Sexual Health In College

Is it safer to double-up on birth control methods, like using two condoms during sex?

Some kinds of "doubling up" are safer than others. For example, using condoms while also taking birth control will function as two layers of defense against pregnancy. Scarleteen's "Buddy System" gives an extensive breakdown of the effectiveness of different contraceptive combinations.

However, using two condoms (sometimes called "double-bagging") during sex is actually less effective: friction created between the two condoms makes them both more likely to rip or break. This can happen when using two external condoms or when using one external condom with one internal condom.

Can intrauterine devices (IUDs) and other similar, long-acting removable birth controls cause infertility?

No. IUDs are highly effective at preventing pregnancy once properly implanted (they have a fail rate of less than one percent) and have no proven long-lasting effects once removed.

Is "pulling out" an effective birth control method?

"Pulling out," also known as the "withdrawal method," involves removing the penis from the vagina prior to ejaculation in the hopes of preventing any sperm from entering the vaginal canal. In theory, this should keep sperm from meeting the egg. Unfortunately pulling out is significantly less effective than other contraceptives like the pill and condoms. Sperm may be present in pre-ejaculate and the timing can be difficult to perfect. Ultimately this method is not an effective contraceptive.

Birth control pills can only be taken for a certain number of years before causing permanent damage, right?

No. With the exception of the birth control shot (known as Depo), users can stay on The Pill for as long as necessary or desired. There are generally more benefits to staying on birth control than drawbacks, but always talk to a gynecologist or other prescribing doctor about the risks.

Do antibiotics make birth control less effective?

Generally speaking, no, but talk to your doctor about it if you are prescribed antibiotics. Some specific prescriptions, like those used to treat meningitis and tuberculosis, are known to hinder The Pill's effectiveness. The effect that other antibiotics have on birth control varies from user to user.

I'm new to this city and/or state. How do I find a doctor that takes my insurance?

The first step to finding a doctor is to make sure that your insurance provides coverage where you are. If you are on your parents' coverage and they live halfway across the country, their insurance may not always cover your local doctors. To find out what doctors and options your plan does cover, use the insurance's website to run a doctor search or even call the insurance company customer service. If the insurance plan does not cover where you are now living, look into your insurance's out-of-network options. Out-of-network doctor fees will be higher than in-network but will still be cheaper than seeing a doctor without insurance at all. On-campus health services may also be available at a discount for students.

What should I do if I don't have insurance?

If you do not need immediate medical attention, try to find insurance. The Affordable Care Act can help limited- and low-income individuals find insurance coverage within their budgets. Additionally, a significant number of colleges and universities offer their own insurance plans for students. However, do not put off visiting a doctor or hospital because you do not have insurance. On-campus health centers, urgent cares and community clinics like Planned Parenthood may offer some medical services at lower costs or have payment plans.

I've never been to a doctor on my own before. What should I bring with me?

A new doctor's office generally means new paperwork. The doctor's office will tell you exactly what to bring, but generally you will want to have: current list of medications; personal contact information and emergency contact information; insurance card; driver's license or other photo ID; known personal and family medical history.

I'm on my parent's insurance. Can I get a health checkup / birth control prescription / STD STI test / PAP smear without them knowing?

The answer to this question depends on a few factors, namely the states involved (usually just one state, unless you live in a different state from your parents) and the insurance company's policies. Insurance companies usually send an Explanation of Benefits (EOB) to whoever pays for the insurance coverage (such as your parents). The EOB, depending on the insurance company and state-level regulations, might be a very detailed list of everything the insurance helped pay for. However, some insurance companies can change how charges appear on the EOB or even who sees the EOB in order to protect your privacy. Bedsider, a website that promotes sexual health and knowledge, offers a useful guide for talking to insurance companies about EOBs (even though Bedsider calls it a "girls' guide," guys will find this information handy as well).

Beyond EOBs, most states have laws and regulations that assure individuals aged 13 and older can get STD and STI tests without their parents being informed. Planned Parenthood and other community obstetrician/gynecologist (OB/GYN) offices can usually take additional steps to protect their patients' privacy, so ask them how they can help when you make an appointment.

What are the earliest signs that I'm pregnant?

The first sign of pregnancy is typically a missed menstrual period. Other less consistent signs include nausea, aches and changes in breast tissue (such as increased tenderness).

When pregnancy is suspected, there are two primary tests available. The first is a urine test, readily available over the counter, which are usually taken in-home anywhere from a few days before to week or longer after the missed period. The second test is a blood test. Blood tests are performed in a doctor's office and take longer to give results. However, blood tests in a doctor's office are considered the most accurate.

What are the differences between a morning-after pill and an abortion pill?

Morning-after pills are emergency contraceptives for use in the days immediately following unprotected sex. The sooner you take the pill the more effective it is at preventing pregnancy. The most well-known kinds are Plan B, Plan B One-Step, Ella and Next Choice. Ella requires a prescription, but the others are available over-the-counter to individuals aged 17 or older.

Morning-after pills are not abortion pills. Rather than ending a pregnancy through miscarriage, they prevent the pregnancy altogether by stopping sperm from fusing with an egg or blocking a fertilized egg from attaching to the womb. The window in which to take a morning-after pill is within three days of unprotected sex. For Ella users, that window is five days. When taken within 24 hours of unprotected sex, Plan B and Plan B One-Step can be 95 percent effective at preventing pregnancy.

Abortion pills, also known as medication abortions, are intended to end a pregnancy in its early stages. Unlike morning-after pills, abortion pills are not available over the counter. A prescription is necessary in order to obtain abortion pills. The first pill (out of two) is typically given in the doctor's office and the second pill taken up to two days later. Abortion pills block the body's production of progesterone (a hormone necessary for a pregnancy to develop) then cause cramping and bleeding that empties the uterus of its content. This process can be compared to a heavy menstrual period. Medication abortions are most effective within eight weeks of pregnancy.

Can I get pregnant the first time I have sex?

Yes. While the likelihood of becoming pregnant depends on a variety of factors, whether or not it is your first time is not one of them. If there is nothing to block sperm from fusing with an egg, such as a condom or hormone-based block like the birth control pill, pregnancy is possible.

Am I allowed to stay in college if I become pregnant?

Yes. Schools (K–12 and higher education alike) that receive federal funding are required to abide by Title IX. Title IX outlines a variety of students' rights and protections, including the rights of pregnant students. Pregnant students are entitled the same rights as students with temporary disabilities. Additionally, schools must allow them to make up missed schoolwork, have pregnancy-related absences excused and more. Every college and university has a Title IX coordinator who can provide the specifics on the school's accommodations. Additionally, pregnant students cannot be excluded from on-campus housing. The Pregnant on Campus Initiative provides resources and support for pregnant college students.

I'm not interested in sex the same way my friends and peers are. Am I queer?

Potentially. Nobody can decide an individual's identity other than that individual. If someone does not want to use a specific label or if they do not want to settle on a term while they are exploring who they are, that is entirely okay. Identities and terminologies evolve as fast as people themselves do.

That said, asexuality is also an identity worth discussing. It is a sexuality distinct from homosexuality, heterosexuality, and/or bisexuality. Asexual individuals (also known as "aces") are considered members of the LGBTQ community. Asexuality is essentially a lack of sexual attraction. Individuals who identify as asexual are not necessarily celibate (which is an active choice to not engage in sex regardless of sexual attraction). Some aces have sex drive and many still experience romantic attraction. Visit the UCLA's list of asexuality resources and the Asexual Visibility & Education Network (AVEN) to further explore this topic.

How can I explore my gender and sexual identities in a safe way?

Many students find themselves exploring and expanding their identities while attending college. This happens for a variety of reasons, from exposure to new ideas and histories to increased independence from family. Students can use campus and community resources to investigate their identities in what may be a more comfortable and protected environment. Some schools offer workshops about gender and sexual identity, the vast majority have queer student unions, and there are even schools with classes, programs and majors or minors in queer/LGBTQ studies.

My gender identity is different from what's listed on my birth certificate. What can I expect from my campus administration in regard to this?

Most large colleges, and many smaller ones, have policies and guidelines in place for how the administration protects and includes transgender students. Campus Pride can help students find transgender and genderqueer friendly colleges as determined by campus policies for housing, name changes, medical services and bathrooms. Federal mandates on the treatment of transgender individuals are still highly contested, so how colleges approach this topic will vary between states, campuses, and even from professor to professor.

Do I need to use different kinds of protection for queer sex than for heterosexual sex?

Generally speaking, the tools of safe sex are the same for all genders. There just might be differences in how frequently they are used and what they're used for. Sex between queer people might exclude the risk of pregnancy, so protection is more centered around avoiding STDs and STIs.

Will I be able to tell if I have an STI or STD?

Not necessarily. STDs and STIs typically have no symptoms, but they may also cause: bumps on the groin, thighs and rear; unusual vaginal or penile discharge; itchy genitals; painful or frequent urination. Always see a doctor if you suspect you have an STD or STI, but also get tested regularly regardless of symptoms.

How often should I get tested?

Some individuals should get tested for STDs and STIs more frequently than others depending on their unique risk factors (such as their number of sexual partners and the types of protection they use). At the very least, the Center for Disease Control recommends annual screening for women below age 25, men who have sex with other men, and individuals who share needles. Groups with elevated exposure risks, such as bisexual and gay men, may want to be tested more frequently. The Center for Disease Control's Get Tested service helps individuals find testing locations and determine how often they should test.

Can STDs and STIs be transmitted through non-penetrative sex?

Yes. Because STDs and STIs can be transmitted through oral sex, it is important to always use protection. Condoms should be used when performing oral sex on a penis, and dental dams should be used for anal or vaginal oral sex. The Center for Disease Control has a useful guide on how to properly use a dental dam. Remember to only use one condom or one dental dam per sex act. Reusing them makes tears more likely and also increases the risk of STD and STI transmission.

What are PEP and PrEP?

PEP and PrEP are both used to prevent the transmission of HIV. PEP is short for post-exposure prophylaxis and PrEP refers to pre-exposure prophylaxis. PrEP should be taken before having sex with someone who is positive for HIV or AIDS (for example, if your partner is HIV positive). PrEP is most commonly taken as a daily pill and is available on a prescription-only basis. Men who have sex with other men, transgender individuals and heterosexual individuals at high risk for HIV should consider asking their doctors about PrEP. More information about PrEP can be found at PrEPster

PEP, on the other hand, should be taken after potential exposure to HIV (such as unprotected sex). PEP is a four-week course of medication that is typically prescribed at clinics and hospitals. The first course of PEP needs to be taken within 72 hours of potential exposure, but the sooner the better. PEP is not 100 percent effective at preventing HIV and should not be used in place of safer sex practices such as condoms. Like PrEP, PEP is typically used by men who have sex with other men, transgender individuals and heterosexual individuals at risk of HIV infection.

What should I do if I test positive?

Always contact your doctor as soon as possible to begin treatment. Many STDs, such as chlamydia and syphilis, can be cured and have no lasting effects if they are rapidly treated.

Other STDS such as herpes and HIV have no current cure but can be controlled with medication. Safer sex methods and medications can help prevent the spread of STDs between partners. Testing positive for an incurable STD can result in some major changes but does not mean that you are unable to live a normal life. Rutgers University's Sex, Etc. has extensive resources, support and stories by teens and young adults including posts by HIV and herpes-positive individuals.

If you test positive for an STD or STI, it is good sexual etiquette to let past partners know they may have been exposed.

DO

Have specifics in mind. Instead of "Want to go out sometime?" say, "Do you want to get coffee tomorrow?" Ask someone out if you want to go on a date with them even if tradition holds that you are "not the gender that is supposed to ask". Guys are not the only ones who can ask someone out.

DON'T

Do not ask someone out on a date when you know nothing about them. Going on a date involves some trust and people usually do not trust a total stranger. Do not be too persistent. If someone says they are not interested, take their word for it.

DO

Give each other space when necessary.

DON'T

Do not let the new relationship consume you. You still have friends, you still have classes and you still have other responsibilities. Do not rush into big commitments until you have thought about them and made a choice based on both emotions and reason.

DO

Make time to talk to them, especially with social technology, laptops and smartphones mean you can stay connected more easily than ever. Have an idea of when you will see them again. This way you will have a goal in sight.

DON'T

Do not assume that dating long distance will be easy. Relationships involve effort and long-distance relationships involve even more. Do not assume that your partner expects the same things out of the relationship as you. Talk to them about how being long distance will affect both of you and affect your relationship.

DO

Treat your ex the way you want them to treat you. Keep the breakup as civil as you can and try not to drag too many third parties into the picture, it can tend to escalate drama.

DON'T

Do not break up over text. Break up in person or at least over the phone. Do not post mean things on social media for everyone to see and do not share intimacies they told or gave you.

DO

Attend LGBTQ groups on campus to learn and ask questions in a supportive and safe environment. Take as much time as you need to come to conclusions, and even then, remember that you are an ever-evolving person whose identity may evolve as well.

DON'T

Do not feel like you have to come out immediately. Your identity belongs to you and you alone and should be shared when and if you are comfortable. Do not let the pressure to "fit in" make you feel like you can't be honest with yourself.

DO

Talk honestly with your doctor so they can help you pick the option that will best suit your lifestyle. If you choose to take birth control, make sure you do as prescribed.

DON'T

Do not let fear of a physical exam with the doctor keep you from getting birth control. The doctors do this for a living and are not going to judge you. Do not let myths about birth control influence you. Ask your doctor questions and do research using resources like Bedsider.

DO

Know which lubricants are safe to use with condoms (hint: do not use oil based lubricants with latex condoms) using guides like AVERT. Know what size condom to buy (condom-sizes.org can help you figure it out).

DON'T

Do not assume that your partner will provide protection. Always take an active role in having safer sex. Do not use expired condoms.

DO

Talk openly with your partner about what you are comfortable with doing and what you are not. Make sure you know how to use the type of protection you have picked by using resources like Scarleteen's guide for putting on a condom or Condom Depot's explanation of dental dams.

DON'T

Do not go beyond what you are comfortable with. Do not expect your partner to go beyond what they are comfortable with either. Talking mean you'll "ruin the mood", use these tips from Consent is Sexy to get more comfortable communicating about your needs and boundaries.

DO

Stay calm. Get tested and, if pregnancy is a possibility, consider taking a morning-after pill.

DON'T

Do not ignore the seriousness of what happened. Even if you're not sure, it's best to talk to your doctor or a campus health professional and be safe. They will be able to help you figure out why this happened and what you can do to prevent it from happening again in the future.

First, know that men and women experience different symptoms of depression. Read more about the difference in symptoms between the genders from Mayo Clinic and Men's Health. This article from Delta College dives into the issue of depression and how it affects student relationships.

Try to be supportive while also taking care of yourself: explore the Mayo Clinic's guide to managing caregiver stress for resources and ideas. If possible, attend therapy yourself and perhaps even join a group for people with physically or mentally ill partners.

Reach out to friends and family for support. Read Scarleteen's article on surviving a breakup for advice, suggestions and inspiration.

Anxiety is like a misfiring in your brain that makes you feel like something is about to go wrong regardless of what is actually happening. This can mean you need constant validation that your partner does not actually dislike you or you feel like bumps in your relationship are just precursors to heartbreak. Try to keep your anxiety in check by seeing a therapist for guidance and tools. Additionally, read Scarleteen's advice about dating and love while anxious.

Talk with your partner about what you need from them and how they can (and how they cannot) help you. Good Therapy's guide on trauma and relationships is a good starting point. Remember that you cannot fix your partner and they cannot fix you. Healing is a very personal journey that takes time.

Make sure they know that you are there to support them and explore professionally-developed resources like ULifeline for ideas and resources. If you are concerned they may harm themselves or others, contact mental health professionals through community and campus services or text "START" to 741-741 or call 1-800-273-TALK (8255) to get in touch with someone now.