Abortion

Comparison Between Surgical Abortion and Medical Abortion with Mifeprex™, or Methotrexate, with Misoprostol
PregnancyOptions.info: A Workbook of Options including Abortion, Adoption and Birth.

5. Can I still have children later in life?

Regardless of method, abortion is 20 times safer than childbirth. Infections are the greatest threat to fertility, not abortion. Childbearing is not affected, barring rare, serious complications.

6. What are possible serious side effects (complications)?

Mifeprex™ with misoprostol:
• Both Mifeprex™ and misoprostol have been formally studied and used safely.
• Mifeprex™ will not end ectopic or tubal pregnancies which, if undetected, can be dangerous or fatal. (See p.3)
• Need for transfusion (rare).
• Some women may be allergic to medications.

Methotrexate with misoprostol:
• Methotrexate and misoprostol have been formally studied and used safely.
• Methotrexate can effectively treat some ectopic pregnancies with supervision of a doctor.
• Need for transfusion (rare).
• Some women may be allergic to medications.

Vacuum Aspiration:
• Surgical abortion has been formally studied for over 25 years.
• Injury to the uterus is rare in the first trimester. Excessive bleeding is rare. Infection and retained tissue, which would require antibiotics or a re-suctioning, are less than 1%.
• Vacuum aspiration will not end ectopic or tubal pregnancies which, if undetected, can be dangerous or fatal. (See p.3)

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Abortion

Comparison Between Surgical Abortion and Medical Abortion with Mifeprex™, or Methotrexate, with Misoprostol
PregnancyOptions.info: A Workbook of Options including Abortion, Adoption and Birth.

7. What are the common side effects ?

Mifeprex™ with misoprostol:
• Nausea, vomiting, diarrhea, cramping, bleeding, headache, dizziness, fever or chills, anemia (rare). Possible need for surgical abortion.

Methotrexate with misoprostol:
•Nausea, vomiting, diarrhea, cramping, bleeding, headache, dizziness, fever or chills, mouth sores (rare), and anemia (rare). Possible need for surgical abortion.

Vacuum Aspiration:
• Cramping, bleeding
• For some, light-headedness, nausea.

8. How much does it cost?

Mifeprex™ with misoprostol:
• Sometimes higher than surgical. Prices vary. Check what is included.

Methotrexate with misoprostol:
• May be less than Mifeprex™, same or more than surgery. Prices vary. Check what is included.

Vacuum Aspiration:
• May be less than medical abortion. Prices vary. Check what is included.

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Abortion

Comparison Between Surgical Abortion and Medical Abortion with Mifeprex™, or Methotrexate, with Misoprostol
PregnancyOptions.info: A Workbook of Options including Abortion, Adoption and Birth.

9. What are the advantages of each method?

Mifeprex™ with misoprostol:
• Mifeprex™ induces a miscarriage-like process.
• If available, highly effective and safe for very early pregnancy.
• Avoids shots, anesthesia, instruments, or vacuum aspiration, unless it fails. (Blood work required. Injection needed if your blood type is Rh-. Vaginal ultrasound usually required.)
• Being at home instead of a clinic may seem more comforting and private.
• Any support person can be there with you during the abortion process.
• It is finished quicker than the Methotrexate method.
• The timing is more predictable than for Methotrexate.

Methotrexate with misoprostol:
• Methotrexate induces a miscarriage-like process.
• If available, effective and safe for very early pregnancy.
• Avoids anesthesia, instruments, or vacuum aspiration, unless it fails. (Blood work required. Injection needed if your blood type is Rh-. Vaginal ultrasound usually required.)
• Methotrexate may end a tubal pregnancy as well as a normal pregnancy.
• Being at home instead of a clinic may seem more comforting and private.
• Any support person can be there with you during the abortion process.

Vacuum Aspiration:
• It's quick, predictable, and over in a few minutes.
• It's highly successful.
• If available, highly effective and safe for very early pregnancy.
• There's less bleeding for less time than with either of the other two methods.
• Less time cramping than with other methods.
• Performed by a doctor with support of medical or counseling staff, which may seem more comfortable and private.
• Some involvement of support person may be possible.
• If you are trying to conceal abortion, it may be better.
• Avoids medication, except for pain relievers and sedatives.
• It can be done later in the pregnancy than other methods.

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Abortion

Comparison Between Surgical Abortion and Medical Abortion with Mifeprex™, or Methotrexate, with Misoprostol
PregnancyOptions.info: A Workbook of Options including Abortion, Adoption and Birth.

10. Who should not use one of these methods? (What are the contraindications?)

Mifeprex™ with misoprostol:
• If you are more than 7-9 weeks LMP (depends on dr.)
• Medical conditions: allergy to medications; blood clotting problems or on blood thinners; chronic adrenal failure;
chronic systemic corticosteroid use
• IUD in place
• inherited porphyrias
• severe anemia
• possible ectopic pregnancy
• uncontrolled seizures

Methotrexate with misoprostol:
• If you are more than 7 weeks LMP
• Medical conditions: allergy to medications; blood clotting problems or on blood thinners; active liver or renal disease; severe anemia; IUD in place; uncontrolled seizures; inflammatory bowel disease

Vacuum Aspiration:
• Some medical conditions or allergies to anesthesia may require a surgical abortion in a hospital setting.

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Abortion

Comparison Between Surgical Abortion and Medical Abortion with Mifeprex™, or Methotrexate, with Misoprostol
PregnancyOptions.info: A Workbook of Options including Abortion, Adoption and Birth.

11. What are the disadvantages of each method?

Mifeprex™ with misoprostol:
• It takes several days to end a pregnancy.
• It is not completely predictable. There is some uncertainty about when you will bleed and pass the pregnancy.
• Bleeding can be very heavy and lasts longer than with surgical abortion.
• There may be restrictions if you live more than an hour away from the clinic or a hospital, in case of very heavy bleeding, depends on dr.
• Cramping can be severe and lasts longer than with surgical abortion.
• 2-3 visits are required.
• It fails more often than surgical abortion but is more successful than Methotrexate.
• It cannot end an ectopic (tubal) pregnancy.
• It may cost more than other two options.
• Not good method if you are trying to conceal abortion.
• Advisable to have support.

Methotrexate with misoprostol:
• It takes days and sometimes weeks to end a pregnancy.
• It is not completely predictable. There is more uncertainty about when you will bleed and pass the pregnancy.
• Bleeding can be very heavy and lasts longer than with surgical abortion.
• There may be restrictions if you live more than an hour away from the clinic or a hospital, in case of very heavy bleeding, depends on dr.
• Cramping can be severe and lasts longer than with surgical abortion.
• At least 2-3 visits are required, sometimes even more.
• It fails more often than surgical abortion and has a lower success rate than Mifeprex™.
• It takes longer to complete than either Mifeprex™ or surgical abortion.
• Not good method if you are trying to conceal abortion.
• Advisable to have support.

Vacuum Aspiration:
• A doctor must insert instruments inside the uterus.
• Anesthetics and drugs to manage pain during the procedure may cause side effects. (Serious problems are rare.)
• There are possible complications, although they occur in less than 1% of cases.
• You may have less control over the abortion process and who is able to be with you during some parts of the process.
• The vacuum aspirator makes a noise. If available, a manual aspirator is silent.
• It may not be done as early in the pregnancy as with the other methods depending on doctor.
• It cannot end a tubal (ectopic) pregnancy.

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Abortion

Comparison Between Surgical Abortion and Medical Abortion with Mifeprex™, or Methotrexate, with Misoprostol
PregnancyOptions.info: A Workbook of Options including Abortion, Adoption and Birth.

12. How will I be affected emotionally?

No matter which method you choose, it's important to be sure of your decision. No one should be forcing you or pressuring you into any decision about pregnancy. If you have strong doubts about what is right for you, take the time to consider your choices, even if that means you will not be eligible for a medical abortion. Counseling or further thinking may help. The great majority of women do not regret their decision or have serious depression after an abortion. Of course you may have a variety of feelings, as you would about any important life decision.

Mifeprex™ with misoprostol:
• Some women are anxious waiting for the abortion process to complete.
• Viewing the pregnancy tissue may be difficult.

Methotrexate with misoprostol:
• Some women are anxious waiting for the abortion process to complete.
• Viewing the pregnancy tissue may be difficult.

Vacuum Aspiration:
• Some women are anxious in a medical setting or with the idea of surgery.

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that is a great article

hey thank you too much

very helpful! tkx

Five kinds of condoms: A guide for consumers
Go Ask Alice!: Five kinds of condoms: A guide for consumers

s you've noted, condoms are made from different materials — latex, lambskin, polyurethane, and also a new material called polyisoprene. Latex condoms are some of the most widely available and among the least expensive. The market offers several brands, each coming in a variety of sizes, colors, textures, shapes, and even flavors. Some are already coated with the spermicide Nonoxynol-9 (N-9), but this slight amount has been found to be inadequate in protecting against pregnancy. Additionally, research no longer promotes the use of N-9 as it may facilitate HIV transmission (read Condoms with nonoxynol-9 (N-9) — do they increase HIV risk? in the Go Ask Alice! archive).

Polyisoprene condoms are the newest condom option on the market. Ideal for people allergic to latex or polyurethane, polyisoprene condoms have a soft natural feel that conforms to the skin similarly to latex. Some claim polyisoprene condoms are more comfortable than latex; you'll have to experiment as a couple to find which material suits your groove the best. Right now polyisoprene condoms are sold in the United States by LifeStyles (SKYN) and Durex (Avanti Bare) brands.

Polyurethane condoms have long been the go-to for those with latex allergies. But even with the new polyisoprene condom on the market, polyurethane may still be a great choice for lots of couples. Compared to latex, polyurethane condoms are thinner and stronger, and tend to have a less constricting fit. Polyurethane condoms also transfer heat more efficiently, which some say increases pleasure.

Unlike other condoms, the polyurethane variety are available in male and female versions. Worn by women, the female condom is a sheath that's inserted into a vagina up to eight hours before intercourse. Adding extra water-based lube helps increase comfort and decrease noise. (Note: female condoms should not to be used together with male condoms.) Check out What is a female condom? in the Go Ask Alice! archive for more information about this method. Polyurethane and latex condoms provide comparable protection against sexually transmitted infections (STIs). And while they also offer comparable pregnancy protection, polyurethane are pricier than latex condoms.

Lambskin condoms, in contrast, are made from the oldest material on the market — the intestinal membrane of a lamb. Small pores make lambskin condoms ineffective in protecting against viruses that cause STIs. But they do protect against pregnancy, since the pores are too small for sperm to pass through. Lambskin supposedly has a more "natural" feel than latex and polyurethane, although the verdict is still out on how they stack up to polyisoprene condoms in this department.

All four male condom types offer the same statistical effectiveness against pregnancy, which is your primary concern. Contraceptive Technology estimates that only 3 percent of couples who consistently and correctly use male condoms will experience failure in the first year of usage. Female condoms have a probability of pregnancy of 5 percent, which still makes them quite an effective method of pregnancy prevention. The safest route in avoiding an unexpected pregnancy is to use a combination of hormonal birth control and a backup method, such as using male condoms. When using condoms alone, correct and consistent use will maximize their intended efficacy to keep you from getting pregnant.

All five condom options — male latex, polyisoprene, polyurethane, and lambskin condoms as well as the female condom — offer similar protection against pregnancy. Other factors that could figure into your choice might include your budget, availability, how they feel, willingness to experiment, and animal rights convictions. Have fun trying them out!

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Pain in Testicle
Go Ask Alice!: Testicle hurts

Since you seem to be having new pain and are concerned about the cause, your best course of action at this point is to visit a health care provider. But while you're here, boning up on testicular particulars can't hurt: testicular cancer most commonly appears as a firm, painless swelling of one testicle. Cancerous lumps in the testes are generally not tender when they are touched. Relatively rare, testicular cancer usually occurs in men between the ages of fifteen and twenty-five years, especially if they have an undescended testicle.

Other causes of swelling and/or pain in the testes can include:

* hydrocele, a collection of fluid in the scrotum
* epididymal cyst, a fluid-filled swelling of the epididymis (the structure behind the testicle where sperm mature) which may also cause fever and discharge from the penis
* varicocele, varicose veins in the scrotum, which is described as feeling like "a bag of worms"
* bacterial infections

Torsion of the testis, another possible explanation, occurs when a testicle rotates, obstructing the tube sperm travels through and cutting off the blood supply. This most commonly occurs around puberty and causes acute severe pain and swelling of the testes. Pain in your testicle is most likely not a hernia (a protrusion of an organ or tissue through a weak area in the muscle or other tissue that normally constrains it, which commonly occurs in your abdominal area).

If during sex or masturbation you are engaging in activities which involve twisting, pulling, or squeezing of your testicles, this may be a cause of pain. Otherwise, average masturbatory or sexual techniques (even many times per day!) do not cause your testicles to swell.

Again, since you are experiencing pain and tenderness, it would be good idea to schedule an appointment with a health care provider to discuss this problem in the context of the rest of your life, including any recent changes before your testicle started to hurt.

While you're there, you and your health care provider could discuss testicular self-exams, which can help you become familiar with your anatomy, and note if any changes occur. You can do a testicular self-exam during a shower, when the heat of the water relaxes the scrotum. Basically, you rotate each testicle between your thumb and forefinger making sure you feel a round, firm surface and look at your scrotum for any changes. Your provider can give you detailed instructions about a self-exam.

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Circumcision and sex
Go Ask Alice!: Circumcision and sex

Circumcision has become so popular in the United States in the past fifty years — roughly 56 percent of American male infants are circumcised — that uncircumcised penises can be relatively hard to come by (pun intended). If you haven't encountered one before, an uncut member can be a surprise. As with anything unknown, myths and stories about uncircumcised penises abound. And as is always true, different people have different preferences — some people have reported a preference for uncircumcised men while others prefer circumcised. Either way, when beginning a sexual relationship with an uncircumcised man, it's a great idea to educate yourself about these potential differences, so you can have an idea of what to expect and what you can do.

The simple difference between a circumcised and uncircumcised penis is a thin layer of skin, the foreskin, which is highly sensitive and surrounds the end of the uncircumcised penis like a sleeve. When erect, an uncircumcised man's foreskin generally retracts over the shaft, exposing the head of the penis and looking very similar to a circumcised penis. During intercourse, oral sex, and masturbation, the retracted foreskin acts like a lubricant or a sleeve. As the penis thrusts, it glides on its own bedding of movable skin, which minimizes friction. A circumcised penis, which has had the foreskin surgically removed, may need additional lubrication for both partners to experience pleasure. Because of this, some people prefer uncircumcised partners.

For some uncircumcised men, the foreskin doesn't retract completely when erect, leaving the head of the penis covered. If you or your partner desire, you can be manually retract the foreskin by gently pulling it back over the shaft. Foreskin is very delicate, has tons of nerve endings, and should be handled carefully. You can ask your partner how far back to pull the foreskin, and how he likes to be touched. If your partner experiences any pain when trying to retract the foreskin, stop! For more information about foreskin pain, check out Frenulum breve, foreskin doesn't fully retract when penis is erect — surgery? and Penis pain could be phimosis.

It's common for the partner(s) of uncircumcised men to notice a distinct odor or taste when coming in close contact with the penis and foreskin. A distinct smell around the genitals is normal for men (and women), however if the odor seems overly strong, it may be time to gently suggest taking a shower together to wash up. It's also possible for uncircumcised men to have an infection under their foreskin; if there are any signs of irritation, redness, offensive odor, or other abnormal symptoms, your partner may need to see a health care provider.

One bonus of circumcision is that removing the foreskin can lower the chance of contracting certain sexually transmitted infections (STIs). HPV (human pamplona virus), a prevalent STI that is linked to cervical cancer in women and penile cancer in men, is transferred by contact of mucous membranes with sexual fluids. Removing the foreskin shrinks the surface area of mucosal skin vulnerable to the virus, decreasing the chance of transmission. In an uncircumcised man, the glans of the penis, which is exposed and has thicker skin, is more resistant to abrasions and therefore less susceptible to the entry of viruses. The same decreased vulnerability applies to HIV and other STIs. While studies suggest that circumcision lowers the risk of contracting these diseases, they also show that behavioral factors such as using a condom, or getting tested before having intercourse, are more effective risk reducers than just circumcision. Cut or uncut, remember that condoms and other safer sex practices are still important in preventing STIs.

While your first glance at foreskin may give you a bit of a jolt, it's nothing to panic over. Try experimenting with this new situation you're in. Because the foreskin is so sensitive, it can be pleasured just like any other sensitive, erotic part of the body. Using the tongue or the fingers to stimulate the foreskin and the head is often extremely pleasurable for the man. You may be pleased to find that a foreskin offers a whole new dimension of pleasure not only for your partner but for you as well.

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Penis pain could be phimosis
Go Ask Alice!: Penis pain could be phimosis
One of the most common causes of painful intercourse in men is a condition called phimosis. With phimosis, the foreskin is too tight to be completely retracted (pushed back) over the glans (head of the penis). The majority of uncircumcised infants cannot have their foreskin fully retracted because of natural, connective tissue between the foreskin and the glans, but this similar, non-phimotic condition typically resolves in early childhood. By adolescence, most uncircumcised men can fully and painlessly retract their foreskin. Occasionally, penile infections, or forced retraction of the foreskin (either during bathing or sex), can cause scar tissue to develop in the foreskin. Tight bands of scar tissue do not stretch easily and can prevent full retraction of the foreskin.

Depending on the severity of the problem (some men with phimosis cannot retract their foreskin at all, while others have problems with difficult or painful retraction only when their penis is erect), there are a few solutions, including:

* gentle stretching of the foreskin, sometimes with the help of creams or steroids to provide extra lubrication and relieve inflammation, that can relieve mild cases of phimosis
* making a slit in the dorsal (top) side of the foreskin, a medical provider's procedure that allows the foreskin to be more easily retracted
* circumcision, the surgical removal of the foreskin (typically done with a local anesthetic), that cures phimosis

Your boyfriend can make an appointment with a urologist who can help him decide which type(s) of treatment would best suit his condition.

You mentioned that your boyfriend has never had an orgasm during sex. Does he mean from intercourse? Oral sex? Touching? Masturbating? This is important to determine in order to assist him in feeling pleasure and in having orgasms during sex or otherwise.

After the phimosis has been correctly diagnosed and treated, your boyfriend can be more certain about the cause of his absent orgasms. Then he can learn or begin to explore or expand the feelings of pleasure during intercourse, and you can enjoy the feelings of pleasure together.

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A penis with two holes (Hypospadias)
Go Ask Alice!: A penis with two holes (Hypospadias)

Most likely your boyfriend was born with hypospadias, a relatively common abnormality that may affect up to 3 in 1000 newborn boys. Instead of having a urethral opening at the end of the penis, boys born with hypospadias have an opening on the underside of the shaft.

If this is a problem, the condition can be surgically corrected. Often, surgery is arranged before the child reaches school age. The surgery, performed under anesthesia, involves using a small piece of foreskin to fashion a tube to extend the urethra to the end of the penis. The original hole is most often left as is since the urethra now bypasses it. This probably explains why your boyfriend's penis has two holes; only one is functional.

Have you tried asking your boyfriend about the two openings? He has surely noticed that his penis has two holes and probably knows that this is rather unique; and, if he had surgery, perhaps his parents never told him about it.

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Testicular self-exams — how?
Go Ask Alice!: Testicular self-exams — how?

A prostate exam can be complicated and is difficult to do on your own. Generally your health care provider should check your prostate health as part of a routine exam.

The exam you can, and should, do yourself is the testicular exam, which is relatively easy to perform (see the steps below). By doing a monthly testicular self-exam (TSE), men can learn more about their own anatomy, including knowing what's familiar for them and what's not. Monthly exams can help with early detection of lumps, changes in sensation or size, aches, or other unusual symptoms in the genitals. Testicular cancer and other conditions, when caught at an early stage, are easier to cure (these are the same reasons monthly breast self-exams are recommended for women). Unlike many kinds of cancer, testicular cancer is more common in younger men, meaning men should start performing TSEs around age 14.

Steps for doing a testicular self-exam:

1. Stand in front of a mirror and look for any changes, especially swelling, in the appearance of your scrotum (the sac that holds the testes). It's useful to do this immediately after a shower or bath, when the heat of the water relaxes the scrotum.
2. Rotate each testicle between your fingers and thumbs (fingers on the underside the testicle and thumbs on the top).
3. Examine the rest of your scrotum's contents (especially the epididymis) for any changes, particularly hard, small lumps. The epididymis can feel like a cord or rope, and may seem like a lump at first, however it is a normal structure; become familiar with the feel of the epididymis so you can notice actual lumps if they appear.
4. Be on the lookout for hard lumps, masses, or nodules. Often cancerous lumps are painless, but pain can be a symptom of cancer as well as a number of other infections or conditions, so keep note of any discomfort.

It's normal for one testicle to be a little larger than the other, and it's normal for your testicles and scrotum to look a bit different from those of your friends or male family members. The key is knowing what's normal for you, and keeping an eye out for any changes. If you notice pain, swelling, redness, lumps, cysts, or any abnormal changes while doing an exam, you should visit your health care provider right away. Urologists are the type of doctor who specialize in male genital health, however you can begin with your regular provider and get a referral to a urologist if necessary. Many abnormal changes could be signs of an infection (rather than cancer), which are also important to diagnose and treat.

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