Jock Itch Jock itch is a fungal infection in the groin area. Often it occurs in athletes because the non-absorbent fabric of the athletic supporter provides a warm and moist environment in which fungi thrive. Symptoms include burning, itching, and red, scaly rash. It can be treated with over-the-counter antifungal creams such as Micatin, Cruex, Desenex, Lotrimin, or Tinactin. However, if the rash worsens at any time or fails to improve after seven days of treatment, you should follow up with one of the clinicians at the Health Center. To avoid infection, keep the groin dry by wear absorbent cotton underwear and changing athletic supporters frequently. Prostatitis Prostatitis is an inflammation or infection of the prostate, the gland surrounding the neck of the bladder and urethra (the tube through which urine passes). Prostatitis may result from a bacterial or sexually-transmitted infection and can be treated with antibiotics. The symptoms of prostatitis include burning with urination, urinating frequently, trouble starting urination or incompletely emptying bladder, fever, chills, and low back pain. Testicular self-examination Just as women should perform a monthly breast self-exam (BSE), men should do a testicular self-examination (TSE) just as often. A regularly scheduled self-exam will enable you to distinguish between normal and abnormal findings. If you detect any change in your testicles, regardless of how subtle that change might be, you should have a clinician evaluate it. Testicular cancer is one of the most common cancers in men ages 15-34, occurring four times more often in white than black men. Early detection and treatment is usually curative. The first sign of testicular cancer is a slight enlargement of one of the testes and a change in its consistency. If pain is present, it often feels like a dull ache in the lower abdomen and groin. The best hope for early detection is a simple three-minute self-exam. The best time is after a warm bath or shower, when the scrotal skin is most relaxed. Roll each testicle between the thumb and fingers of both hands. The testes should feel completely smooth and slightly rubbery, like a hard-boiled egg with the shell removed. If you find any lumps or nodules, schedule an appointment at the Health Center. Genital Self-Examination It is also a good idea to perform regular genital self-exams. To do this, look at the entire penis, beginning with the head and progressing down the shaft to the base. Look for any bumps or blisters (either reddish or flesh-colored, possibly resembling pimples), open sores or warts (which might be similar in appearance to warts on other parts of the body). Continue by spreading the pubic hair to check the skin underneath, and then check the underside of the scrotum. Because it is difficult to see the entire genital area, using a hand-held mirror is helpful. Also, check for any unusual drip or discharge from the penis back to top of Page _____________________________________________ Women's Health Issues: The clinicians at the Health Center (x2018) provide a wide array of gynecological primary care services such as: performing gynecological exams; discussing menstrual problems; prescribing and providing forms of contraception including free condoms, oral contraception (the Pill), the diaphragm, and Depo Provera; treating sexually and non-sexually transmitted vaginal infections; conducting pregnancy tests; and referring to other agencies for pregnancy-options counseling. Here are some more details on services and issues the Health Center Staff can help you with: A Routine Gynecological Exam Many young women hesitate to make their first appointment for a GYN exam because they feel either uncomfortable or embarrassed. But every woman should have a GYN exam at age 18 or when she is contemplating becoming sexually active. The clinicians at the Health Center are experienced at doing initial GYN exams and would be willing to meet with you before your appointment to discuss the procedure with you. The visit includes a routine breast and pelvic exam as well as checking your heart, lungs, and thyroid gland. The following is an overview of what to expect. Sexual History The clinician will ask you about your periods, when they first began and how often and long they occur; and about your sexual practices. Some of the questions the clinician asks might seem very personal, but your answers will help her/him care for you better. All of the information you give will be kept confidential. Breast Exam The breast exam helps detect abnormalities in the breasts that might indicate cancer or other problems. The clinician will feel each breast, moving in a circular motion, to check for lumps or other abnormalities. She/he will show you how to examine your breasts yourself. Pelvic Exam A pelvic exam is an essential part of every woman’s health care. It helps the woman and her clinician evaluate the health of her reproductive organs and check for any unusual color, rash, lesions, swelling, irritation, or discharge.  You will be asked to position yourself on your back on the examination table, placing each foot in a footrest, so that the clinician can examine the pelvic area. After looking at the external genitalia, the clinician will insert a speculum, a device that spreads the vaginal walls, to provide a clear view of the vagina and cervix.  The clinician will then collect cells from the vaginal walls and from the opening of the cervix, using a small wooden spatula and a soft brush. This sampling of cells constitutes the Pap smear, a test to detect cellular abnormalities of the vagina or cervix. The clinician also uses a Q-tip to take cultures from the cervix to check for two sexually-transmitted infections, chlamydia and gonorrhea, if the woman’s sexual history warrants it.  Once the tests are performed, the clinician removes the speculum and begins the bimanual exam, by placing one hand on your lower abdomen and two fingers of the other hand in the vagina. This exam enables her/him to get a sense of the size and shape or the uterus and ovaries or to detect any tender areas. Rectal Exam Last, the clinician might perform a rectal exam, by briefly inserting one lubricated gloved finger into your rectum. This procedure will push your uterus, ovaries and fallopian tubes toward the surface of the abdomen, allowing the clinician to feel irregularities that may not be detected otherwise.  The entire exam is usually painless. Most women describe a stretching feeling as the speculum is gently opened in the vagina.  It usually takes 1-2 weeks for the laboratory to send the Health Center the results of your Pap and cultures. Your clinician will notify you of your result Breast Self-Examinations Breast Self Examination (BSE) should be performed every month about one week after the menstrual period ends. It is important to determine what feels normal initially, then to check for any changes. The examination has both a visual and a manual component. Before a Mirror: Inspect your breasts with arms at your sides. Next, raise your arms overhead. Look for any changes in contour of each breast, a swelling, dimpling of skin or changes in the nipple. Then, rest palms on hips and press down firmly to flex your chest muscles. Left and right breasts will not exactly match – few women’s breasts do. Regular inspection shows what is normal for you and will give you confidence in your examinations. Lying Down:  To examine your right breast, put a pillow or folded towel under your right shoulder. Place your right hand behind your head – this distributes breast tissue more evenly on the chest. With your left hand, fingers flat, press gently in small circular motions around an imaginary clock face. Begin at the outermost top of you right breast for 12 o’clock, then move to 1 o’clock and so on around the circle back to 12. A ridge of firm tissue in the lower curve of each breast is normal. Then move in an inch toward the nipple; keep circling to examine every part of your breast, including the nipple. This requires at least three more circles. Now slowly repeat the procedure on your left breast with a pillow under your left shoulder and left hand behind your head. Notice how your breast structure feels. Finally, squeeze the nipple of each breast gently between thumb and index finger. Any discharge, clear or bloody, should be reported to your clinician immediately. Women themselves first discover most breast cancers. Since breast cancers that are found early and treated promptly have excellent chances for cure, learning how to examine your breasts properly can help save your life. If you discover a lump or dimple or discharge during BSE, it is important to see your clinician as soon as possible. Don’t be frightened. Most breast lumps are not cancerous, but only your clinician can make the diagnosis. Vulva Self-Exam A vulva self-exam is a simple exam than can help you detect any abnormalities of the skin. The vulva is the entire external portion of the vagina. To perform an exam, first undress and examine the area of your genitals covered with pubic hair. It may help to use a mirror. Spread the hair and look for bumps or blisters (either reddish or flesh-colored, possibly resembling pimples), open sores or warts (which may be similar in appearance to warts on other parts of the body). Next, spread the outer lips of your vagina and check the hood of your clitoris. Then look at the clitoris itself by gently pulling up the hood. Again, check for sores, bumps, blisters or warts. Then look at the inner lips on all sides and check the area surrounding the urinary and vaginal opening. Also, check for any unusual discharge from your vagina.  If you notice anything unusual, call the Health Center (x 2018). Because some sexually-transmitted infections appear in your vagina rather than on the vulva, it is important to have a pelvic exam performed by a clinician if you think you have been exposed. Menstrual Problems Even if the problem seems minor, you should discuss your concerns about menstrual irregularity, heavy flow and bad cramps with a clinician. Most of these problems can be alleviated with proper treatment.  PMS Many women experience symptoms, usually occurring one to ten days before their periods begin, that have come to be known as Pre-Menstrual Syndrome (PMS). The most common symptoms are anxiety, depression, angry outbursts, weight gain, bloating, breast tenderness, cramps and cravings for sweets. The two most widely accepted theories about PMS implicate vitamin deficiencies due to poor nutrition and hormonal imbalances. To help alleviate PMS symptoms, you can try: Reducing your consumption of refined sugar, salt, and caffeine. Increasing Vitamin B6 (found in green vegetables) consumption Exercising regularly Using a heating pad on your stomach or back If you experience PMS, you may want to consult a clinician at the Health Center to get more recommendations for easing your symptoms. Toxic Shock Syndrome Toxic Shock Syndrome (TSS) is a serious but very rare disease occurring most often in women under 30 who use tampons. In severe cases, TSS can cause death. Staphylococcus aureus, a bacterium that can release toxins into the bloodstream, is believed to cause this illness. Although tampons themselves do not cause TSS, they are suspected as acting as a carrier for this bacteria. The following symptoms of TSS can appear quickly and be severe: Sudden high fever (102 or higher) Vomiting Diarrhea Dizziness or fainting A rash that looks like a sunburn Symptoms of TSS may differ; sometimes it seems like a case of the flu. If you think you may be experiencing TSS, remove your tampon if you are using one and get medical attention immediately. Treatment for TSS may include administration of fluids, drugs to raise blood pressure, and antibiotics.  If you have never had TSS but want to reduce your risk of getting it, choose the lowest absorbency or smallest size of tampons that will still be effective for your menstrual flow, and change your tampon frequently. You can also alternate between using tampons and sanitary pads, especially at night. back to top of Page _____________________________________________ Sex & Sexuality: Throughout life we are sexual beings, whether we engage in sexual relationships or not. Our deepest feelings for other people, our fantasies, our feelings about our bodies and our sensual pleasures are all part of our personalities and our sexuality. We are all sexual – young or old; married, single or committed; gay, lesbian, bisexual, or transgender; sexually active or celibate; physically challenged or not. Learning about sex and our sexual selves is a life-long process. Making choices Many of us have been conditioned to view our own sexual desires as dirty or shameful. We learn early on to judge our bodies according to socially-defined standards of beauty and attractiveness. As a result, we may then lose respect for our own uniqueness, and judge ourselves only in relation to others. We may make choices for ourselves based on what we perceive to be cultural expectations. These perceptions influence the way we experience ourselves sexually. However, leaving home and going away to college present students with the opportunity, sometimes for the first time, to think more independently about sexuality. While learning to think and talk more honestly about sexual decisions, it might help to ask yourself the following questions: How do I feel at this moment? Do I want to be sexually close to this person right now? In what ways? What if I don’t know? Can I say I’m confused? Can I communicate clearly what I want and don’t want? By encouraging communication, we all might able to ultimately challenge assumptions and misconceptions about sex, while also learning to be more assertive about our own sexual needs and desires. Learning to talk comfortably about sex and acknowledging your feelings might also protect you against some of the unpleasant consequences of sex, such as HIV and other sexually-transmitted infections, unplanned pregnancy, and acquaintance rape. Sexual Orientation Few people are completely “straight” or completely “gay” throughout their lives. For example, adolescents who identify themselves as heterosexual might have a same-sex relationship at some point. The researcher Alfred Kinsey found that human sexual orientation exists not as exact categories of behavior, but on a continuous spectrum bounded on the extremes by exclusive heterosexuality and exclusive homosexuality. Few people can truly say they belong exclusively to either extreme. Neither can people claim superiority based on their sexual orientation; the sexual orientation that is best for a given individual is the one with which she or he is most comfortable. That’s it. Homosexuality is not a disease, nor is it as uncommon as many people think. The most quoted statistic says that one in ten people identifies her- or himself as exclusively gay or lesbian. Others fall on the bisexual continuum. You may consider yourself gay, lesbian or bisexual; if not, you probably know students who do, whether they are close friends, classmates, or teammates. When sexual orientation is thought of in terms of friends or neighbors it becomes obvious that it is of utmost importance that we, as members of the Trinity community, respect the sexual choices of others. Intimacy and Sexual Intercourse Deciding to become sexually intimate with a partner is usually a significant step in a relationship, especially since, for many people, having sex involves an emotional as well as physical commitment. You will probably find yourself influenced by cultural, ethical, religious, and moral factors. You should not feel pressured to engage in sexual intercourse, or any other form of sexual activity, unless it is your personal choice to do so. Intimacy does not necessarily mean you have to have sex. Many people abstain from sexual intercourse, choosing other ways to express their affection. What is most important is that you are comfortable with the level of sexual closeness you have chosen. You will also want to consider your own health risks before engaging in sexual activity. Unfortunately, college-aged students are at risk for contracting sexually-transmitted infections, some of which may be asymptomatic. That means one person could transmit a disease to another without ever being aware of his/her infection. Unplanned pregnancy is another concern in heterosexual relationships (see the “Contraceptive Methods and STI Prevention” section of this web page for a complete discussion of birth control). Abstinence is the only foolproof method of preventing sexually-transmitted infections and pregnancy, but chastity is not for everyone. Practicing safer sex allows you to show your love, concern, and respect for your partner and yourself by being smart and staying healthy. Safer sex means enjoying sex to the fullest without transmitting or acquiring infections. By using a barrier method -- such as a condom or dental dam during all genital contact, whether this involves oral sex or intercourse -- you can significantly reduce, but not completely eliminate, the risks. Because you can have only “safer” sex, you and your partner should feel comfortable discussing all aspects of sexuality. Deciding with your partner, through open discussion, how best to minimize the risks can empower you as a couple and strengthen the bond between you. Male Problems with Sexual Functioning In our society, men are often expected to exhibit sexual prowess. Because of this, some men might find it difficult to ask questions or raise concerns about sex. They tend to worry a great deal about “size” and “performance.” Potency has nothing to do with the length or width of the penis, nor does size have anything to do with sexual performance. In the flaccid state, penises do vary in size, but when erect these variations become less noticeable. Impotence:  Men sometimes experience situations in which they expect to have an erection but don’t. This temporary form of impotence is usually associated with fatigue, nervousness or large amounts of alcohol and/or other drugs. In young men, the problem is most often performance anxiety – if you worry too much about not having an erection, you probably won’t wind up having one. The ability to have a nocturnal erection (awakening with a stiff penis) is usually an indication that there is not a physical cause for the impotence. The man might find that talking with his partner about his anxiety improves the situation. If the condition occurs frequently, he might want to see a clinician to rule out a medical problem. Unintended Ejaculation:  Unintended or premature ejaculation simply refers to the experience of ejaculating without wanting to. In heterosexual intercourse, men usually become sexually excited and reach orgasm faster than women. This lack of synchronization can cause frustration between partners. Sometimes, especially with a new partner, a man might ejaculate “too soon,” often before the other person has reached orgasm. If sexual activity stops at this point, it is best for the man to be up front about the problem with his partner. Trying to delay its existence or becoming embarrassed will probably lead to further misunderstanding and may contribute to a recurrence of the problem. On the other hand, talking about it often leads to a solution, possibly based on a change of position or foreplay. Solving the problem together usually increases the comfort level and thus the intimacy. If unintended ejaculation continues, partners can easily be taught techniques to improve ejaculatory control. Blue Balls:  Prolonged sexual excitement without ejaculation can sometimes cause a cramping feeling in the testicles and/or urinary tract, commonly known as “blue balls.” One of the oldest lines men have used with their partners after heavy or prolonged foreplay is that they will incur pain or even bodily harm if unable to ejaculate. Although this condition can be indeed uncomfortable, it is short-lived and physically harmless. It provides no rationale for pressuring a woman to have sexual intercourse. Masturbation can relieve the cramping and tightness in the testicles. Female Problems with Sexual Functioning Male sexual dysfunction often receives more attention than female anorgasmia (the inability to have an orgasm). In heterosexual relationships, men are typically perceived as the partner who must “perform.” But women may also have problems preventing them from fully enjoying intercourse. When both partners are conscious of each other’s emotional and physical feelings, sexual intimacy – whether it takes the form of sexual intercourse or other activities – may be a more pleasurable experience for each. Dyspareunia:  Women may experience uncomfortable or painful intercourse, known as dyspareunia, for a variety of physical reasons. The first few times a woman has intercourse, she might feel pain due to an unstretched hymen or to anxiety. Waiting until she is aroused and helping her relax might help reduce this discomfort. A lack of readiness or arousal can interfere with vaginal lubrication, which is needed to facilitate penetration. A spermicidal or water-based lubricant is the best method for adding moisture to the vagina, particularly if you are using condoms. Avoid oil-based lubricants with condoms because they will break down the latex and make the condom ineffective as protection against STIs or pregnancy. Women can also develop reactions to contraceptive products, lubricants or other feminine hygiene products. Vaginal infections or irritations might make vaginal penetration uncomfortable; and penetration itself sometimes might actually contribute to an infection. If any pain during intercourse persists, the woman should see her clinician. Vaginismus:  Strong involuntary contraction of the vaginal muscles, specifically of the outer third of the vagina, may make penetration sharply painful. This spasm of the vagina muscles, known as vaginismus, may be an unconscious defense against an uncomfortable sexual situation. Previous unwanted sexual experiences, including rape, may also result in vaginismus. Health care professionals or psychotherapists may be able to suggest self-treatment techniques to help alleviate painful penetration. back to top of Page _____________________________________________ Sexually Transmitted Infection (STIs): The term “sexually-transmitted infection” (STI) has replaced the term “venereal disease.” This shift in terminology serves to expand awareness of a greater number of infectious diseases transmitted through sexual contact. There are more than twenty STIs, including HIV, chlamydia, herpes and other organisms and syndromes. Every year millions of STIs are passed from person to person, primarily through sexual contact. Many STIs can be treated, if not cured. STI Transmission The organisms that cause these diseases usually enter the body through mucous membranes, such as the warm, moist surfaces of the vagina, urethra, anus, and mouth. STIs can be transmitted through intimate contact with someone who is infected, especially during oral, anal, or genital sex. Sexually active college-aged women and men are at the highest risk for contracting STIs.  STI Protection You can protect yourself from acquiring an STI in a number of ways: Talk to your partner about STIs before having sex, and ask if she/he has any signs or symptoms of infection. Look carefully at your partner’s body. If you notice any unusual discharge, sores, bumps or redness and think your partner may have an infection, you should refrain from intercourse until he/she is evaluated and treated. Use a dental dam or condom, cut length-wise, during vaginal oral sex (cunnilingus) or a latex condom during the penile oral sex (fellatio). Use a latex condom with spermicidal lubrication during intercourse. Consider using vaginal spermicidal jelly as well. Spermicides containing nonoxynol-9 provide some protection against some STIs. Also, please remember that condoms are not foolproof, but they are the best choice for infection protection during intercourse. If You Think You Have an STI First of all, don’t be embarrassed. If you think you have an STI, call the Health Center for an appointment. In most cases, antibiotics can cure bacterial STIs. Antibiotics are not effective, however, in fighting viral infections like HIV, herpes, and genital warts. If you have an STI, your partner should also seek care and oral/genital/anal intercourse should be avoided until treatment is complete for you and your partner. HIV and AIDS The Human Immune Deficiency Virus (HIV) causes a breakdown in the body’s immune system, which leaves a person incapable of fighting infection and disease. AIDS, or Acquired Immune Deficiency Syndrome, is the final stage of a progressive illness caused by HIV. Having HIV does not necessarily mean one has AIDS; a person can be a carrier of the virus and not manifest AIDS symptoms, but only HIV-infected people can develop AIDS. It may also take many months or years for a person to develop AIDS after becoming infected with the virus. HIV Transmission Anyone, any age, male or female, who engages in unprotected sex, shares needles, or receives blood from someone infected with HIV is at risk. The virus that causes AIDS is transmitted through the exchange of bodily fluids, especially blood, semen and vaginal secretions. The virus enters the body through mucous membranes, open cut or sore, or can be injected directly into the bloodstream. HIV can be transmitted between sexual partners during anal, oral or vaginal sex; through the sharing of contaminated needles; or from mother to child during pregnancy, birth or breast-feeding. Symptoms and Diagnosis of HIV Most people infected with HIV show no symptoms for months or years after becoming infected. When they do exhibit symptoms, their illness can be confused with a flu-like virus. Often all they experience initially is nausea, diarrhea, and fatigue. Some may also have weight loss and/or fatigue; swollen glands; fever, shaking or chills lasting more than several weeks; blurred vision; severe headaches; easy bruising; and pink to purple blotches, flat or raised and usually painless, found beneath the skin or mucous membranes such as the nose, mouth, eyes or rectum. As AIDS progresses, people might develop opportunistic infections (the most common of which is Pneumocystis carinii pneumonia [PCP] – a lung infection), indicating a compromised immune system. Once these symptoms appear, a health care professional might suspect and diagnose AIDS. Though it can be a life-threatening illness, there are many new medications that can significantly extend the lives of people with AIDS. At present, the best way to determine if you have been exposed to HIV is to have an HIV antibody test. This is NOT a test for AIDS, however. It simply tests for the presence of antibodies (substances produced in the blood to fight invading organisms) to HIV. A substantiated positive test indicates that a person had been exposed to the HIV virus. For a conclusive result to be obtained, testing for HIV must take place six months after a possible exposure. Individual circumstances sometimes dictate that a test be done as early as three months after a possible exposure; in the case of a negative result at three months, re-testing might be necessary. If you think you might have been exposed to the virus, you should abstain from any activities in which you could expose someone else. It is especially important to avoid donating blood during this time. Although all donated blood is now screened for HIV and other blood-borne viruses, there is still a small chance of a donor infecting the blood supply during the window period, the time between exposure and six months later. Furthermore, donating blood is not the way to find out if you are infected with HIV. Other safer and more reliable means are available and should be used. The Trinity College Health Center performs both confidential and anonymous HIV testing.  Below is a list of other agencies that also do this testing: AIDS Ministries Program of Connecticut 525-5955 Community Health Services 249- 9625 Hartford Hospital 545-5398 Planned Parenthood 953-620 PREVENTION OF HIV: WHAT IS SAFE? WHAT IS RISKY? Because HIV is spreading at an alarming rate and no cure has been found, prevention is crucial. If you do not have anal, oral or vaginal intercourse and never share needles, you have almost no risk of becoming infected with HIV. But it is possible to be sexually active and remain healthy. Safer sex practices can reduce your risk of HIV infection: Reduce your number of sexual partners. Remember, in terms of your risk for contracting HIV, when you have sexual intercourse with a person, consider yourself to be having intercourse with every other partner she/he has had before you. Avoid the exchange of bodily fluids. Use latex condoms and dental dams correctly during all types of intercourse. Ask about the health status of your partners. It is possible to overcome shyness, but it may well not be possible to overcome AIDS. Avoid sexual contact when under the influence of alcohol and/or other drugs Chlamydia Chlamydia is the most prevalent STI in the United States, particularly among people in the their late teens and early twenties. It can coexist with gonorrhea and other STIs. Approximately 20% of college students are infected with chlamydia. The infection is most commonly transmitted through sexual intercourse. Infants can also be infected while passing through the birth canal of an infected mother. Left untreated, chlamydia can cause Pelvic Inflammatory Disease (PID) in women and can cause scarring of the internal reproductive organs and subsequent sterility in both males and females. There is also an increased risk of ectopic pregnancy (a pregnancy in one of the fallopian tubes) associated with untreated chlamydia. People with chlamydia do not necessarily know that they are infected. Sixty to eighty percent of women and ten percent of men who have chlamydia exhibit no symptoms. In women, symptoms, when present, include genital itching and burning, vaginal discharge, dull pelvic pain, bleeding between periods and cervical inflammation. In men, symptoms include mucus discharge from the penis (gradual onset five to twenty-one days after exposure) and painful urination. Again, these symptoms may be so mild as to go unnoticed. Treatment with an antibiotic is usually successful. To diagnose chlamydia, a small Q-tip is used to culture the mucus or discharge from the cervix or penis. Gonorrhea Gonorrhea is another bacterial infection that can be cured with antibiotics. It is spread through vaginal, anal, or oral-genital contact with an infected person. Like chlamydia, if untreated, gonorrhea can cause Pelvic Inflammatory Disease (PID) in women and sterility in both sexes. Though frequently asymptomatic, it can cause a vaginal or penile discharge and painful urination two days to two weeks after exposure. Gonorrhea is diagnosed by taking a culture of the cervical or penile discharge. If you have had oral and/or anal sexual intercourse with an infected partner, a culture of these areas might be taken as well. Avoid oral-genital contact until the antibiotic treatment is completed for you and your partner. Continue to practice safer sex with a condom. Syphilis Although almost completely eradicated at present, syphilis is still an important STI to be aware of because it has serious long-term consequences if untreated. It is spread by contact with a syphilitic sore, sexually or otherwise. Because the disease can be killed with soap and water when it is present on the skin alone, it is a good idea to wash the genital area after sex. A chancre -- a painless, rounded, ulcerated sore -- is the first sign of syphilis. This skin lesion appears, usually in the genital area, between nine and ninety days after transmission, and heals spontaneously in 3 to 6 weeks. The second stage of syphilis presents with a whole-body rash, including the palms and the soles. This rash spontaneously heals and the patient becomes symptom-free, though not disease-free, once again. The third stage of syphilis is serious and systemic, as the disease becomes more invasive, leading to insanity, blindness, paralysis and even death. Syphilis has been dubbed “the Great Imitator” because it mimics many other diseases, and is therefore frequently difficult to diagnose. You should be tested for syphilis, along with other STIs, if you have had unprotected sex. Penicillin and similar antibiotics can cure the disease. Trichomoniasis Trichomonas vaginalis, a flagellated protozoon, causes the sexually-transmitted infection commonly called “trich” (pronounced “trick”). Women may be markedly symptomatic with a foamy, malodorous yellow-green vaginal discharge, along with a burning sensation, itching, redness and swelling. Or they may be asymptomatic. Men are usually asymptomatic carriers of the infection. It is treated with an antibiotic called metronidazole, which can be given in a single or 7-day dosing regimen. Vomiting and flushing can occur with the use of alcohol when taking this medication so complete abstention is important during and a few days after treatment. Both partners should be treated concurrently to avoid re-infection. Pelvic Inflammatory Disease (PID) Pelvic Inflammatory Disease is a general term for an infection anywhere in the female pelvic organs, including the lower abdomen. The condition starts as a cervical infection and spreads upward into the uterus, fallopian tubes, and ovaries and into the abdominal cavity. Two common STIs, chlamydia and gonorrhea, cause most PID found in college-aged women. Minor symptoms might be a slight fever and aching in the lower abdomen, and more serious symptoms might include high fever and intense pelvic pain resembling appendicitis. It is important to see a clinician immediately because the infection and complications can be life threatening, and because scarring and blockage of the fallopian tubes can cause infertility. PID is now the leading cause of infertility in young women. Genital Warts (Human Papilloma Virus) Human Papilloma Virus (HPV) causes lesions in the genital area similar to common skin warts found elsewhere on the body. In women, these warts can be anywhere on the vulva, inside the vagina, or on the cervix. In men, warts usually appear on the scrotum or the head (glans) or shaft of the penis. Warts may also appear around the anus if you have had anal intercourse with an infected partner. Though HPV cannot be cured, the lesions can be removed with the weekly application of weak acid or liquid nitrogen until the warts are resolved. Numerous applications may be necessary. You can still infect a partner with HPV even if there are no visible lesions. There is a relationship between HPV and pre-cancerous cells on the cervix, particularly among women who smoke cigarettes. Therefore, it is especially important to have annual pap smears. Herpes “Herpes” comes from the Greek word meaning “to creep.” In keeping with its name, the Herpes Simplex Virus (HSV) enters the body through the skin and mucous membranes of the mouth and genitals, and then travels along the nerve endings to the base of the spine. There are two types of Herpes Simplex Virus. Type I is characterized by cold sores or fever blisters on the lips, face, and mouth. Type II usually causes genital sores. While Type I is usually found above the waist and Type II below, there can be some crossover, primarily from oral-genital sex. Most people contract Type II HSV from genital skin-to-skin contact with an infected partner. Herpes cannot be cured. Medications are available by prescription at the Health Center, however, that can reduce the pain of the blisters and the duration of an outbreak. Where Else Can Help Be Found For Herpes Simplex Virus? Here are several sources of info concerning herpes: The American Social Health Association (ASHA), Herpes Resource Center, PO Box 13827, Research Triangle Park, NC 27709. For the National Herpes Hotline call (919) 361-8488 to speak to a counselor and call 800-230-6039 to order information. The Internet address is http://www.ashastd.org/. The organization provides up-to-date practical information and publishes a newsletter.   National Women's Health Network 514 10th St. NW, Suite 400 Washington, DC 20004 Call (202) 347-1140. Centers for Disease Control and Prevention 1600 Clifton Road, NE Atlanta, GA 30333 Call (404 639-2709) On the Internet http://www.cdc.gov/ Internet Resources for Herpes Information Original Herpes Home Page: www.racoon.com/herpes/herpes.html British Herpes Management Forum: www.ihmf.org/ Lists foods high in lysine and low in arginine:  http://www.herpes.com/Nutrition.shtml   Hepatitis B Hepatitis B is a virus that can cause liver inflammation, which can be either mild and transient or chronic and debilitating. Although not commonly thought of as an STD, this potentially fatal disease can be spread sexually through bodily fluids or blood (more commonly through needle-sharing). Symptoms, occurring one to six months after exposure, include fatigue, loss of appetite, nausea, vomiting, diarrhea, tenderness in the upper right abdomen, low-grade fever, sore muscles and joints, and an altered sense of taste and smell, malaise and jaundice. Because there is no current cure for hepatitis B, vaccination against it provides the best protection. The Health Center offers the three-shot series of the vaccine. Pediculosis (Pubic Lice or Crabs) and Scabies Crabs is caused by small, grayish-white lice that infest the pubic and axillary hair. Their eggs, resembling specks of thick paste, may be seen attached to the base of individual hairs. Itching of the pubic area is the main symptom of pediculosis, but because this is probably an allergic skin reaction to the louse, itching might not always occur in every individual. Tiny mites, at most half a millimeter in length, making them very difficult to see, cause scabies. A clinician can, however, reliably diagnose this problem by examining typical areas of infestation, such as the areas between the fingers and toes, the wrists, elbows, armpits, buttocks, breasts, and genitals. Small red bumps or tiny lines (burrows) may appear. Treatment is by commercially available lotions like ELIMITE, Nix, or Kwell, which are applied following a bath or shower. It is usually necessary to use a nit comb to comb out and remove the lice eggs. To avoid re-infestation, all clothing and bedding should be washed in very hot water or dry-cleaned and all sexual partners should be treated. back to top of Page _____________________________________________ Non-Sexually Transmitted Diseases: Yeast Infections Yeast, or Candida albicans, is always present in the vagina. Normally, it doesn’t cause any problems because the vagina’s normal secretions inhibit its overgrowth. But under certain conditions -- such as pregnancy, menstruation, diabetes, or when you begin taking antibiotics or birth control pills -- the pH of the vaginal secretions can change. This shift can create an environment more conducive to yeast, causing its over-growth. It is possible to contract the fungus through sexual intercourse, but it is not usually a sexually-transmitted infection. When a woman has a yeast infection, her discharge might become thick and white, resembling cottage cheese. It might even smell “yeasty.” Typically, intense vaginal itching, burning and discomfort, particularly with intercourse or with urine running over the labia (vaginal lips), will accompany the discharge. Such symptoms usually warrant a pelvic exam because other vaginal discharges can mimic a yeast infection; it is important to determine the particular organism and provide specific treatment. Anti-fungal vaginal cream or suppositories, such as the two over-the-counter medications Gyne-Lotrimin and Monistat, will usually relieve the symptoms in 3 to 5 days. Self-medication, if done at all, is only for those women who have been diagnosed previously for a yeast infection by a clinician and are certain they are having a recurrence. Bacterial Vaginosis Formerly considered a sexually-transmitted infection, bacterial vaginosis (BV) is now known to result from a disruption in the pH of the vagina, where the environment becomes more alkaline, allowing for the overgrowth of bacteria. Women typically experience a milky white, fishy-smelling vaginal discharge. Treatment is with metronidazole, either orally or vaginally. Partners do not need to be treated. Urinary Tract Infections (UTIs) Cystitis and urethritis are infections, usually bacterial, of the urinary tract that cause frequent and painful urination, lower abdominal pain, and/or pain during intercourse. UTIs primarily affect women because the female urethra (the transport tube from the bladder to the opening in the genital area) is relatively short; bacteria do not have as far to travel as in the longer male urethra. Nonetheless, men can also get UTIs. Some UTIs are sexually transmitted in that they are caused by vigorous or repeated intercourse. Simple hygiene rules can minimize the risk of infection. It is good practice to wipe from front to back after defecation, which will reduce the chance of bacteria from the anal area getting into the vagina or the urethra. Urinate when feeling the urge rather than waiting for a long time; urinate immediately after intercourse; and drink fluids to keep the urine diluted and the urinary tract flushed. UTIs are usually treated with sulfa drugs or other antibiotics. Treatment often brings relief within 48 hours. You should avoid intercourse until after your urinary symptoms are completely gone. Non-Gonococcal Urethritis (NGU) Non-gonococcal urethritis is the inflammation of the male urethra (the tube through which urine passes) caused by organisms other than gonorrhea. It is similar to a urinary tract infection, with painful urination and can be treated with antibiotics. back to top of Page _____________________________________________ Contraceptive Methods, Pregnancy Prevention, & STD Prevention: Deciding on a method of Contraception Because no form of contraception, except for total abstinence, is 100% effective at preventing pregnancy and infection, you need to understand the advantages and disadvantages of the various forms and find what works for you and your sexual relationship. People engaging in vaginal intercourse will likely choose to try to combine both contraception (birth control) and STI/HIV prevention. When performing oral or anal sex, the primary concern will be the STI/HIV protection. There are a number of questions that should be considered when making a decision about a particular method or combination of methods: Is this method right for me? Am I comfortable with my ability to use it correctly? Does this method protect against STD/HIV transmission? How much can I afford to spend? Will I feel shy or embarrassed about using this method? Am I comfortable touching my body in the way the use of this method requires? Is this a first or new relationship? Do I plan to have more than one sexual relationship at a time? The bottom line is that the “best” method is the one that you will use correctly and consistently. The effectiveness rates below are based on the first year an average couple uses a particular contraceptive method. The rates take into account user error and motivation. Method Highest Expected Effectiveness Typical User Effectiveness Abstinence 100%   Norplant 99.9% 99.9% Depo-Provera 99.7% 99.7% Oral Contraceptives 99.9% 97% Condom & Spermicide 99% 95% Condom 98% 88% Spermicide 97% 79% Diaphragm 96% 82% Choosing a method for contraception and/or STI prevention at a particular time does not mean it becomes a permanent method for the duration of your sexual life. The method that is right for a person at any given point in her or his life may evolve along with a changing body, personal preferences, relationships and reproductive technology. Abstinence Abstinence ranks among the cheapest forms of contraception and has been utilized for thousands of years. Abstinence, when used as a form of birth control, means abstaining from vaginal intercourse, but not necessarily abstaining from other behaviors which would put him/her at risk for HIV and other STDs. “Outercourse,” intimate sexual activity without actual intercourse, can provide great fulfillment. Non-coital forms of intimacy can range from holding hands, hugging, kissing and dancing to mutual masturbation, petting, oral-genital sex and the use of stimulating devices like vibrators. Advantages Very low risk of pregnancy Reduced risk of STD No cost Disadvantages: May be difficult to sustain Norplant Norplant is one of the newest and statistically most effective methods of birth control available to women today. Six matchstick-sized implants are inserted in the skin of a woman’s inner arm under a local anesthetic. These sticks release a continuous low dosage of the synthetic form of the hormone progestin, which inhibits ovulation and also thickens the cervical mucous, making it difficult for the sperm to travel. Norplant is effective for five years but may be removed earlier if the woman desires. Advantages: Norplant does not involve any interruption between foreplay and intercourse. Effectiveness rates are statistically higher than those are for female sterilization. Unlike oral contraceptives, you do not need to remember to take a pill every day. Disadvantages: Norplant does not protect against STIs. Menstrual irregularities such as vaginal spotting between periods and skipped periods can occur. Implants are expensive. There is no refund if a woman decides to have Norplant removed early. Implants can be slightly visible. Implants must be inserted and removed by a clinician. Removal of implants can be difficult and may cause minor scarring. Depo-Provera Depo-Provera is an intra-muscular injection of the hormone progestin, which must be given once every 13 weeks. Like Norplant and the “pill,” Depo-Provera prevents ovulation. It also changes the consistency of the cervical mucus, thereby reducing the sperm’s ability to enter the uterus. The first injection or “shot” of Depo-Provera must be given within five days of the beginning of a menstrual period, unless the woman has been using the “pill” consistently or an IUD. Depo-Provera begins to give protection against pregnancy within 24 hours after the first injection. The drug slowly wears off over time, and one cannot count on being protected from pregnancy after the twelve-week mark. Advantages: No need to remember to take a pill each day. Highly effective. No interruption between foreplay and intercourse. Some women consider it an advantage that Depo-Provera may eliminate monthly menstrual periods. Disadvantages: Depo-provera does not protect against STIs. Possible side effects include menstrual changes, pregnancy symptoms, weight changes and mental depression. Once Depo-Provera is injected, it cannot be neutralized or reversed should side effects be experienced. Side effects may last until the shot wears off. Return to fertility may be delayed up to 6 or 12 months after the last injection. Oral Contraception (OC) OC works to prevent the release of the egg from the ovary. It usually contains the synthetic forms of both hormones estrogen and progestin. For it to be effective, a woman must take a birth control pill each day at approximately the same time. Oral contraceptives are available by prescription at the Health Center. OC is not recommended for women who have a history of high blood pressure or heart disease, blood clots in the legs or lungs, angina pectoris, tumors in the breast or sex organs or any unusual vaginal bleeding. Advantages: OC is one of the most effective methods of pregnancy prevention. Many women prefer this method because they find it convenient and relatively problem free. It requires no pause between foreplay and intercourse. Physical benefits of using oral contraception may include a more regular menstrual cycle, decreased menstrual flow and decreased cramping. Some studies have associated the use of oral contraception with reduced risk of benign breast disease, ovarian cysts, ovarian cancer, Pelvic Inflammatory Disease, endometriosis, cancer of the endometrium, and iron deficiency anemia. Disadvantages: OC does not protect against STIs. Use of OC involves changing body chemistry through the addition of synthetic hormones, something to which some women may object. There may be a reduction in blood levels of folic acid and Vitamins B6, B12, and C, so OC users should eat more foods containing these vitamins or take dietary supplements. Some women on OC may experience side effects including weight gain or loss, bloating, nausea, vomiting, breast tenderness or enlargement, headaches, moodiness or depression, yeast infections, spotting between periods, improvement or worsening of acne and increased or decreased sex drive. These problems are usually not dangerous and vary from woman to woman. They may subside after two or three cycles on OC. There are several serious but rare side effects associated with OC including circulatory disorders (abnormal blood clotting, heart disease, and stroke), formation of tumors and gall bladder disease. The chance of circulatory problems is greater in women who smoke or are over the age of 35. If You Miss a Birth Control Pill If a woman forgets to take an OC pill at the usual time one day, she should take the missed pill as soon as she remembers and next pill at the usual time. If she forgets for two days in a row, she should take two the day she remembers and two the next day. If one missed pill is taken more than twelve hours late at any point during the cycle, another form of contraception must be used or intercourse avoided for the remainder of the cycle. Back-up contraception must be used even if your period occurs or a new pill pack is started. If three or more consecutive pills are missed, the remainder of the packet for that cycle should be thrown away and a new packet started after the menstrual period. Another form of contraception must be used through the first two weeks of the next packet. Vaginal spotting is likely to occur if you miss any pills. Condoms (Prophylactics or Rubbers), Dental Dams, and Vaginal Spermicides A condom is a sheath or “skin” of latex or polyurethane that fits over the erect penis. It prevents the escape of ejaculated semen during vaginal, oral, or anal intercourse or manual play. Condoms are available in various shapes, colors and flavors. Some people may opt for specialty condoms that have ribs or bumps. Non-lubricated or flavored condoms can and should be used during oral sex to protect against STIs. How to Use a Condom 1. When used in vaginal intercourse, a condom should be used in conjunction with another method of contraception to assure maximum protection against pregnancy. Options include spermicidal foam, cream, jelly, the diaphragm, and the pill 2. Be sure to put the condom on the erect penis before it comes in contact with any mucous membranes or genitalia. 3. Unroll the condom approximately one half inch, then place the open end over the erect penis. This extra half-inch should hang loosely past the head of the penis to catch the semen. Many condoms also have reservoir tips that serve the same purpose. Squeeze the end to make sure no air is trapped inside. The condom should then be unrolled down to the base of the penis. When unrolling the condom, be careful not to puncture or tear it with your fingernails. 4. After ejaculation, the penis should be withdrawn before erection subsides. When withdrawing, a man should be careful to hold onto the rim at the base of the condom to prevent spilling. Should the condom tear or come off during vaginal intercourse, you should immediately insert a spermicidal foam, gel, or cream into the vagina, and the female partner should come to the Health Center to discuss Emergency Contraception (the “morning-after” pill). Condom Care Condoms come with expiration dates and must be kept away from heat. Condoms that are still “good” should have an air bubble in the package. If either the package or the condom is flat, cracked, or looks dried, the condom should not be used. A condom should be used only once and then it should be discarded. A non-petroleum-based lubricant, like K-Y Jelly, should be used with condoms. Vaseline, or any other products containing petroleum jelly, will weaken the condom. For highest effectiveness, condoms should always be used with a vaginal spermicide, such as creams, jellies, suppositories and foam – all of which block the cervix and kill sperm. Nonoxynol-9 is the active ingredient in almost all spermicides. Effectiveness varies greatly. Vaginal contraceptives are most effective when used in conjunction with some form of barrier method, like a condom, and should never be used alone. Advantages Condoms, along with dental dams, provide the best protection, short of abstinence, against STIs, including HIV. They are highly effective contraception when used with another form of birth control. They have little health risk. Some people may have an allergic reaction to the latex or lubricant of a certain condom brand, but this problem can usually be resolved by trying a different brand. They are easily accessible and available free of charge from the Health Center. Disadvantages Some couples consider it a disadvantage that a condom must be put on prior to intercourse, thus interrupting foreplay. Others, however, integrate condom application into their foreplay. Some men find that a condom dulls sensation, but this can often be remedied by adding a drop of K-Y Jelly or another lubricant to the inside of the condom. Some men may find a particular brand of condom too tight or too loose. They may need to try several different kinds of condoms to find one they like. Dental Dam Like a condom, a dental dam is made of thin latex. It is used to prevent the transmission of STIs during cunnilingus (oral sex on women). When used, this small rectangular piece of latex is stretched across a woman’s vaginal opening and labia to prevent the exchange of bodily fluids. The dental dam itself is not lubricated, but using a water-based lubricant on the vaginal side of the dam may help keep it in place and increase feeling. Diaphragm A diaphragm is a dome-shaped rubber cup with a firm flexible metal band or spring rim. For use, the diaphragm is coated with a spermicidal cream or jelly and inserted into the vagina. The latex dome covers the cervix and holds the cream or jelly inside, directly against the cervix. The pubic bone helps hold the diaphragm in place. The diaphragm itself does not create a tight seal against the vagina. Sperm can swim around the rim of the diaphragm to the cervix. The spermicidal jelly will immobilize and kill these sperm before they enter the cervical canal. Since the width of the vagina varies with the woman, the diaphragm must be fitted by a clinician. The object is to select the largest one comfortable for the woman, thus insuring that the diaphragm stays in place during sexual intercourse. The clinicians at the Health Center are available to discuss and prescribe this option. Advantages: A diaphragm does not cause any physical, chemical or hormonal changes in the woman’s body, and there are no serious side effects directly related to its use. A diaphragm is used only when needed. Contraceptive jellies and creams made with Nonoxynol-9 may decrease the risk of contracting HIV. With proper care, a diaphragm will last several years. A diaphragm cannot be felt during intercourse. Disadvantages: A diaphragm may be embarrassing or inconvenient for either partner to use because it requires thought and action before each act of intercourse. A diaphragm may slip out of place due to improper insertion. Some people may have allergic reactions to the rubber or spermicides. A diaphragm may exert pressure on the urethra or bladder, causing some diaphragm users to develop recurrent urinary tract infections. Using a different type or size may alleviate this problem. Vaginal infections may result if the diaphragm is not properly cleaned and dried between uses or if it is left in the vagina for too long. There is an increased risk for Toxic Shock Syndrome. A woman may have trouble inserting or removing the diaphragm correctly on any given occasion, necessitating the use of an alternate method. Female Condom Also known as the vaginal pouch, the female condom is a disposable sheath designed to protect a woman from pregnancy and STIs by lining and covering the vagina. The man’s penis must be guided into the sheath. After intercourse, the man may stay in the woman; unlike with traditional condoms, there is no need for immediate withdrawal. Advantages: This method allows a woman to protect herself from STIs as well as pregnancy. The vaginal pouch does not require the male to be fully erect; therefore, it can be inserted well before penetration is desired. There is no need for withdrawal immediately following a male orgasm. Disadvantages: Some women complain that the sheath moves or is uncomfortable. Creams and Jellies Spermicidal creams and jellies should be used with another method of birth control (e.g., condoms or a diaphragm). With a condom, spermicidal cream or jelly increases contraceptive protection. It is also useful as a lubricant, helping to reduce the chances of condom breakage. With a diaphragm, the spermicidal cream or jelly is essential in creating a protective seal around the cervix. In addition, the spermicide will help trap and immobilize any sperm that make it past that seal. Film A small, film-like square of spermicide, vaginal film is placed on the fingertip and inserted against the cervix at least fifteen minutes prior to intercourse. It is effective for one hour. Foam Foam is the most effective spermicide. While lying down, the woman inserts an applicator full of foam into the vagina. With the applicator tip approximately half an inch from the cervix, the plunger should be pressed to dispense the foam. Care should be taken not to draw back on the plunger while removing the applicator. Additional applications must be made before each new act of intercourse. Vaginal Suppositories Suppositories are small, solid spermicidal pellets that are inserted into the vagina at least twenty minutes prior to intercourse. During that twenty-minute interval, the suppository melts and covers the cervix with a spermicidal film. Because this birth control method relies on a particular timing of events, spermicidal suppositories are not convenient for some couples. Cervical Cap The cervical cap works in much the same way as the diaphragm and has similar effectiveness rates. A small latex cap is inserted by the woman before intercourse and fits over the cervix, serving as a barrier to semen. Spermicide inside the cap is held against the cervix and can destroy any sperm that make it pass the barrier. Fertility Awareness Fertility Awareness methods of birth control are not recommended for college-aged women because they require a relatively stable ovulation cycle. Because stress, illness and exercise easily effect ovulation, college-aged women are not likely to have stable cycles. Fertility awareness hinges on the identification of a woman’s fertile and infertile days. Most important, a woman must determine when she ovulates. Usually, a woman will work with a clinician to accurately determine her cycle by charting her body temperature and mucous discharge. It is important that consistent and accurate records are kept and that thorough initial instruction is received. Almost every religious group accepts these methods. They are relatively inexpensive and require no medication. Fertility awareness can be discontinued easily and can be used to plan a pregnancy. Keeping precise records requires a high level of motivation. Abstaining from intercourse on fertile days can be frustrating for some couples. Finally, women with irregular periods or whose emotional or physical habits might alter hormonal changes may have difficulty predicting ovulation. Intrauterine Device (IUD) The IUD is a small device that is placed inside the uterus to prevent pregnancy. Currently, only two IUDs are on the market: the Progestasert, which must be replaced yearly; and Paraguard-T-380A, which is approved for 8 years of use. The exact way the IUD functions to prevent pregnancy is not fully understood. It appears to interfere with the implantation of a fertilized egg. Infection fighting white blood cells gather in the lining of the uterus and disrupt the normal structure of the uterine lining. The Progestasert IUD further improves its effectiveness by releasing into the uterus the hormone progesterone, which causes the uterine lining to be thinner and thus less hospitable for implantation. Because an IUD can make an existing vaginal infection worse or cause pelvic inflammatory disease (PID), it is recommended only for women who are at very low risk for STIs, such as being in a mutually monogamous relationship. Also, IUDs are easier to insert in women who have either experienced childbirth or have had an abortion because the cervical opening has been previously dilated during these events. back to top of Page _____________________________________________ Emergency Contraception: Coitus Interruptus (Withdrawal) Coitus interruptus, also known as “withdrawal,” has long been used as a contraceptive technique. Using this non-method, a couple may have intercourse until ejaculation seems imminent. At that point, the male withdraws his penis and ejaculates away from his partner’s genitalia. There are many disadvantages associated with “withdrawal.” The male may fail to withdraw or may not withdraw fast enough. Even if he successful, preliminary ejaculatory fluid released before ejaculation can carry enough sperm to result in pregnancy. IN CASES OF CONTRACEPTIVE FAILURE Emergency Contraception (“The Morning-After” Pill) Up to 72 hours after unprotected intercourse, you may choose to take Emergency Contraception (EC). This treatment consists of two pills, one taken initially and one more taken twelve hours after the first dose. Each of the pills contains an identical high dosage of the synthetic hormone progesterone. It is believed that the pills prevent ovulation or implantation of a fertilized egg into the uterus. Some women may experience headache, nausea, or vaginal spotting, though most experience very few side effects with this medication. EC is 89% effective if taken within the first 72 hours following unprotected intercourse. If pregnancy does occur, the hormones may pose some slight risk to the developing fetus, though no birth defects have been linked to EC. If a woman is already pregnant when she takes EC, it will not induce an abortion. “The Morning-After Pill” is a form of emergency contraception. Sexually-active individuals should use other, more reliable methods of birth control to ensure adequate contraception. Emergency Contraception is available at the Health Center. If the Health Center is closed, EC can be obtained by calling 888-NOT-2-LATE. back to top of Page _____________________________________________ Vegetarianism: Vegetarianism in a Nutshell Vegetarian diets can be healthful and meet all your nutritional needs. However, proper planning and correct nutritional advice is the key factor. The Vegi diet needs to include fruits, vegetables (plenty of leafy greens), whole-grain products, nuts, seeds, and legumes on a daily basis and in the correct amounts. There are different types of vegetarian diets: Vegan – excludes all animal products, including meat, fish, poultry, milk, cheese, eggs and other dairy products. Many vegans do not eat honey. Lactovegetarian – excludes meat, poultry, fish and eggs, but includes dairy products. Lacto-ovo vegetarian – excludes meat, poultry and fish, but includes dairy products. Making The Change To a Vegetarian Diet . . . Meat, fish, and poultry contain high amounts of protein, iron, and vitamin B12. Dairy products are abundant in calcium, vitamin D and protein. If these foods are to be eliminated from the diet, it is important to get the correct amounts from other food sources in order to meet your needs. Sources Of Protein (2-3 servings/day) Legumes, nuts, seeds, peanut butter, tofu, tempeh, soy products, hummus and low-fat dairy products are all excellent sources. Sources Of Iron (2 or more/day) Dried beans, leafy dark green vegetables, dried fruits, (i.e., raisins, figs, prunes), iron-fortified cereals, blackstrap molasses, pumpkin seeds, sesame seeds, and soybean nuts.  For maximum absorption of iron, eat these products with foods high in vitamin C, such as citrus fruits or juices, broccoli, tomatoes, or green peppers!! Sources Of Calcium (3-4 servings/day) Low-fat dairy products, collard greens, broccoli, kale, tofu prepared with calcium, calcium-fortified soy milk and orange juice. Sources Of Vitamin B12 A diet containing dairy products or eggs provides vitamin B12. Fortified foods, such as Grape Nuts cereal, some brands of nutritional yeast and soy milk, some soy analogs are all good sources of B12. If you are a vegan who does not consume these fortified foods regularly, you can take a non-animal derived vitamin supplement. With the addition of plenty of fruits, vegetables and whole-grain products, your vegetarian diet should be nutritionally complete! You’re always welcome to talk with the Registered Dietician at the Trinity College Health Center to ensure you’re on the right track. back to top of Page _____________________________________________ Eating Disorders: What are Eating Disorders? Eating disorders -- such as anorexia, bulimia, and binge eating disorder -- include extreme emotions, attitudes, and behaviors surrounding weight and food issues. Eating Disorders are serious emotional and physical problems that can have life-threatening consequences for females and males. Anorexia Nervosa Anorexia Nervosa is characterized by self-starvation and excessive weight loss.  Symptoms include: Refusal to mai