Family Planning And Sexual Reproductive Health

MumsVillage recently held a WhatsApp Flash Chat courtesy of MYDAWA.  Our resident Expert, Esther Kimani answered all the questions on Family Planning and Sexual Reproductive Health which have compiled below. Esther is a certified Doula, nutritionist, lactation specialist and infant massage instructor who has answered concerns from mums in the Village before. Finally, MYDAWA is an online pharmacy that makes it possible for us to provide the resources to Mums.

Family Planning & Sex Drive

Before pregnancy and birth I had high libido which decreased after birth. It’s been a year and some months now and my libido is so low.  My husband has been complaining a lot. What can I do to bring back my sex urges?

 

It is sometimes normal for the libido or sex urge to dip after childbirth. This is mostly due to the new challenge of being a new mum and also hormonal changes. You can always ignite the fire again by being very intentional about sex. The more sex  you have, the more your libido increases. Have dates with your husband and find time away.

 

Why is it that after giving birth my sex drive took a dive?

This is related to the pressures of being a new mum and hormonal changes.The oxytocin hormone that helps the milk to flow during breastfeeding is the  same hormone that helps your libido so you may not really feel like having sex.

Women also have body image issues due to the impact of child birth that may affect their libido. Work on feeling good about yourself too to increase libido.

 

If the discharge after delivery has stopped at 5 weeks, is it okay to have sex?
You can resume your sexual relations as long as you feel up to it. Remember you can get pregnant so it’s important to first see your doctor before resuming sexual relations,  so as to get an appropriate birth control method.

 

How does a person on pills deal with decreased sexual desire?

You can speak to your doctor to change your pill to a different one. Moreover, become more intentional about having sex. The more sex you have, the more your libido increases.

 

When is it the right time to have sex after birth?
Around 6 weeks after delivery, you can resume your sexual relations.  However, it also depends on your mental and emotional state as well. Most women may need longer time.

 

Is it safe to wax your genitals a month after Caesarean section?
It would be better to wait for at least 6 to 8 weeks to allow the incision area to heal completely.

 

Is it true that when you detox you will easily get pregnant?
Whenever your gut is healthy, your  ovulation improves, which then helps you get pregnant easily.

 

Family Planning & Breastfeeding

I stopped breastfeeding my 3 year old last year December but I still have a lot of milk. What should I do?

If the milk makes you uncomfortable, avoid expressing it to avoid stimulating it. You can also ask your doctor to give you medication to stop the milk. Alternatively, mix a tablespoon of sage spice with hot water and take it 4 times daily help reduce the flow.

 

Is it okay to breastfeed whilst pregnant? If yes, when should one stop?
For breastfeeding as long as your current pregnancy is going on alright and your doctor gives you a go ahead, you can continue to breastfeed up to around 30 weeks.  After 30 weeks, stop to allow your milk to change from mature milk to colostrum for the new baby.

 

What contraceptive pills are great for breastfeeding mums?

Breastfeeding mums would need to take the one-hormone pill or progestin only pill. It carries only one hormone. Taking a combined one will lead to milk dry up.

 

Can one become pregnant while breastfeeding?

Yes. Yes. Yes. Breastfeeding may offer some protection but only if the baby is always breastfeeding on the breast. This means no pumping,  no bottle feeding and even then the risk is still there.

 

What is the best family planning method that does not affect milk supply?

Use either barrier methods like condoms, diaphragm or cervical cap. For hormonal methods, use the single hormone methods like pregestin only pills, implant like implanon, injectables and coil.

 

Since I gave birth in September 2018, my periods have never returned. I am not on family planning  but I am breastfeeding exclusively. Can I get pregnant?

Yes you can get pregnant. Remember ovulation happens before your period appears so if you do ovulate, you may conceive if you are having sexual relations.

 

Does exercise and detox reduce milk supply?

Yes it may. For some people, the lactic acid produced during the work out may suppress the hormones that make milk. Avoid doing heavy exercises at once rather build up slowly to allow your body to adjust. Detox is not recommended during breastfeeding as the toxins will be passed on to your baby through breast milk.

 

How long should you wait after Caesarean for you to start exercises to get rid of the tummy?

You can start mild exercise after 6 to 8 weeks and increase intensity after around 3 to 4 months.

 

Does coffee decrease milk supply?

Small amounts of coffee like a cup a day is fine. However, taking more than that may reduce milk supply due to caffeine. Large amounts may also be passed to your baby.

 

Fibroids & UTIs

Do hormonal contraceptives cause existing fibroids to grow?
Fibroids tend to be very responsive to hormones such as estrogen and progesterone that are commonly found in birth control.  These hormones do stimulate the growth of the fibroids.

 

Can a person with a case of fibroids have a coil inserted?

There are some concerns that use of coils by women with uterine fibroids might increase their uterine bleeding or risk for device being expelled during their monthly period. It  may be better to seek a different method.

 

What’s the main cause of UTIs in women? How can one avoid getting them frequently?

Women are more prone to UTIs because they have shorter urethras, which allow bacteria quick access to the bladder.  To avoid getting them frequently; always wipe from front to back, pee after sex, wear cotton underwear, keep the area shaved and maintain high standards of hygiene. Finally, avoid holding pee for long periods of time.

Although peeing after sex is deemed as unromantic, it helps remove any bacteria introduced into the urinary tract during sex before it settles. If it recurs, seek treatment as a couple.

 

Fertility, Infertility 

Can the prolong usage of Postinor2 cause barrenness in future?

P2 is supposed to be used as an emergency contraceptive.Using it often causes you to have a high likelihood of failure and you can get pregnant, it may also lead to hormonal imbalance.

 

Injectables & Coils

What are some of the effects of using depo?
Side effects of Depo-Provera Contraceptive Injection include; weight gain and other side effects such as irregular menstrual bleeding, amenorrhea, headache, nervousness, abdominal cramps, dizziness, weakness or fatigue, decreased sexual desire, leg cramps, nausea, vaginal discharge or irritation, breast swelling and sensitivity.

 

I have been having a one off blood discharge.  I am on coil for 2 months, is this normal?

Yes. It’s common to have some spotting with the coil but it does settle down after a while.

 

What are some of the side effects of using the non-hormonal coil, or what advice would you give to someone who intends to use it?

It is a good method for someone who does not want to take pills everyday. The side effects could be irregular menstrual bleeding, no periods at all, headaches, abdominal cramps, decreased sexual desire, leg cramps, nausea, vaginal discharge or irritation, breast swelling and sensitivity.

 

What are the effects of using jadelle as a contraceptive method?

Jadelle consists of 2 small rods that are inserted into your arm and gives prevention for 5 years. It is quite great if it agrees with you. The side effects are similar to the other hormonal methods.

 

What are the risks involved to the mum and the baby if a mum conceives on a coil?

If you do conceive on a coil, your doctor would perform a scan to determine the best course of action.They may be able to remove it or leave it till the end of pregnancy but most babies are born safely even after this.

 

I have been using the non hormonal coil for 5 months now and I have been very okay.  However I have been feeling an on and off pain since making love with my husband. What could be the problem?

Your coil could be slightly dislodged or having an infection. Please see your doctor for further consultation to confirm that the coil is still in place.

 

Vaginal Concerns

When I look at my Vagina in the mirror, it seems as  though something moved. Is that normal?
It is normal after birth for the physiology of the vagina to change due to the swelling caused by the whole birth process. Everything does go back to normal after several weeks. You can do kegel exercises to help tone the pelvic area.

 

How long should the vaginal discharge after birth take?

The bleeding after birth is called lochia and is the vaginal discharge  after giving birth, containing blood, mucus and uterine tissue. It does clear within 4-6 weeks.

 

How often should I go for a pelvic exam or pap smear post birth?

Every woman who is not pregnant should have a pap smear once a year.

 

What is the best method of shaving the genital area?

This is a personal preference but whatever method you use should be easy on the area to avoid infection. For instance, if you choose waxing do it at a place that has a high standard of hygiene.

 

Contraceptive Pills

Is it advisable to use chaguo langu (pills) for long ?

They’re are safe to use as long as you are using it for family planning and do not have major side effects

 

If I am taking contraceptive pills within the same 2 hour window every day but not at the same actual time; does that reduce my chances of being protected?

As long as you take it at around the same time everyday like you do, it should offer you the protection. However, it is best to try take it at the same time daily even if this means putting an alarm.

 

Which contraceptive pills are good?

It all depends on your body, you need ton sit with a health-care provider to determine what works for you.

 

Is it a must to change a family planning method? I have been on the pill for 12 years and it seems to be causing memory loss. Is there an alternative?

You can try the non-hormonal method like the Copper (IUD) but speak to your doctor for further consultation.

 

I  have used the Sophia herbal pill from which I suffered secondary infertility. I was treated and I conceive  my second born. Afterwards, I was was injected with 3 months depo but I conceived, so I settled for the 3 years depo but I bled for a whole month. I removed it yesterday and settled on Femiplan pills. Will they be effective and what can I use apart from coil?

Since you have started the femiplan, wait and see how it settles with you. Alternatively,  you can try another method like patch or implant with the advise of your doctor.

 

I use Sophia herbal. Could it be the cause for my growing tummy?

Since this is a herbal method there is not much information on it’s side effects, it is best with your doctor on it’s usage.

 

I am allergic to Yasmin and other pills but scared of trying other family planning methods such as implanon and coils. Are you able to recommend anything that  works and has the least side effects?

You may need to use a  non hormonal method like the Copper (IUD), condoms or natural family planning if you have  a predictable monthly cycle. The coil is quite an effective method especially if you react to the hormonal methods.

 

After stopping the pill can you conceive in the next cycle and can the periods delay?  I am 9 days late and I’m wondering if I’m pregnant.

Yes. Your fertility may return immediately. There may be delay as your body’s hormones return to normalcy. Furthermore, you can test for pregnancy by doing an early pregnancy test that you can purchase on MYDAWA.

 

It’s 2 months since I started using the 3 years Implanon but for the past two weeks I have experienced light bleeding. What do I do?
Bleeding is a common side effect with implanon. However, by around the third month, it settles.Give your body a bit more time to adjust to the hormones.

 

Choosing Family Planning Methods

If you are in a long distance relationship and don’t get intimate as often, which is the best family planning method?
Even though your partner is away, you would still need to visit your health care provider to do an assessment based on your health, hormones and other factors.

 

Why does family planning fail in some people?

All family planning methods have a margin of error, but mostly it’s because of incorrect usage and sometimes it’s unexplained.

 

If you’re not on family planning and are not ready to have kids, is it advisable to start family planning?

If you are sexually active then it is best to get a method that works for you unless you are practicing abstinence.

 

What are the family planning options for men? Are there any available for them?
There are a bit few. There is condoms which are a barrier method and Vasectomy which is a permanent method. Recently, a pill was launched although it’s still not available locally.

 

I have heard of blood tests that can be done to determine the best family planning method. Is this available in Kenya?
Your doctor may run some test to determine if you have hormonal imbalance and then use them as a family planning method determining factor.

 

I have experienced much heavier periods after my second child. What could be the cause and should I be testing my iron levels regularly to make sure I’m okay?

It may be due to hormonal imbalance or an underlying infection. It is best to see your doctor to determine the cause. In addition to this, do test your iron levels regularly.  Long term bleeding is not sustainable for your body so it is important to seek medical help to reduce the bleeding.

 

What is the patch?

The contraceptive patch is a small sticky patch that releases hormones to your body through your skin to prevent pregnancy. It contains the same hormones as the combined pill oestrogen and progestogen and works in the same way by preventing the release of an egg each month (ovulation).

On usage, you can apply the first patch and wear it for 7 days. On the eighth day, change the patch to a new one. Change it like this every week for 3 weeks and then have a patch free week. The patch can  not be used by a  breast feeding mum because it carries the combined hormones which will interfere with milk supply.

Some women do get mild side effects when they first start using the patch such as headaches, nausea, breast tenderness and mood changes. This usually settles down after a few months.

 

I have never used family planning. How can I go about it?

You can visit your nearest clinic that offers these facilities and have a chat with the health care provider on which method would best fit your body, lifestyle, how you want to space your children and other factors. After you get to see your options, you can choose from there.

 

Sperm Allergy

What is the remedy for sperm allergy?

Usually, couples are advised to use condoms to prevent sperm contact.  If it is mild, treatment would be to help the woman remain tolerant to semen by exposing her to her partner’s semen at least twice a week. At this time the woman may be given some anti-allergy medication to help the symptoms. This is all under a doctor’s supervision.

 

How does one know they have sperm allergy?

Symptoms of sperm allergy are usually  redness, burning and swelling where the semen has contacted the skin, usually in the outer genital area.

 

What anti allergy medications are there for sperm allergy?

In consultation with the doctor, the medication will depend on the extent of the symptoms.

 

Hysterectomy and Tubal Ligation

Is double hysterectomy and tubal ligation surgical procedures?

Yes.  These are minor surgeries that are done and you can be discharged within the day. Furthermore, if you have a c-section, the doctor can do tubal ligation during the Caesarean.

 

Apart from permanent family planning, what are other side effects of tubal ligation?

Actually, this is one method that has no side effects once you are healed as your body continues to work as normal, only that the tubes are tied so the sperm and the egg never get to meet.

 

Can a hysterectomy cause sexual problems for a woman?

It depends. Total hysterectomy may cause problems as both ovaries are removed.  Ovaries produce the hormones testosterone and estrogen that are integral to your libido. However, the doctor may put you on estrogen replacement therapy that can help with that.

 

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