Sexual Health | UNCHealthyHeels

This blog was originally posted on April 25, 2012 and was written by Diana Sanchez.

Condoms are one of the most commonly used contraceptive/STD prevention products used worldwide. The United Nations Population Fund estimated that over 10 billion condoms were used in 2005.  Here on campus, Campus Health Services provides thousands of condoms to students each year.

As a sexual health counselor, I have noticed that many people’s preferences for certain condom brands are based (almost entirely) on their perception of that condom brand’s effectiveness. We offer a variety of condom brands for free to students through Campus Health Services. Occasionally, when people check out the condoms we have available, they’ll ask: “are those safe to use?”, and “don’t those break more than [other condom brand]?”.

So, do some condoms in fact perform better than others in terms of STD/pregnancy prevention?

The answer is no, not really. Condoms are regarded by the United States Food and Drug Administration (FDA) as “Class II medical devices”, a designation that includes pregnancy tests and powered wheelchairs.  Products in this category have to meet special labeling requirements and performance standards. For condoms, the FDA standards include systematic “water leak” tests to ensure that no fluid can leak out of the condoms. To meet standards, all condoms must have at least 996 out of 1,000 condoms, on average, pass this test. This means that FDA-approved condoms must be at least 99.6% effective in laboratory tests to be available to consumers.

In a 2004 publication, Walsh and colleagues used condom use data from trials of three bands of condoms, including Trojan, LifeStyles and Ramses – all of which are FDA-approved condom brands. Out of 3,677 condom-protected sex acts analyzed in the study, the authors found that 55 condom acts failed, either due to breaking (16 condoms broke; break rate = 0.04%) or slipping (39 condoms slipped; slip rate = 1%). The likelihood of condoms breaking during sex was not statistically associated with condom brand.

FDA-approved condoms are all quite effective at preventing pregnancy and STD, and performance is probably not related to brand type. You might be wondering if the condoms you’re using are FDA-approved. With the exception of novelty condoms (which are pretty uncommon), just about all of the condoms you’ll come across in the United States are approved by the FDA.  All the condoms we provide through Campus Health Services are FDA-approved, and same goes for places like Planned Parenthood and local STD/HIV clinics. If you’d like to be certain, you can check the condom packet to look for wording about STD and pregnancy prevention. If it’s on the packet, those condoms meet federal regulations for quality and safety.

Check out the following pictures to see how we’ve looked for this language on some condoms we provide at Campus Health Services:

If you can’t find language about STD/HIV prevention on condom packaging, then it’s not FDA approved.

If you can’t find language about STD/HIV prevention on condom packaging, then it’s not FDA approved for STD/HIV and pregnancy prevention.

All of this said, although condoms must be at least 99.6% effective in safety trials, testing conditions do not necessarily mean 99.6% real-life effectiveness for any condom brand. But here’s the good news:  there’s a lot you can do to increase the effectiveness of condoms. One of the biggest challenges to condom effectiveness is correct use.  Some of the most common errors with condom use are: using the wrong lubricant (water-based, NOT oil-based, lubricants should be used with condoms); incorrect storage (ie, storing a condom in a hot place, like a glove compartment, or in a place with lots of friction, like a wallet or pocket); and not checking the expiration date.

Photo: “Communication” by Joan M. Mass, Flickr Creative Commons.

As many of us know, UNC-Chapel Hill adopted a new affirmative consent standard in August 2014, meaning that, rather than “no means no,” UNC enforces a “yes means yes” standard—where consent is defined as the clearly conveyed, enthusiastic, conscious, non-coerced “yes.” It is the responsibility of person initiating the activity to receive affirmative consent, and being under the influence of drugs or alcohol does not lessen that responsibility. Consent can’t be treated as binding; if your partner and you say that next Friday you plan to have sex, you should still check in with your partner next Friday to make sure they consent. If, next Friday, your partner decides they do not consent, you cannot try to hold them to what they said the week before or make them feel guilty in any way for changing their mind. Also, consent to one activity is not consent to another (so, for example, consent to oral sex is not consent to vaginal sex).

I’ve found in my experience conducting One Act trainings that a lot of students struggle to understand the affirmative consent standard, and have a lot of questions about how it works in practice. Many of us are much more comfortable relying on body language, so enforcing a policy that heavily relies on verbal communication can be daunting.

But how do I ask? Won’t it kill the mood? Isn’t that awkward? Don’t you just know when someone wants to have sex? Is it really necessary to ask permission every step of the way? Does this mean that anytime I don’t explicitly ask permission, they can just regret it and call it rape?

Those are all questions I’ve been asked, on several occasions, by several students. A lot of those questions stem from a “but I just want to have sex” mindset, when the mindset should revolve around what both you and your partner enjoy doing. Affirmative consent isn’t about making things awkward, it’s about making sure your partner really does want to do what you want to do.

So how do you ask? Here are some suggestions:

“I’d really like to do ____, do you want to?”

“How do you feel about trying/doing   ____?”

“Does this feel good to you?”

“Are you interested in doing ___?”

“Are you enjoying this?”

“I like doing _____. What do you like to do?”

The possibilities are endless, so have fun with it! Remember that sex should be an ongoing conversation, where you check in with your partner to make sure they are excited about and are enjoying everything that is happening.

But what about just knowing when someone is consenting to sex? Why this change? Why use an affirmative consent standard, when, for years, relying on body language has been considered acceptable?

It’s simple: there has been new research  that indicates people are likely to freeze up when they feel scared, threatened, or traumatized. While most of us are familiar with flight or fight, there is actually this third chemical reaction in our brains – “freeze.” Because of neurobiology, people may not be able to speak up and say “let’s stop,” so they just disengage and wait for it to be over. Using an affirmative consent standard takes into account what happens in our bodies on a cellular level. Beyond biology, social norms may impact some a person’s ability to speak up. Statements like “maybe later,” “I’m tired,” “not right now,” “let’s just watch a movie,” or even silence are indicators that a person doesn’t actually want to have sex, despite none of those being an explicit “no.”

If you ask someone if they want to have sex with you (or do any other activity) and they say no, you didn’t “kill the mood.” You simply gave that person an opportunity to tell you that they didn’t want to have sex. Rejection usually doesn’t feel good, but neither does hurting someone. Affirmative consent is sexy. So play around with how you ask for consent, figure out what way is most comfortable to you, and practice good communication with your partner(s)! Being able to talk about what you are interested in doing together gets easier, and affirmative consent is sexy! Remember: even if you do find it awkward, a few seconds of feeling awkward is worth preventing harming someone.

If you’re worried that your partner may confuse regret with sexual assault, here is a great blog explaining why that likely won’t happen.

Can you think of any more ways to ask for consent? Post below in the comments!

This blog is a guest blog from Ruth Abebe, a UNC graduate interested in HIV and sexual health, and was originally published on April 1, 2013.

College is a time when many students are discovering and exploring ourselves and the world around us. This world may include sexuality.

Many college students choose to be sexually active, and college-aged students are particularly likely to engage in risky sexual behaviors and are disproportionately affected by negative sexual health outcomes such as STI or unintended pregnancy.  According to national surveys, many college students are engaging in sexual activity without protection. In a 2011 survey of undergraduate students across the US, approximately 70% of sexually active students reported using condoms inconsistently or not at all during sex in the last 30 days. With all the information out there regarding sexually transmitted infections (STI), unintended pregnancy and ways to prevent them, why do college students still put themselves at risk?

As a college student myself, I have heard several of my peers talk about why they don’t use condoms.  But, there are ways to go beyond these barriers and make sure sexual experiences are safe and pleasurable.

1. Cost — Most of us are on a budget, and the cost of safer sex supplies like condoms is still an obstacle for students when deciding to use protection. However, this is a problem that can be easily remedied. Here at UNC, we have access to free safer sex supplies. Condoms, both male and female, and dental dams, as well as lube, are available to us through UNC Student Wellness and at several residence halls around campus. Furthermore, with the introduction of Wellness’s free condom dispensers, cost will be even less of an issue (update: These condom dispensers are now in service! They are located around campus, including in the Union and the Rams Head Recreation Center, and are refilled frequently). Click here for more information on where you can currently access safer sex supplies throughout Campus Health Services.

2. Many consider only pregnancy risk—Some students only consider pregnancy as a possible consequence of unprotected sex. For this reason, many believe they will be able to protect themselves using prescription contraceptives (examples: the pill, patch, ring, IUD, etc.). However, STI risk and protection should be considered in every sexual partnership.  Aside from abstinence, condoms are the only method which can protect against both pregnancy and STIs, including HIV/AIDS. They can also be converted to a dental dam.

3. “Oral sex isn’t sex.” – Many are under the false impression that oral sex is “safe sex.” Oral sex, just like anal and vaginal sex, carries a risk for STI transmission.  Condoms and dental dams can protect against the risk of STI transmission during oral sex.

4. Pleasure Factor— Some college students don’t use condoms during sexual activity because they believe “it doesn’t feel the same.”  But you can do things to make sex with condoms feel just as good. Plus, knowing that you have the protection of a condom can help you to relax and enjoy the moment.  There are several kinds of condoms out there, including “ultra-sensitive” condoms that enhance the feeling of both parties during sex. Using lube can also make sex more pleasurable for both partners. In addition, there are condoms and other safer sex supplies geared toward making sex more pleasurable. Explore different condom styles and protect yourself!

5. “It’ll ruin the moment.” – Some college students are not protecting themselves for fear of ruining the mood of the moment. There are ways around this too. If you are having sex with someone, you can talk about condom use beforehand. Of course, I realize that not all sexual activity will be between two people in either a romantic or ongoing sexual relationship. In these cases, it’s important to place your sexual health above any potential awkwardness. Cases of STIs are on the rise, and aside from the dangers to your health, having an STI can make your sex life more difficult in the future. So, why not protect and enjoy yourself?

Despite these barriers, there are several ways to allay your fears and hesitations about using protection. As college students, preventing against STIs and pregnancy by using condoms is essential to protecting our sexual health.

Previously known as CHECS appointments, Student Wellness offers sexual wellness education appointments with a trained health educator to individuals as well as student pairs. Topics for these appointments include but are not limited to:

• Contraceptive option consultations and education;

  Photo “Devious Question” by Zita, Flickr Creative Commons

• HIV testing and counseling;
• Well Woman’s Exams questions;
• Post-diagnosis STI management questions; and
• Other concerns or questions relating to sexual health.

When are educational appointments available?

For the Fall 2014 semester, sexual wellness education appointments will be offered:

• Tuesdays, 1PM-3PM
• Wednesdays, 10AM-12PM
• Thursdays, 10AM-1PM
• Fridays, 10AM-11AM

How does a student make a sexual wellness education appointment?

Because of limited availability and space, students should call Student Wellness at 919-962-WELL ahead of time to schedule an appointment. Depending on demand, there are usually available appointments within the week. Walk-in appointments may also be available if other appointments are not yet scheduled.

Free HIV Testing at World AIDS Day!

Photo “World AIDS Day, December 1″ by Sully Pixel, Flickr Creative Commons

Every year on December 1, people worldwide write to increase awareness and testing for HIV on World AIDS Day. This year Student Wellness and other campus partners will be celebrating this day on December 2 by offering a free, confidential, fast HIV testing in the Union from 10am-4:45pm. For more information visit the Facebook event for the day.

For further questions about these appointments and World AIDS Day, please contact [email protected].

Welcome (back) to Carolina! It’s a brand new year with new classes, new opportunities, and possibly new friends. Maybe you’re ready to hit the ground running or maybe you’re a bit anxious about all of these changes. Either way, Student Wellness is here to help you find your way. Specifically, we want to make sure that you know what resources are available and nearest to you for two reasons:

1. If you know where helpful resources are NOW, then in times of need, you’ll know exactly where to go (or where to direct your friends)!
2. We want you to become familiar with what resources this fantastic campus has to offer. I can tell you from personal experience that I WISH I knew these places existed, and I found out about them…4 years too late!

image from 5kmissionpossible.com

It’s time to WIN PRIZES! Here’s how to play:

• Below you’ll find some of my favorite Carolina hotspots, split up by location.
• Visit at least 1 spot in each location category (South Campus, Bell Tower, Old Well)
• Take a selfie in front of the building or sign or whatever is accessible for you.
• Post that photo to Instagram or to the Tar Heel Wellness Challenge Facebook Page with #THWC for a chance to win a $20.00 gift card for UNC Student Stores!
• Come visit us at Student Wellness Services on the 2^nd floor of the Campus Health (James A. Taylor) building, show us your pics, and EVERY PERSON will leave with a prize – whether it’s a pair of rockin’ sunglasses, a sweet notebook, or a surprise!

Jani’s Favorite Campus Hotspots
Visit each center’s website for some great online resources!

image from housing.unc.edu

Near the South Campus Dorms…

The Learning Center
SASB North
This center has a great supportive environment. They connect you with peer tutors, academic coaches, study groups, and learning disability and accessibility resources. They can also help you out with test prep!

The Writing Center
SASB North
Folks at this center edit and proofread papers and even help develop your unorganized thoughts into a full essay. They send a notice to your professor to let them know you’re taking advantage of their resource, you really care about the work, and you take it seriously. In my experience, this really helped boost my grades.

 LGBTQ Center
SASB North
This is a wonderful place to meet great people. The center also has a resource library and a cozy, safer space to relax in. You do not have to identify as gay, queer, bisexual, etc. to enjoy this space!

 Accessibility Resources and Services
SASB North
This center hooks you up with alternative testing conditions, provides assistive listening devices, provides means of alternative format course textbooks, and more. As someone who gets panic attacks and an increase in my anxiety in high-stress situations, I wish I took advantage of these services as an undergrad. You can BET I’m going to as a graduate student!

 Rams Head Rec Center
Near Morrison and Rams Head Dining Center
This gym has group classes throughout the day, exercise equipment, and a climbing wall.

Tip: To get from South Campus (first-year dorms) to Mid Campus (classes) the fastest – walk to Morrison, find the path that starts behind the dumpsters and goes through a wooded area. The path exits at the Campus Health Building (James A. Taylor Building)!

image from unc.edu

Near the Bell Tower…

 Women’s Center
Stone Center
This is a great place to chat and connect with people who are passionate about gender equity work. There are also tons of interesting classes, lectures, and performances hosted here throughout the semester.

 Counseling and Psychological Services (CAPS)
3^rd floor of Campus Health Building (James A. Taylor Building)
CAPS offers a range of mental health services from 1-on-1 counseling to group therapy.

 Campus Health Services
1^st floor of Campus Health Building (James A. Taylor Building)
Feeling under the weather? See a doctor at CHS for free. You can also visit CHS for anything from a pelvic exam to immunizations.

 Healthy Heels Shoppe
Basement of Campus Health Building (James A. Taylor Building)
Get everything you need from prescription refills to popular over-the-counter meds and nutrition bars.

 Student Wellness Services
2^nd floor of Campus Health Building (James A. Taylor Building)
This is the greatest spot on campus 😉 But for real – we offer a supportive, safer, and non-judgmental environment for conversations around health and well-being. We connect you to peer education groups, campus student groups and resources, or trained staff that can discuss an array of topics from HIV testing to microaggressions to decision-making to active bystander skills.

 Student Rec Center
Near Student Stores, the Football Stadium, on Stadium Drive
This is another gym on campus that has fun group classes and equipment. It’s very easy to stop by between classes.

 The Study Abroad Office
FedEx Global Education Center, up McCauley Street
The building itself is awesome with a lovely café and cozy study spots throughout. Advisors connect you to programs around the world depending on your interests, major, and goals. They’ll also work with you on how to transfer classes back to UNC for course credit. For example, I learned how to pick classes strategically at Dublin City University in Dublin, Ireland to count towards my Environmental Sciences and Engineering BSPH degree. I ended up not having to take some required courses at UNC and was able to take some fun electives my senior year.

image from unc.edu

Near the Old Well…

 Academic Advising
Steele Building, Near South Building and Saunders Hall
Do you have a hold on class registration because you haven’t seen your academic advisor? I suggest you visit advising on a regular basis, not just before registering for classes!

 Career Services
Hanes Hall (NOT HANES ART CENTER!), across from Saunders, near Carroll Hall (School of Journalism and Mass Communication)
Don’t wait until senior year. This is a great place to come chat about your passions and they’ll help connect you with jobs and internships throughout your time at UNC to figure out what you like and don’t like.

 The Office of Scholarship and Student Aid
Pettigrew Hall, North Campus across from the Franklin Street Post Office
Whether you’re an undergraduate or professional student, you can visit walk-in hours to ask advisors financial questions or to get info about financial aid and scholarship options.

SO, start clicking away, snap some pics, and get hashtaggin’! I hope to see you all in our office soon J

Jani

There can be a lot of anxiety surrounding a trip to the pharmacy to buy emergency contraception such as the “morning-after” pill, but keep in mind, a trip to the doctor to confirm an unplanned pregnancy would probably be even more anxiety-inducing! Emergency contraception is used in the first few days after unprotected sex to prevent unplanned pregnancy. If you’re worried about what pharmacy employees may think about you, rest assured that they’ve dispensed emergency contraceptives enough times that they probably won’t think anything of it. Having the pharmacy run it on your insurance (if you have a prescription) may make your purchase visible to the policy holder (e.g. your parent), but paying with cash or credit may prevent anyone from ever finding out.

Did you know half of all pregnancies in the United States each year are unintended? As a busy college student, chances are you may not be ready to commit to parenthood just yet, so it’s important to take necessary precautions to protect against pregnancy.

So what happens when things don’t go exactly as planned?
Maybe the condom broke. Or you just didn’t have one. Perhaps you forgot to start your new pack of birth control pills. It could be anything really, but what matters is that you are at an increased risk for pregnancy. Fortunately there are options available for when mishaps happen.

Plan B® (a.k.a. the “morning-after” pill) is probably the most well-known option, thanks to a catchy name and “over the counter” status. The active ingredient is a progestin called levonorgestrel, and there are generic versions of Plan B® available that have the same ingredient and dose. Many hormonal birth control options contain levonorgestrel, but one difference between birth control pills and emergency contraceptives is the dose. Plan B® contains 1.5 mg, whereas some birth control pills (e.g. Orsythia™) contain as little as 0.1 mg.

So why not just take a bunch of my regular birth control pills instead of buying an emergency contraceptive pill?
The other key difference between Plan B® and birth control pills is the estrogen component (i.e. estradiol) that is included in birth control pills but not emergency contraceptives. Some websites recommend women take multiple birth control pills at once (instead of something like Plan B®), but this frequently causes vomiting. Not only is vomiting unpleasant, but more importantly, it means the medication is much less likely to be effective. Some women may vomit after taking an emergency contraceptive pill, but the incidence is much lower than taking multiple birth control pills containing estrogen.

Should I go ahead and buy Plan B® (or the generic equivalent?)
Not so fast! There are some reasons why Plan B® may be less effective or not recommended in certain women. A copper intrauterine device (IUD) or ella®, another emergency contraceptive pill, may be better options.

What’s ella®?
ella® is the brand name for a pill called ulipristal, which is a progestin receptor modulator, meaning it blocks progestin from binding to the progesterone receptors, thereby delaying ovulation. Listed below are some key similarities and differences between Plan B® and ella®. Keep in mind, neither of these medications causes abortion, and they should not be used in women who are already pregnant.

*BMI = body mass index. A BMI calculator can be found here. Recent news reports claim the morning-after pill may not work in obese women, so ella® or the copper IUD are likely preferred in overweight or obese women. In women with a BMI>35, the copper IUD is the most effective option.

Which emergency contraceptive method is the most effective?

• The copper IUD (Paragard®) is the most effective method of emergency contraception available for any woman. Of the approximately 12,000 copper IUDs that have been placed for emergency contraception in the United States since 1976, only 12 women (0.1%) have become pregnant. The copper IUD is a reversible birth control method that is effective for up to 10 years. While it may be considerably more expensive than emergency contraception pills or birth control pills, it often offers a long-term cost savings and may even be fully or partially covered by your health insurance plan.
• ella® is considered the next most effective method. Pregnancy is prevented in about two-thirds of women who would have otherwise become pregnant (i.e. were in a fertile time of their menstrual cycles) with the use of ella®.
• About half of expected pregnancies are prevented with Plan B®.
• All forms of emergency contraception are more effective when they are used as soon as possible!

What should I expect from “the pill?”
A few things happen; most importantly, ovulation is delayed and changes occur in the uterine lining to prevent implantation of any fertilized eggs. Unfortunately, you may experience some side effects of emergency contraceptives:

• Nausea/vomiting
• Irregular menstrual bleeding, delayed menstruation, or “spotting”
• Abdominal discomfort
• Headache or dizziness

If your period has still not occurred 7 days after the expected time or if you think you may be pregnant, make an appointment with a doctor.  For further answers or advice on emergency contraception, consider calling Campus Health at 919-966-2281, visiting the Campus Health website, or checking out some of the additional resources listed below.

If you believe you may have been sexually assaulted, call 919-966-3650 or come directly to the Women’s Health Clinic located on the third floor of Campus Health Services (CHS) as soon as possible after the incident.

Additional emergency contraception resources can be found at the following websites:

Sources:

• Lexi-Comp
• James Trussell, Elizabeth Raymond, and Kelly Cleland. “Emergency Contraception: A Last Chance to Prevent Unintended Pregnancy.” http://ec.princeton.edu/questions/ec-review.pdf. 11/2013.
• Glasier A. “Emergency contraception: clinical outcomes.” Contraception. 2013;87(3):309.

No, not the awkward sex talk with your parents.  But the talk you have with your partner to tell them about you, your likes, desires, wishes and needs, and to maybe learn more about theirs! Open communication is a cornerstone of any healthy relationship, and this applies to telling your partner that while you love them cooking for you, you really just don’t like olives in everything, to telling your partner what you like in the bedroom.

Telling your partner about your sexual likes and dislikes can be a little scary, but just like talking about condom usage, it’s just as important.  There are a million and one different ways that people can have sex, and a million and one fantasies that each individual has, and letting your partner know what you want is an important part of your relationship, and your sexual well being.

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