia were under 25 years old.

Read more information about the causes of chlamydia.

Chlamydia symptoms

Most people who have chlamydia don’t notice any symptoms, and so don't know they have it. Research suggests that 50% of men and 70-80% of women don't get symptoms at all with a chlamydia infection. 

Symptoms of chlamydia could be pain when you urinate (pee), unusual discharge from the penis, vagina or rectum or, in women, bleeding between periods or after sex.

Read more information about chlamydia symptoms.

Getting tested for chlamydia

Testing for chlamydia is done with a urine test or a swab test. You don't always have to have a physical examination by a nurse or doctor.

Anyone can get a free and confidential chlamydia test at a sexual health clinic, a GUM (genitourinary medicine) clinic or a GP surgery. Find out more about getting a chlamydia test.

People under 25 years old can also get tested by the National Chlamydia Screening Programme (NCSP). This is often in places such as pharmacies, contraception clinics or colleges.

You can also buy chlamydia testing kits to do at home, however, the accuracy of these tests varies. If you use one of these tests, talk to your pharmacist or GP.

Read more information about diagnosing chlamydia.

Treating chlamydia

Chlamydia is easily treated with antibiotics. You may be given a single dose, or a longer course of antibiotics to take for a week.

Read more information about treating chlamydia.

If chlamydia isn’t treated, the infection can sometimes spread to other parts of your body and lead to serious long-term health problems such as pelvic inflammatory disease and infertility (not being able to have children).

Read more information about complications of chlamydia.

The National Chlamydia Screening Programme

Chlamydia is most common in people under 25 years old, although people of any age can get it. If you are under 25, you can get a free, confidential chlamydia test under the National Chlamydia Screening Programme (NCSP). This offers tests in various places, including some pharmacies. Find your nearest NCSP testing site.

Some NCSP areas may also send chlamydia testing kits to you through the post. You can request these online. Find out about free online chlamydia tests for under 25s.

Find out answers to some common questions about chlamydia:

• Can chlamydia be caught only through sexual contact?

• How soon do STI symptoms appear? 

• What should I do if I think I've got an STI? 

Introduction 

Sexually transmitted infections (STIs) are passed from one person to another through unprotected sex or genital contact.

You can be tested for STIs at a sexual health clinic, genitourinary medicine (GUM) clinic or GP surgery. Search for a sexual health clinic near you and find out what services they offer.

This page provides an overview of the different STIs and links to more information about these conditions.

Chlamydia

Chlamydia is the most common STI in the UK and is easily passed on during sex. Most people don't experience any symptoms, so they are unaware they're infected.

In women, chlamydia can cause pain or a burning sensation when urinating, a vaginal discharge, pain in the lower abdomen during or after sex, and bleeding during or after sex or between periods. It can also cause heavy periods.

In men, chlamydia can cause pain or a burning sensation when urinating, a white, cloudy or watery discharge from the tip of the penis, and pain or tenderness in the testicles.

It's also possible to have a chlamydia infection in your rectum (bottom), throat or eyes.

Diagnosing chlamydia is done with a urine test or by taking a swab of the affected area. The infection is easily treated with antibiotics, but can lead to serious long-term health problems if left untreated, including infertility. 

Read more about chlamydia.

Genital warts

Genital warts are small fleshy growths, bumps or skin changes that appear on or around your genital or anal area. They're caused by the human papilloma virus (HPV) and are the second most common STI in England after chlamydia.

The warts are usually painless, but you may notice some itching or redness. Occasionally, they can cause bleeding.

You don't need to have penetrative sex to pass the infection on because HPV is spread by skin-to-skin contact.

Several treatments are available for genital warts, including creams and freezing the warts (cryotherapy).

Read more about genital warts. 

Genital herpes

Genital herpes is a common infection caused by the herpes simplex virus (HSV), which is the same virus that causes cold sores.

Some people develop symptoms of HSV a few days after coming into contact with the virus. Small, painful blisters or sores usually develop, which may cause itching or tingling, or make it painful to urinate.

After you've been infected, the virus remains dormant (inactive) most of the time. However, certain triggers can reactivate the virus, causing the blisters to develop again, although they're usually smaller and less painful.

It's easier to test for HSV if you have symptoms. Although there's no cure for genital herpes, the symptoms can usually be controlled using antiviral medicines.

Read more about genital herpes.

Gonorrhoea

Gonorrhoea is a bacterial STI easily passed on during sex. About 50% of women and 10% of men don't experience any symptoms and are unaware they're infected.

In women, gonorrhoea can cause pain or a burning sensation when urinating, a vaginal discharge (often watery, yellow or green), pain in the lower abdomen during or after sex, and bleeding during or after sex or between periods, sometimes causing heavy periods.

In men, gonorrhoea can cause pain or a burning sensation when urinating, a white, yellow or green discharge from the tip of the penis, and pain or tenderness in the testicles.

It's also possible to have a gonorrhoea infection in your rectum, throat or eyes.

Gonorrhoea is diagnosed using a urine test or by taking a swab of the affected area. The infection is easily treated with antibiotics, but can lead to serious long-term health problems if left untreated, including infertility.

Read more about gonorrhoea.

Syphilis

Syphilis is a bacterial infection that in the early stages causes a painless, but highly infectious, sore on your genitals or around the mouth. The sore can last up to six weeks before disappearing.

Secondary symptoms such as a rash, flu-like illness or patchy hair loss may then develop. These may disappear within a few weeks, after which you'll have a symptom-free phase.

The late or tertiary stage of syphilis usually occurs after many years, and can cause serious conditions such as heart problems, paralysis and blindness.

The symptoms of syphilis can be difficult to recognise. A simple blood test can usually be used to diagnose syphilis at any stage. The condition can be treated with antibiotics, usually penicillin injections. When syphilis is treated properly, the later stages can be prevented.

Read more about syphilis.

HIV

HIV is most commonly passed on through unprotected sex. It can also be transmitted by coming into contact with infected blood – for example, sharing needles to inject steroids or drugs.

The HIV virus attacks and weakens the immune system, making it less able to fight infections and disease. There's no cure for HIV, but there are treatments that allow most people to live a long and otherwise healthy life.

AIDS is the final stage of an HIV infection, when your body can no longer fight life-threatening infections.

Most people with HIV look and feel healthy and have no symptoms. When you first develop HIV, you may experience a flu-like illness with a fever, sore throat or rash. This is called a seroconversion illness.

A simple blood test is usually used to test for an HIV infection. Some clinics may also offer a rapid test using a finger-prick blood test or saliva sample.

Read more about HIV and AIDS and coping with a positive HIV test.

Trichomoniasis

Trichomoniasis is an STI caused by a tiny parasite called Trichomonas vaginalis (TV). It can be easily passed on through sex and most people don't know they're infected.

In women, trichomoniasis can cause a frothy yellow or watery vaginal discharge that has an unpleasant smell, soreness or itching around the vagina, and pain when passing urine.

In men, trichomoniasis rarely causes symptoms. You may experience pain or burning after passing urine, a whitish discharge, or an inflamed foreskin.

Trichomoniasis can sometimes be difficult to diagnose and your GP may suggest you go to a specialist clinic for a urine or swab test. Once diagnosed, it can usually be treated with antibiotics.

Read more about trichomoniasis.

Pubic lice

Pubic lice ("crabs") are easily passed to others through close genital contact. They're usually found in pubic hair, but can live in underarm hair, body hair, beards and occasionally eyebrows or eyelashes.

The lice crawl from hair to hair but don't jump or fly from person to person. It may take several weeks for you to notice any symptoms. Most people experience itching, and you may notice the lice or eggs on the hairs.

Pubic lice can usually be successfully treated with special creams or shampoos available over the counter in most pharmacies or from a GP or GUM clinic. You don't need to shave off your pubic hair or body hair.

Read more about pubic lice.

Scabies

Scabies is caused by tiny mites that burrow into the skin. It can be passed on through close body or sexual contact, or from infected clothing, bedding or towels.

If you develop scabies, you may have intense itching that's worse at night. The itching can be in your genital area, but it also often occurs between your fingers, on wrists and ankles, under your arms, or on your body and breasts.

You may have a rash or tiny spots. In some people, scabies can be confused with eczema. It's usually very difficult to see the mites.

Scabies can usually be successfully treated using special creams or shampoos available over the counter in most pharmacies, or from a GP or GUM clinic. The itching can sometimes continue for a short period, even after effective treatment.

Read more about scabies.

Introduction 

Gonorrhoea is a sexually transmitted infection (STI) caused by bacteria called Neisseria gonorrhoeae or gonococcus. It used to be known as "the clap".

The bacteria are mainly found in discharge from the penis and vaginal fluid from infected men and women.

Gonorrhoea is easily passed between people through:

• unprotected vaginal, oral or anal sex

• sharing vibrators or other sex toys that haven't been washed or covered with a new condom each time they are used

The bacteria can infect the cervix (entrance to the womb), the urethra (tube that carries urine out of the body), the rectum and, less commonly, the throat or eyes. The infection can also be passed from a pregnant woman to her baby.

Gonorrhoea is not spread by kissing, hugging, sharing baths or towels, swimming pools, toilet seats, or sharing cups, plates and cutlery, because the bacteria can't survive outside the human body for long.

Signs and symptoms

Typical symptoms of gonorrhoea include a thick green or yellow discharge from the vagina or penis, pain when urinating and bleeding in between periods in women.

However, around 1 in 10 infected men and almost half of infected women don't experience any symptoms.

Read more about the symptoms of gonorrhoea.

Getting tested

If you have any of the symptoms of gonorrhoea or you are worried you may have an STI, you should visit your local genitourinary medicine (GUM) or sexual health clinic for a sexual health test.

Gonorrhoea can be easily diagnosed by testing a sample of discharge picked up using a swab. Testing a sample of urine can also be used to diagnose the condition in men.

It's important to get tested as soon as possible because gonorrhoea can lead to more serious long-term health problems if it's not treated, including pelvic inflammatory disease (PID) in women, or infertility.

You can find your nearest sexual health clinic by searching by postcode or town.

For information on all sexual health services, visit the FPA website.

Read more about diagnosing gonorrhoea and the possible complications of gonorrhoea.

Treating gonorrhoea

Gonorrhoea is usually treated with a single antibiotic injection and a single antibiotic tablet. With effective treatment, most of your symptoms should improve within a few days.

It's usually recommended that you attend a follow-up appointment a week or two after treatment so another test can be carried out to see if you are clear of infection.

You should avoid having sex until you have been given the all-clear.

Read more about how gonorrhoea is treated.

Who is affected?

Anyone who is sexually active can catch gonorrhoea, especially people who change partners frequently or don't use a barrier method of contraception such as a condom when having sex.

Gonorrhoea is the second most common bacterial STI in the UK after chlamydia. More than 25,000 cases were reported in England during 2012, with most cases affecting young men and women under the age of 25.

Previous successful treatment for gonorrhoea doesn't make you immune from catching the infection again.

Preventing gonorrhoea

Gonorrhoea and other STIs can be successfully prevented by using appropriate contraception and taking other precautions, such as:

• using male condoms or female condoms every time you have vaginal sex, or male condoms during anal sex

• using a condom to cover the penis, or a latex or plastic square (dam) to cover the female genitals, if you have oral sex

• not sharing sex toys, or washing them and covering them with a new condom before anyone else uses them

If you are worried you may have an STI, visit your local GUM or sexual health clinic for advice.

Page last reviewed: 27/04/2015

Next review due: 27/04/2017

 Source: NHS Choices, UK

Birth control methods fact sheet

• What is the best method of birth control (or contraception)?

• What are the different types of birth control?

• Can all types of birth control prevent sexually transmitted infections (STIs)?

• How well do different kinds of birth control work? Do they have side effects?

• Where can I get birth control? Do I need to see a doctor?

• Are there any foams or gels I can use to keep from getting pregnant?

• How effective is withdrawal as a birth control method?

• Everyone I know is on the pill. Is it safe?

• Will birth control pills protect me from sexually transmitted infections (STIs), including HIV/AIDS?

• I've heard my girlfriends talking about dental dams — what are they?

• More information on birth control methods

What is the best method of birth control (or contraception)?

There is no "best" method of birth control. Each method has its pros and cons.

All women and men can have control over when, and if, they become parents. Making choices about birth control, or contraception, isn't easy. There are many things to think about. To get started, learn about birth control methods you or your partner can use to prevent pregnancy. You can also talk with your doctor about the choices.

Before choosing a birth control method, think about:

• Your overall health

• How often you have sex

• The number of sex partners you have

• If you want to have children someday

• How well each method works to prevent pregnancy

• Possible side effects

• Your comfort level with using the method

Keep in mind, even the most effective birth control methods can fail. But your chances of getting pregnant are lowest if the method you choose always is used correctly and every time you have sex.

What are the different types of birth control?

You can choose from many methods of birth control. They are grouped by how they work:

Types of birth control

Detailed information on each type is provided in the following charts. Talk with your doctor if you have questions about any of the choices.

Continuous abstinence
This means not having sex (vaginal, anal, or oral) at any time. It is the only sure way to prevent pregnancy and protect against sexually transmitted infections (STIs), including HIV.

Natural family planning/rhythm method

This method is when you do not have sex or use a barrier method on the days you are most fertile (most likely to become pregnant). You can read about barrier methods in the following chart. A woman who has a regular menstrual cycle has about 9 or more days each month when she is able to get pregnant. These fertile days are about 5 days before and 3 days after ovulation, as well as the day of ovulation. To have success with this method, you need to learn about your menstrual cycle. Then you can learn to predict which days you are fertile or "unsafe." To learn about your cycle, keep a written record of: When you get your period What it is like (heavy or light blood flow) How you feel (sore breasts, cramps) This method also involves checking your cervical mucus and recording your body temperature each day. Cervical mucus is the discharge from your vagina. You are most fertile when it is clear and slippery like raw egg whites. Use a basal thermometer to take your temperature and record it in a chart. Your temperature will rise 0.4 to 0.8° F on the first day of ovulation. You can talk with your doctor or a natural family planning instructor to learn how to record and understand this information.

Barrier methods — Put up a block, or barrier, to keep sperm from reaching the egg
Contraceptive sponge This barrier method is a soft, disk-shaped device with a loop for taking it out. It is made out of polyurethane (pah-lee-YUR-uh-thayn) foam and contains the spermicide (SPUR-muh-syd) nonoxynol-9. Spermicide kills sperm. Before having sex, you wet the sponge and place it, loop side down, inside your vagina to cover the cervix. The sponge is effective for more than one act of intercourse for up to 24 hours. It needs to be left in for at least 6 hours after having sex to prevent pregnancy. It must then be taken out within 30 hours after it is inserted. Only one kind of contraceptive sponge is sold in the United States. It is called the Today Sponge. Women who are sensitive to the spermicide nonoxynol-9 should not use the sponge.
Diaphragm, cervical cap, and cervical shield These barrier methods block the sperm from entering the cervix (the opening to your womb) and reaching the egg. The diaphragm is a shallow latex cup. The cervical cap is a thimble-shaped latex cup. It often is called by its brand name, FemCap. The cervical shield is a silicone cup that has a one-way valve that creates suction and helps it fit against the cervix. It often is called by its brand name, Lea's Shield. The diaphragm and cervical cap come in different sizes, and you need a doctor to "fit" you for one. The cervical shield comes in one size, and you will not need a fitting. Before having sex, add spermicide (to block or kill sperm) to the devices. Then place them inside your vagina to cover your cervix. You can buy spermicide gel or foam at a drug store. All three of these barrier methods must be left in place for 6 to 8 hours after having sex to prevent pregnancy. The diaphragm should be taken out within 24 hours. The cap and shield should be taken out within 48 hours.
Female condom This condom is worn by the woman inside her vagina. It keeps sperm from getting into her body. It is made of thin, flexible, manmade rubber and is packaged with a lubricant. It can be inserted up to 8 hours before having sex.  Use a new condom each time you have intercourse. And don't use it and a male condom at the same time.
Male condom Male condoms are a thin sheath placed over an erect penis to keep sperm from entering a woman's body. Condoms can be made of latex, polyurethane, or "natural/lambskin". The natural kind do not protect against STIs. Condoms work best when used with a vaginal spermicide, which kills the sperm. And you need to use a new condom with each sex act. Condoms are either: Lubricated, which can make sexual intercourse more comfortable Non-lubricated, which can also be used for oral sex. It is best to add lubrication to non-lubricated condoms if you use them for vaginal or anal sex. You can use a water-based lubricant, such as K-Y jelly. You can buy them at the drug store. Oil-based lubricants like massage oils, baby oil, lotions, or petroleum jelly will weaken the condom, causing it to tear or break. Keep condoms in a cool, dry place. If you keep them in a hot place (like a wallet or glove compartment), the latex breaks down. Then the condom can tear or break.

Hormonal methods — Prevent pregnancy by interfering with ovulation, fertilization, and/or implantation of the fertilized egg
Oral contraceptives — combined pill ("The pill") The pill contains the hormones estrogen and progestin. It is taken daily to keep the ovaries from releasing an egg. The pill also causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining the egg. Some women prefer the "extended cycle" pills. These have 12 weeks of pills that contain hormones (active) and 1 week of pills that don't contain hormones (inactive). While taking extended cycle pills, women only have their period three to four times a year. Many types of oral contraceptives are available. Talk with your doctor about which is best for you. Your doctor may advise you not to take the pill if you: Are older than 35 and smoke Have a history of blood clots Have a history of breast, liver, or endometrial cancer Antibiotics may reduce how well the pill works in some women. Talk to your doctor about a backup method of birth control if you need to take antibiotics. Women should wait three weeks after giving birth to begin using birth control that contains both estrogen and progestin. These methods increase the risk of dangerous blood clots that could form after giving birth. Women who delivered by cesarean section or have other risk factors for blood clots, such as obesity, history of blood clots, smoking, or preeclampsia, should wait six weeks.
The patch Also called by its brand name, Ortho Evra, this skin patch is worn on the lower abdomen, buttocks, outer arm, or upper body. It releases the hormones progestin and estrogen into the bloodstream to stop the ovaries from releasing eggs in most women. It also thickens the cervical mucus, which keeps the sperm from joining with the egg. You put on a new patch once a week for 3 weeks. You don't use a patch the fourth week in order to have a period. Women should wait three weeks after giving birth to begin using birth control that contains both estrogen and progestin. These methods increase the risk of dangerous blood clots that could form after giving birth. Women who delivered by cesarean section or have other risk factors for blood clots, such as obesity, history of blood clots, smoking, or preeclampsia, should wait six weeks.
Shot/injection The birth control shot often is called by its brand name Depo-Provera. With this method you get injections, or shots, of the hormone progestin in the buttocks or arm every 3 months. A new type is injected under the skin. The birth control shot stops the ovaries from releasing an egg in most women. It also causes changes in the cervix that keep the sperm from joining with the egg. The shot should not be used more than 2 years in a row because it can cause a temporary loss of bone density. The loss increases the longer this method is used. The bone does start to grow after this method is stopped. But it may increase the risk of fracture and osteoporosis if used for a long time.
Vaginal ring This is a thin, flexible ring that releases the hormones progestin and estrogen. It works by stopping the ovaries from releasing eggs. It also thickens the cervical mucus, which keeps the sperm from joining the egg. It is commonly called NuvaRing, its brand name. You squeeze the ring between your thumb and index finger and insert it into your vagina. You wear the ring for 3 weeks, take it out for the week that you have your period, and then put in a new ring. Women should wait three weeks after giving birth to begin using birth control that contains both estrogen and progestin. These methods increase the risk of dangerous blood clots that could form after giving birth. Women who delivered by cesarean section or have other risk factors for blood clots, such as obesity, history of blood clots, smoking, or preeclampsia, should wait six weeks.

Implantable devices — Devices that are inserted into the body and left in place for a few years.
Implantable rod This is a matchstick-size, flexible rod that is put under the skin of the upper arm. It is often called by its brand name, Implanon. The rod releases a progestin, which causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining an egg. Less often, it stops the ovaries from releasing eggs. It is effective for up to 3 years.
Intrauterine devices or IUDs An IUD is a small device shaped like a "T" that goes in your uterus. There are two types: Copper IUD — The copper IUD goes by the brand name ParaGard. It releases a small amount of copper into the uterus, which prevents the sperm from reaching and fertilizing the egg. If fertilization does occur, the IUD keeps the fertilized egg from implanting in the lining of the uterus. A doctor needs to put in your copper IUD. It can stay in your uterus for 5 to 10 years. Hormonal IUD — The hormonal IUD goes by the brand name Mirena. It is sometimes called an intrauterine system, or IUS. It releases progestin into the uterus, which keeps the ovaries from releasing an egg and causes the cervical mucus to thicken so sperm can't reach the egg. It also affects the ability of a fertilized egg to successfully implant in the uterus. A doctor needs to put in a hormonal IUD. It can stay in your uterus for up to 5 years.

Permanent birth control methods — For people who are sure they never want to have a child or they do not want more children
Sterilization implant (essure) Essure is the first non-surgical method of sterilizing women. A thin tube is used to thread a tiny spring-like device through the vagina and uterus into each fallopian tube. The device works by causing scar tissue to form around the coil. This blocks the fallopian tubes and stops the egg and sperm from joining. It can take about 3 months for the scar tissue to grow, so it's important to use another form of birth control during this time. Then you will have to return to your doctor for a test to see if scar tissue has fully blocked your tubes.
Surgical sterilization For women, surgical sterilization closes the fallopian tubes by being cut, tied, or sealed. This stops the eggs from going down to the uterus where they can be fertilized. The surgery can be done a number of ways. Sometimes, a woman having cesarean birth has the procedure done at the same time, so as to avoid having additional surgery later. For men, having a vasectomy (vuh-SEK-tuh-mee) keeps sperm from going to his penis, so his ejaculate never has any sperm in it. Sperm stays in the system after surgery for about 3 months. During that time, use a backup form of birth control to prevent pregnancy. A simple test can be done to check if all the sperm is gone; it is called a semen analysis.

Emergency contraception — Used if a woman's primary method of birth control fails. It should not be used as a regular method of birth control.

Emergency contraception (Plan B One-Step or Next Choice. It is also called the "morning after pill.") Emergency contraception keeps a woman from getting pregnant when she has had unprotected vaginal intercourse. "Unprotected" can mean that no method of birth control was used. It can also mean that a birth control method was used but it was used incorrectly, or did not work (like a condom breaking). Or, a woman may have forgotten to take her birth control pills. She also may have been abused or forced to have sex. These are just some of the reasons women may need emergency contraception. Emergency contraception can be taken as a single pill treatment or in two doses. A single dose treatment works as well as two doses and does not have more side effects. It works by stopping the ovaries from releasing an egg or keeping the sperm from joining with the egg. For the best chances for it to work, take the pill as soon as possible after unprotected sex. It should be taken within 72 hours after having unprotected sex. A single-pill dose or two-pill dose of emergency contraception is available over-the-counter (OTC) for women ages 17 and older.

Can all types of birth control prevent sexually transmitted infections (STIs)?

No. The male latex condom is the only birth control method proven to help protect you from STIs, including HIV. Research is being done to find out how effective the female condom is at preventing STIs and HIV. For more information, see Will birth control pills protect me from sexually transmitted infections (STIs), including HIV/AIDS?

 How well do different kinds of birth control work? Do they have side effects?

All birth control methods work the best if used correctly and every time you have sex. Be sure you know the right way to use them. Sometimes doctors don't explain how to use a method because they assume you already know. Talk with your doctor if you have questions. They are used to talking about birth control. So don't feel embarrassed about talking to him or her.

Some birth control methods can take time and practice to learn. For example, some people don't know you can put on a male condom "inside out." Also, not everyone knows you need to leave a little space at the tip of the condom for the sperm and fluid when a man ejaculates, or has an orgasm.

Here is a list of some birth control methods with their failure rates and possible side effects.

Birth control methods, failure rates, and side effects

Method	Failure rate (the number of pregnancies expected per 100 women)	Some side effects and risks
Sterilization surgery for women	Less than 1 pregnancy	Pain Bleeding Complications from surgery Ectopic (tubal) pregnancy
Sterilization implant for women (Essure)	Less than 1 pregnancy	Pain Ectopic (tubal) pregnancy
Sterilization surgery for men	Less than 1 pregnancy	Pain Bleeding Complications from surgery
Implantable rod (Implanon)	Less than 1 pregnancy Might not work as well for women who are overweight or obese.	Acne Weight gain Ovarian cysts Mood changes Depression Hair loss Headache Upset stomach Dizziness Sore breasts Changes in period Lower interest in sex
Intrauterine device (ParaGard, Mirena)	Less than 1 pregnancy	Cramps Bleeding between periods Pelvic inflammatory disease Infertility Tear or hole in the uterus
Shot/injection (Depo-Provera)	Less than 1 pregnancy	Bleeding between periods Weight gain Sore breasts Headaches Bone loss with long-term use
Oral contraceptives (combination pill, or "the pill")	5 pregnancies Being overweight may increase the chance of getting pregnant while using the pill.	Dizziness Upset stomach Changes in your period Changes in mood Weight gain High blood pressure Blood clots Heart attack Stroke New vision problems
Oral contraceptives (continuous/extended use, or "no-period pill")	5 pregnancies Being overweight may increase the chance of getting pregnant while using the pill.	Same as combination pill Spotting or bleeding between periods Hard to know if pregnant
Oral contraceptives (progestin-only pill, or "mini-pill")	5 pregnancies Being overweight may increase the chance of getting pregnant while using the pill.	Spotting or bleeding between periods Weight gain Sore breasts
Skin patch (Ortho Evra)	5 pregnancies May not work as well in women weighing more than 198 pounds.	Similar to side effects for the combination pill Greater exposure to estrogen than with other methods
Vaginal ring (NuvaRing)	5 pregnancies	Similar to side effects for the combination pill Swelling of the vagina Irritation Vaginal discharge
Male condom	11-16 pregnancies	Allergic reactions
Diaphragm with spermicide	15 pregnancies	Irritation Allergic reactions Urinary tract infection Toxic shock if left in too long
Sponge with spermicide (Today Sponge)	16-32 pregnancies	Irritation Allergic reactions Hard time taking it out Toxic shock if left in too long
Cervical cap with spermicide	17-23 pregnancies	Irritation Allergic reactions Abnormal Pap smear Toxic shock if left in too long
Female condom	20 pregnancies	Irritation Allergic reactions
Natural family planning (rhythm method)	25 pregnancies	None
Spermicide alone	30 pregnancies It works best if used along with a barrier method, such as a condom.	Irritation Allergic reactions Urinary tract infection
Emergency contraception ("morning-after pill," "Plan B One-Step," "Next Choice")	1 pregnancy It must be used within 72 hours of having unprotected sex. Should not be used as regular birth control; only in emergencies.	Upset stomach Vomiting Lower stomach pain Fatigue Headache and dizziness Irregular bleeding Breast tenderness

Where can I get birth control? Do I need to see a doctor?

Where you get birth control depends on what method you choose.

You can buy these forms over the counter:

• Male condoms

• Female condoms

• Sponges

• Spermicides

• Emergency contraception pills (girls younger than 17 need a prescription)

You need a prescription for these forms:

• Oral contraceptives: the pill, the mini-pill

• Skin patch

• Vaginal ring

• Diaphragm (your doctor needs to fit one to your shape)

• Cervical cap

• Cervical shield

• Shot/injection (you get the shot at your doctor's office)

• IUD (inserted by a doctor)

• Implantable rod (inserted by a doctor)

You will need surgery or a medical procedure for:

• Sterilization, female and male

Are there any foams or gels I can use to keep from getting pregnant?

You can buy spermicides over the counter. They work by killing sperm. They come in many forms:

• Foam

• Gel

• Cream

• Film

• Suppository

• Tablet

Spermicides are put in the vagina no more than 1 hour before having sex. If you use a film, suppository, or tablet, wait at least 15 minutes before having sex so the spermicide can dissolve. Do not douche or rinse out your vagina for at least 6 to 8 hours after having sex. You will need to use more spermicide each time you have sex.

Spermicides work best if used along with a barrier method, such as a condom, diaphragm, or cervical cap. Some spermicides are made just for use with the diaphragm and cervical cap. Check the package to make sure you are buying what you need.

All spermicides contain sperm-killing chemicals. Some contain nonoxynol-9, which may raise your risk of HIV if you use it a lot. It irritates the tissue in the vagina and anus, so it can cause the HIV virus to enter the body more freely. Some women are sensitive to nonoxynol-9 and need to use spermicides without it. Medications for vaginal yeast infections may lower the effectiveness of spermicides. Also, spermicides do not protect against sexually transmitted infections.

How effective is withdrawal as a birth control method?

Not very! Withdrawal is when a man takes his penis out of a woman's vagina (or "pulls out") before he ejaculates, or has an orgasm. This stops the sperm from going to the egg. "Pulling out" can be hard for a man to do. It takes a lot of self-control.

Even if you use withdrawal, sperm can be released before the man pulls out. When a man's penis first becomes erect, pre-ejaculate fluid may be on the tip of the penis. This fluid has sperm in it. So you could still get pregnant.

Withdrawal does not protect you from STIs or HIV.

Everyone I know is on the pill. Is it safe?

Today's pills have lower doses of hormones than ever before. This has greatly lowered the risk of side effects. But there are still pros and cons with taking birth control pills. Pros include having:

• More regular and lighter periods

• Fewer menstrual cramps

• A lower risk of ovarian and endometrial cancers, pelvic inflammatory disease (PID), noncancerous ovarian cysts, and iron deficiency anemia

Cons include a higher chance, for some women, of:

• Heart disease, high blood pressure, and blood clots

• Nausea, headaches, sore breasts, and weight gain

• Irregular bleeding

• Depression

Many of these side effects go away after taking the pill for a few months. Women who smoke, are older than 35, or have a history of blood clots or breast or endometrial cancer are more at risk of bad side effects and may not be able to take the pill. Talk with your doctor about whether the pill is right for you.

Will birth control pills protect me from sexually transmitted infections (STIs), including HIV/AIDS?

No, they won't protect you. Birth control pills and most other birth control methods will not protect you from STIs, including HIV (the virus that causes AIDS). They only protect against pregnancy.

The male latex condom is the best birth control method that also can protect you from STIs, including HIV. If you are allergic to latex, polyurethane condoms are a good alternative. If your partner can't or won't use a male condom, female condoms also create a barrier that can help protect you from STIs.

It is important to only use latex or polyurethane condoms to protect you from STIs. "Natural" or "lambskin" condoms have tiny pores that may allow for the passage of viruses like HIV, hepatitis B, and herpes. If you use non-lubricated male condoms for vaginal or anal sex, you can add lubrication with water-based lubricants (like K-Y jelly) that you can buy at a drug store. Never use oil-based products, such as massage oils, baby oil, lotions, or petroleum jelly, to lubricate a male condom. These will weaken the condom, causing it to tear or break. Use a new condom with each sex act.

I've heard my girlfriends talking about dental dams — what are they?

The dental dam is a square piece of rubber that is used by dentists during oral surgery and other procedures. It is not a method of birth control. But it can be used to help protect people from STIs, including HIV, during oral-vaginal or oral-anal sex. It is placed over the opening to the vagina or the anus before having oral sex. You can buy dental dams at surgical supply stores.

More information on birth control methods

For more information about birth control methods, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

• American College of Obstetricians and Gynecologists
  Phone: 800-762-2264 x 349 (for publications requests only)

• Food and Drug Administration
  Phone: 888-463-6332

• Planned Parenthood Federation of America
  Phone: 800-230-7526

• Population Council
  Phone: 212-339-0500

Source: Office on Women's Health, HHS

Infertility fact sheet

• What is infertility?

• Is infertility a common problem?

• Is infertility just a woman's problem?

• What causes infertility in men?

• What increases a man's risk of infertility?

• What causes infertility in women?

• What things increase a woman's risk of infertility?

• How does age affect a woman's ability to have children?

• How long should women try to get pregnant before calling their doctors?

• How will doctors find out if a woman and her partner have fertility problems?

• How do doctors treat infertility?

• What medicines are used to treat infertility in women?

• What is intrauterine insemination (IUI)?

• What is assisted reproductive technology (ART)?

• How often is assisted reproductive technology (ART) successful?

• What are the different types of assisted reproductive technology (ART)?

• More information on infertility

What is infertility?

Infertility means not being able to get pregnant after one year of trying (or six months if a woman is 35 or older). Women who can get pregnant but are unable to stay pregnant may also be infertile.

Pregnancy is the result of a process that has many steps. To get pregnant:

• A woman's body must release an egg from one of her ovaries (ovulation).

• The egg must go through a fallopian tube toward the uterus (womb).

• A man's sperm must join with (fertilize) the egg along the way.

• The fertilized egg must attach to the inside of the uterus (implantation).

Infertility can happen if there are problems with any of these steps.

Is infertility a common problem?

Yes. About 10 percent of women (6.1 million) in the United States ages 15-44 have difficulty getting pregnant or staying pregnant, according to the Centers for Disease Control and Prevention (CDC).

Is infertility just a woman's problem?

No, infertility is not always a woman's problem. Both women and men can have problems that cause infertility. About one-third of infertility cases are caused by women's problems. Another one third of fertility problems are due to the man. The other cases are caused by a mixture of male and female problems or by unknown problems.

What causes infertility in men?

Infertility in men is most often caused by:

• A problem called varicocele (VAIR-ih-koh-seel). This happens when the veins on a man's testicle(s) are too large. This heats the testicles. The heat can affect the number or shape of the sperm.

• Other factors that cause a man to make too few sperm or none at all.

• Movement of the sperm. This may be caused by the shape of the sperm. Sometimes injuries or other damage to the reproductive system block the sperm.

Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men.

What increases a man's risk of infertility?

A man's sperm can be changed by his overall health and lifestyle. Some things that may reduce the health or number of sperm include:

• Heavy alcohol use

• Drugs

• Smoking cigarettes

• Age

• Environmental toxins, including pesticides and lead

• Health problems such as mumps, serious conditions like kidney disease, or hormone problems

• Medicines

• Radiation treatment and chemotherapy for cancer

What causes infertility in women?

Most cases of female infertility are caused by problems with ovulation. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods.

Ovulation problems are often caused by polycystic ovarian syndrome (PCOS). PCOS is a hormone imbalance problem which can interfere with normal ovulation. PCOS is the most common cause of female infertility. Primary ovarian insufficiency (POI) is another cause of ovulation problems. POI occurs when a woman's ovaries stop working normally before she is 40. POI is not the same as early menopause.

Less common causes of fertility problems in women include:

• Blocked fallopian tubes due to pelvic inflammatory disease, endometriosis, or surgery for an ectopic pregnancy

• Physical problems with the uterus

• Uterine fibroids, which are non-cancerous clumps of tissue and muscle on the walls of the uterus.

What things increase a woman's risk of infertility?

Many things can change a woman's ability to have a baby. These include:

• Age

• Smoking

• Excess alcohol use

• Stress

• Poor diet

• Athletic training

• Being overweight or underweight

• Sexually transmitted infections (STIs)

• Health problems that cause hormonal changes, such as polycystic ovarian syndrome and primary ovarian insufficiency

How does age affect a woman's ability to have children?

Many women are waiting until their 30s and 40s to have children. In fact, about 20 percent of women in the United States now have their first child after age 35. So age is a growing cause of fertility problems. About one-third of couples in which the woman is over 35 have fertility problems.

Aging decreases a woman's chances of having a baby in the following ways:

• Her ovaries become less able to release eggs

• She has a smaller number of eggs left

• Her eggs are not as healthy

• She is more likely to have health conditions that can cause fertility problems

• She is more likely to have a miscarriage

How long should women try to get pregnant before calling their doctors?

Most experts suggest at least one year. Women 35 or older should see their doctors after six months of trying. A woman's chances of having a baby decrease rapidly every year after the age of 30.

Some health problems also increase the risk of infertility. So, women should talk to their doctors if they have:

• Irregular periods or no menstrual periods

• Very painful periods

• Endometriosis

• Pelvic inflammatory disease

• More than one miscarriage

It is a good idea for any woman to talk to a doctor before trying to get pregnant. Doctors can help you get your body ready for a healthy baby. They can also answer questions on fertility and give tips on conceiving.

How will doctors find out if a woman and her partner have fertility problems?

Doctors will do an infertility checkup. This involves a physical exam. The doctor will also ask for both partners' health and sexual histories. Sometimes this can find the problem. However, most of the time, the doctor will need to do more tests.

In men, doctors usually begin by testing the semen. They look at the number, shape, and movement of the sperm. Sometimes doctors also suggest testing the level of a man's hormones.

In women, the first step is to find out if she is ovulating each month. There are a few ways to do this. A woman can track her ovulation at home by:

• Writing down changes in her morning body temperature for several months

• Writing down how her cervical mucus looks for several months

• Using a home ovulation test kit (available at drug or grocery stores)

Doctors can also check ovulation with blood tests. Or they can do an ultrasound of the ovaries. If ovulation is normal, there are other fertility tests available.

Some common tests of fertility in women include:

• Hysterosalpingography (HIS-tur-oh-sal-ping-GOGH-ru-fee): This is an x-ray of the uterus and fallopian tubes. Doctors inject a special dye into the uterus through the vagina. This dye shows up in the x-ray. Doctors can then watch to see if the dye moves freely through the uterus and fallopian tubes. This can help them find physical blocks that may be causing infertility. Blocks in the system can keep the egg from moving from the fallopian tube to the uterus. A block could also keep the sperm from reaching the egg.

• Laparoscopy (lap-uh-ROS-kuh-pee): A minor surgery to see inside the abdomen. The doctor does this with a small tool with a light called a laparoscope (LAP-uh-roh-skohp). She or he makes a small cut in the lower abdomen and inserts the laparoscope. With the laparoscope, the doctor can check the ovaries, fallopian tubes, and uterus for disease and physical problems. Doctors can usually find scarring and endometriosis by laparoscopy.

Finding the cause of infertility can be a long and emotional process. It may take time to complete all the needed tests. So don't worry if the problem is not found right away.

How do doctors treat infertility?

Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology. Many times these treatments are combined. In most cases infertility is treated with drugs or surgery.

Doctors recommend specific treatments for infertility based on:

• Test results

• How long the couple has been trying to get pregnant

• The age of both the man and woman

• The overall health of the partners

• Preference of the partners

Doctors often treat infertility in men in the following ways:

• Sexual problems: Doctors can help men deal with impotence or premature ejaculation. Behavioral therapy and/or medicines can be used in these cases.

• Too few sperm: Sometimes surgery can correct the cause of the problem. In other cases, doctors surgically remove sperm directly from the male reproductive tract. Antibiotics can also be used to clear up infections affecting sperm count.

• Sperm movement: Sometimes semen has no sperm because of a block in the man’s system. In some cases, surgery can correct the problem.

In women, some physical problems can also be corrected with surgery.

A number of fertility medicines are used to treat women with ovulation problems. It is important to talk with your doctor about the pros and cons of these medicines. You should understand the possible dangers, benefits, and side effects.

What medicines are used to treat infertility in women?

Some common medicines used to treat infertility in women include:

• Clomiphene citrate (Clomid): This medicine causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. This medicine is taken by mouth.

• Human menopausal gonadotropin or hMG (Repronex, Pergonal): This medicine is often used for women who don't ovulate due to problems with their pituitary gland. hMG acts directly on the ovaries to stimulate ovulation. It is an injected medicine.

• Follicle-stimulating hormone or FSH (Gonal-F, Follistim): FSH works much like hMG. It causes the ovaries to begin the process of ovulation. These medicines are usually injected.

• Gonadotropin-releasing hormone (Gn-RH) analog: These medicines are often used for women who don't ovulate regularly each month. Women who ovulate before the egg is ready can also use these medicines. Gn-RH analogs act on the pituitary gland to change when the body ovulates. These medicines are usually injected or given with a nasal spray.

• Metformin (Glucophage): Doctors use this medicine for women who have insulin resistance and/or PCOS. This drug helps lower the high levels of male hormones in women with these conditions. This helps the body to ovulate. Sometimes clomiphene citrate or FSH is combined with metformin. This medicine is usually taken by mouth.

• Bromocriptine (Parlodel): This medicine is used for women with ovulation problems due to high levels of prolactin. Prolactin is a hormone that causes milk production.

Many fertility drugs increase a woman's chance of having twins, triplets, or other multiples. Women who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born too early (prematurely). Premature babies are at a higher risk of health and developmental problems.

What is intrauterine insemination (IUI)?

Intrauterine insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, the woman is injected with specially prepared sperm. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.

IUI is often used to treat:

• Mild male factor infertility

• Women who have problems with their cervical mucus

• Couples with unexplained infertility

What is assisted reproductive technology (ART)?

Assisted reproductive technology (ART) is a group of different methods used to help infertile couples. ART works by removing eggs from a woman's body. The eggs are then mixed with sperm to make embryos. The embryos are then put back in the woman's body.

How often is assisted reproductive technology (ART) successful?

Success rates vary and depend on many factors. Some things that affect the success rate of ART include:

• Age of the partners

• Reason for infertility

• Clinic

• Type of ART

• If the egg is fresh or frozen

• If the embryo is fresh or frozen

The U.S. Centers for Disease Control and Prevention (CDC) collects success rates on ART for some fertility clinics. According to a 2006 CDC report on ART, the average percentage of ART cycles that led to a live birth were:

• 39 percent in women under the age of 35

• 30 percent in women aged 35-37

• 21 percent in women aged 37-40

• 11 percent in women aged 41-42

ART can be expensive and time-consuming. But it has allowed many couples to have children that otherwise would not have been conceived. The most common complication of ART is multiple fetuses. But this is a problem that can be prevented or minimized in several different ways.

What are the different types of assisted reproductive technology (ART)?

Common methods of ART include:

• In vitro fertilization (IVF) means fertilization outside of the body. IVF is the most effective ART. It is often used when a woman's fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man's sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the woman's uterus.

• Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is similar to IVF. Fertilization occurs in the laboratory. Then the very young embryo is transferred to the fallopian tube instead of the uterus.

• Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into the woman's fallopian tube. So fertilization occurs in the woman's body. Few practices offer GIFT as an option.

• Intracytoplasmic sperm injection (ICSI) is often used for couples in which there are serious problems with the sperm. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus or fallopian tube.

ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who can not produce eggs. Also, donor eggs or donor sperm is sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These are embryos that were either created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.

Surrogacy

Women with no eggs or unhealthy eggs might also want to consider surrogacy. A surrogate is a woman who agrees to become pregnant using the man's sperm and her own egg. The child will be genetically related to the surrogate and the male partner. After birth, the surrogate will give up the baby for adoption by the parents.

Gestational carrier

Women with ovaries but no uterus may be able to use a gestational carrier. This may also be an option for women who shouldn't become pregnant because of a serious health problem. In this case, a woman uses her own egg. It is fertilized by the man's sperm and the embryo is placed inside the carrier's uterus. The carrier will not be related to the baby and gives him or her to the parents at birth.

Recent research by the Centers for Disease Control and Prevention showed that ART babies are two to four times more likely to have certain kinds of birth defects. These may include heart and digestive system problems, and cleft (divided into two pieces) lips or palate. Researchers don’t know why this happens. The birth defects may not be due to the technology. Other factors, like the age of the parents, may be involved. More research is needed. The risk is relatively low, but parents should consider this when making the decision to use ART.

More information on infertility

For more information about infertility, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

• American College of Obstetricians and Gynecologists
  Phone: 202-638-5577

• Division of Reproductive Health, NCCDPHP, CDC 
  Phone: 800-323-4636 (TDD: 888-232-6348)

• Fertile Hope, LiveStrong
  Phone: 888-965-7205

• Food and Drug Administration
  Phone: 888-463-6332

• InterNational Council on Infertility Information Dissemination, Inc.
  Phone: 703-379-9178

• RESOLVE: The National Infertility Association
  Phone: 703-556-7172