Raleigh Gynecology & Wellness

North Carolina GYN Care & Treatment

Conditions and Management

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An IUD, or intrauterine device, is a long-lasting type of birth control placed inside your uterus to prevent pregnancy. Many women choose IUDs because they are more than 99% effective when it comes to preventing pregnancy. This means that in the course of one year, less than one of every 100 women using this device will get pregnant. Therefore, it is one of the most effective types of birth control available.

Nevertheless, it is still possible to get pregnant while using an IUD, particularly if it is expired. Unfortunately, if you get pregnant with an IUD in place, it raises your risk of miscarriage or ectopic pregnancy. Therefore, it is important to be vigilant and have your IUD replaced at the appropriate time.

Can an Expired IUD Slip Out of Place?

A woman experiencing severe stomach pain after waking up from her bed

IUDs can slip out of place over time, and expired IUDs are particularly vulnerable to this problem. An improperly positioned IUD puts you at a higher risk of pregnancy.

You can check the positioning of your IUD yourself. First, wash your hands thoroughly and then sit or squat and insert your middle or index finger into your vagina. If your IUD is in the right place, you should feel the strings attached to the IUD but not any of the hard plastic casing of the device.

If you cannot feel the string, the string feels shorter or longer than it did before, or you can touch the hard plastic of the device coming out of your cervix, contact your doctor right away. They will use an ultrasound to determine the positioning of the device and will be able to insert a new one if it has slipped out of place. In the meantime, you may not be protected from pregnancy.

When Do IUDs Expire?

Your doctor usually informs you when you have the device inserted how long you can expect your IUD to provide protection from pregnancy. Copper IUDs can last for as long as 10 years, while hormonal IUDs can be effective for three to eight years depending on the brand and type in question.

It is important to remember that leaving an IUD in place after it has expired is never a good idea, even if you are not concerned about accidental pregnancy. Leaving it in for too long can complicate the removal process. It can also cause health risks, such as infections that may lead to sterility or potentially migrating into your abdomen.

Complications of Pregnancy With an Expired IUD

A woman's hand holding a pregnancy testing kit

Here is a look at some of the major complications that may occur if you become pregnant with an expired IUD in place.

Ectopic Pregnancy

An ectopic pregnancy is one that develops outside of your uterus. One common cause of ectopic pregnancy is a fertilized egg growing in the fallopian tube. This is a serious condition that can lead to internal bleeding, infection, and possibly death if it is left untreated.

Unfortunately, getting pregnant while an IUD is in place puts you at a higher chance of having an ectopic pregnancy. However, it is worth noting that the overall risk of an ectopic pregnancy is low.

Miscarriage

Another potential problem women may encounter if they get pregnant with an expired IUD is miscarriage. For women who get pregnant while they are using an IUD, the device itself can raise the risk of miscarriage. This occurs when a pregnancy ends spontaneously prior to its 20th week, and when the fetus has not developed sufficiently to survive outside of the uterus.

What Happens if You Get Pregnant With an Expired IUD?

If you discover that you are pregnant with an IUD in place, it is important to contact your doctor right away. In many cases they will recommend to have your IUD removed as soon as possible.

IUD Removal: What to Expect

A doctor holding an IUD after the removal

When your IUD has expired, it is important to have a professional like a gynecologist remove it. This procedure can be carried out at any time. This is a relatively simple and quick process that does not usually cause any complications. Your doctor will pull gently on the string attached to the device with forceps. The arms of the IUD will then fold upward as it slides out of the uterus. You may experience some cramping or light bleeding during or after the process. If you are concerned about pain, you may want to take an over-the-counter painkiller before your appointment to reduce discomfort.

If your IUD is removed due to an infection, you may need to take antibiotics afterward. However, for routine removals without infections or complications, you can have a new IUD inserted immediately at the same office visit.

Reach Out to the Contraceptive Care Professionals at Raleigh Gynecology & Wellness

Although IUDs are highly effective at preventing pregnancy, it is important to ensure you have them replaced when they are approaching expiration and regularly check to ensure the device is positioned properly. If you have any doubts about the integrity of your IUD or have questions about this method of birth control, schedule an appointment with the contraceptive care professionals Raleigh Gynecology & Wellness today.

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One of the most effective forms of birth control available today is Nexplanon®. This is a type of birth control implant that is inserted in the skin of your arm, where it releases hormones that prevent pregnancy.

Many women choose it because it provides protection for as long as three years, making it a good option for those who might be prone to forgetting to take daily birth control pills. Read on to learn more about whether Nexplanon® may be an effective birth control option for you.

How Does Nexplanon® Prevent Pregnancy?

Human sperm cells

Nexplanon® is an implant that is in the form of a small and thin rod that is roughly the size of a matchstick. Your doctor inserts it under the skin in your upper arm. Once in place, it releases the hormone progestin, which can prevent you from getting pregnant in two ways. First, it thickens your cervical mucus, preventing sperm from swimming through it to reach your egg. Second, it also stops eggs from leaving the ovaries, meaning there will not be an egg for any sperm that gets through to fertilize.

How Effective Is It?

Nexplanon® is more than 99 percent effective in preventing pregnancy. On average, less than one out of every 100 women who use it will become pregnant. The main reason for its strong efficacy is the fact that it is essentially foolproof. Because it is placed inside your arm, you cannot use it incorrectly or forget to use it.

How Long Does Nexplanon® Offer Protection?

Nexplanon® can last for as long as three years, which means it is a “set it and forget it” approach. However, if you decide to get pregnant in the meantime or wish to change your form of contraception, your doctor simply removes the implant, and you should be able to get pregnant.

If your implant is inserted within the first five days of your menstrual cycle, you will be protected from getting pregnant immediately. If you get it at any other time in your cycle, however, you will need to use a different type of birth control during the first week. After that time, your implant will begin to offer protection that can last for up to three years. Be sure to follow your doctor’s advice on when it should take effect.

Does Nexplanon® Protect Against Sexually Transmitted Diseases?

A couple consulting a doctor for sexually transmitted diseases

Although Nexplanon® is a very effective way to prevent pregnancy, it is important to understand that it does not provide any degree of protection against sexually transmitted diseases. You will still need to use condoms each time you have sex to avoid spreading or contracting sexually transmitted diseases.

How Is the Implant Inserted?

Once your doctor determines that Nexplanon® is a suitable method of birth control for you, you will be given a shot that numbs a small area of your arm. Then, an inserter tool is used to slide the birth control implant under your skin. This process takes only a few minutes. You may feel some stinging or a small pinch when you receive the numbing shot, but you should not be able to feel anything while the implant is being inserted.

Once the pain medication has worn off, you may notice some aching in your arm where the implant was inserted, but it tends to go away quickly. Although you may experience some swelling, bruising, or tenderness around the implant site, they should subside in a week or two.

Does It Have Any Side Effects?

Although some people experience side effects from the hormones in Nexplanon®, many women use it without any problems. The most common side effect is spotting in the form of brown discharge or light bleeding, particularly during the first six to twelve months. For some, it can also cause long-term spotting or irregular periods. However, for most, it will make their period significantly lighter or go away altogether. Once your body gets used to the implant, these side effects will usually go away.

Some of the less common side effects include weight gain, headaches, nausea, breast pain, infections at the implant site, and ovarian cysts.

Doctors recommend giving your body a few months to adjust to the hormones in Nexplanon®. However, if you are unhappy with it after a few months, discuss your concerns with your doctor, who can help you determine if a different method of birth control may be more appropriate for you.

What Happens After Nexplanon® Is Removed?

A woman with her gynecologist in the clinic

Having your birth control implant removed spurs a change in hormones, which always carries the possibility of creating temporary side effects. Your body should eventually return to the way it was before you had the implant. This means that if the implant caused your period to stop, it will eventually come back, although it may take a few months for it to return to your usual cycle.

Keep in mind that you can get pregnant immediately after the implant has been removed from your body, so if you do not wish to become pregnant, you need to use another method of birth control.

Reach Out to the Women’s Health-Care Team

If you are sexually active and wish to avoid pregnancy, contact the women’s health-care team at Raleigh Gynecology & Wellness. We can help you determine which method of contraception best meets your needs and suits your lifestyle.

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Sexual intercourse is meant to be pleasurable, but for some women, it can be a source of considerable physical pain. If you are experiencing pain during sex, you may find it reassuring to learn that it is not uncommon and is generally very treatable. Although it may be uncomfortable to talk about it, your doctor can help you find a solution. Here is a look at some of the management and treatment options for pain during sex.

Diagnosing Pain During Sex

A young couple is consulting a Raleigh Gynecology & Wellness Professional

Before finding the best way to address painful sex, it is important to identify its cause. Your doctor will begin by compiling a thorough medical history, asking you questions about when your pain begins, where you are feeling it, and whether it happens in every position or with every partner.

They may also ask you whether any nonsexual activities cause pain in the area and whether you are experiencing other symptoms such as itching, burning, or irritation. Your doctor might ask questions about your childbirth and surgical history. It is important to be forthcoming and answer these questions as truthfully as possible.

Next, they will carry out a pelvic exam to look for signs of skin irritation, anatomical issues, or infections. They may also conduct a visual exam of your vagina using a speculum to keep it open. If this causes you pain, you can ask the doctor to stop the exam. A pelvic ultrasound may also be used if certain causes of painful intercourse are suspected.

Treatment

The precise treatment your doctor will recommend depends on the cause of your pain. Here is a look at some of the most common approaches.

Medication

Estradiol estrogen pills with other prescription medication bottles

If a medical condition or infection is behind your pain during intercourse, treating the cause may be enough to bring about relief. If you are taking any medications that can cause lubrication issues, changing to a different medication may also lead to improvements.

Painful intercourse for postmenopausal women is often caused by insufficient lubrication due to low levels of estrogen in the body. Birth control pills, menstruation, pregnancy, breastfeeding, and some types of antiestrogen medications may also result in decreases in estrogen production that lead to dryness and pain during sex. Applying topical estrogen directly to your vagina may alleviate this problem; there are also other medications that can help.

Other Types of Treatment

There are also some nonmedication approaches that may help with painful intercourse.

Counseling or Sex Therapy

For some women, painful sex is psychological and may be linked to trauma or low self-esteem. Even in cases where painful sex has a medical cause, you may develop a negative emotional response to any sort of sexual stimulation, even after the pain has been treated, if sex has been painful for a long time. Moreover, in cases where you and your partner have avoided getting intimate due to your pain, it may be necessary to seek outside help in restoring sexual intimacy and improving your communication surrounding these issues. A counselor or sex therapists can be very helpful. In addition, cognitive behavioral therapy can help you to change any negative thought patterns and behaviors that you have concerning intercourse.

Pelvic Physical Therapy

For some women excess tension or dysfunction of the pelvic floor muscles contributes to painful sex. Referral to a special physical therapist with expertise in this area can help to alleviate this problem.

Changing Positions

For women who experience sharp pain during thrusting, switching to different positions may provide some relief. For example, doctors recommend that women try being on top as they may be able to regulate penetration to a more comfortable depth from this position.

Don’t Skip Foreplay

Foreplay can help to stimulate your body’s natural lubrication, which can make sex more comfortable. Try to delay penetration until you feel completely aroused to see if your pain subsides. Many women report that sex is less painful when they are relaxed and can take their time.

Use Lubricants

A woman holding a bottle of sex lubricants

There are many personal lubricants on the market that can help to make sexual intercourse more comfortable. Water or silicone based lubricants are frequently good options. If you are using latex condoms for birth control or STD prevention, be sure to avoid oil-based lubricants as they may lead to condom breakage.

Avoid Irritating Products

If you have pain during sex, it could also be due to irritation from certain types of products. Avoid using vaginal perfumes, scented toilet paper, sanitary pads, and bubble baths. Switch to underwear that is 100 percent cotton, and try a gentler laundry detergent to see if any of these products could be related to your pain.

Reach Out to the Women’s Healthcare Professionals

There are many reasons you may be experiencing painful sex, but you do not have to continue suffering. The women’s healthcare professionals at Raleigh Gynecology & Wellness can help to identify the cause of your painful intercourse so you can manage it effectively and restore normal sexual function. Call us today to set up your appointment with a gynecologist or to schedule an appointment online.

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Sex is supposed to be pleasurable, but for some women, the experience can be painful. Whether you experience pain every time you try to have intercourse or it only happens occasionally, it is important to explore what could be causing the problem so you can take steps to address it. Here is a look at some of the most common reasons women experience painful sex and how you can alleviate it.

What Is Painful Sex?

A young couple facing issues while having sex

Painful sex, also known as dyspareunia, is characterized by pain in the area of the pelvis, labia, or vagina that is felt either during sexual intercourse or immediately afterward. It is so common that it has been described in medical literature as far back as the ancient Egyptian scrolls. However, it is not known precisely how many women experience it because the symptoms can vary, and many women are not comfortable discussing it with their doctors.

The pain may manifest in several ways. Some women report a deep pain, while others experience a sharp pain, a burning sensation, or a feeling of great discomfort. Some women might also experience symptoms such as muscle tightness, muscle spasms, or pelvic cramping.

Types of Painful Sex

There are many types of dyspareunia, so the condition is often broken down into different categories depending on its location and duration.

Location of Painful Sex

First, the location of the pain is considered. There are two main types: entry pain and deep pain.

Entry Pain

Also known as superficial or introital dyspareunia, this pain is felt around the vaginal entrance during initial penetration. It may be related to an infection, injury, or inadequate lubrication.

Deep Pain

Sometimes referred to as collision dyspareunia, this pain is felt during deep penetration and may be worse in specific sexual positions. It may be felt in the cervix or the lower abdomen, and it is sometimes linked to previous surgery or a medical condition.

Duration of Painful Sex

Painful sex is also described in terms of its duration.

  • Primary Pain: Pain during intercourse that you have always experienced since you first became sexually active.
  • Secondary Pain: Pain that develops after a time of painless sex.
  • Complete Pain: You experience pain every time you have sex.
  • Situational Pain: You only experience pain at certain times during sex.

Causes of Painful Sex

Here are some of the most common causes of painful sex.

Insufficient Vaginal Lubrication

Vaginal lubrication and three packs of condom

Many cases of painful sex can be traced to insufficient vaginal lubrication. There is often a psychological component to this; women may find that relaxing a bit before sex or engaging in prolonged foreplay can help them reduce or eliminate pain. You can also purchase sexual lubricant and apply it prior to having sex.

Vaginal Atrophy

The lining of the vagina can sometimes lose thickness and moisture and may even become thin and dry. This can be due to hormonal changes, medication, or menopause. A gynecological exam can diagnose vaginal atrophy, and the treatment will depend on the cause identified. Hormone therapy and lubricants are two common recommendations for women with this issue.

Vaginismus

Vaginismus occurs when the muscles of the vagina automatically tighten up out of fear of vaginal penetration. It is a reaction that cannot be controlled, and it can even occur in women who have previously enjoyed painless sexual penetration. However, it does not always impact the ability to get aroused or enjoy other forms of sexual contact. It is often caused by worries your vagina may be too small to accommodate your partner, negative beliefs about sex, a bad sexual experience, or a medical condition.

There are several possible treatments for vaginismus. Psychosexual therapy, a type of talk therapy that helps you understand your feelings about sex and your body and make changes, is one helpful approach. Pelvic floor exercises, physical therapy, vaginal trainers, and relaxation techniques such as mindfulness can also help you relax the vaginal muscles.

Injury to the Vagina or Vulva

For some women, painful sex can be attributed to injuries to the vagina or vulva, particularly for women who have given birth in the past. These injuries could include a tear that occurred during childbirth or a cut from an episiotomy made during labor to facilitate childbirth.

In addition, having intercourse too soon after childbirth or surgery can also cause painful sex, and this will often go away on its own if you give yourself sufficient time to heal.

Pelvic Inflammatory Disease

A woman showing the symptoms of pelvic inflammatory disease

In pelvic inflammatory disease, or PID, the tissues deep within the vagina and pelvis experience severe inflammation, and this causes the pressure of intercourse to lead to deep pain. This is usually caused by a sexually transmitted infection, and symptoms include pain in the lower abdomen and stomach as well as lower abdominal pain. It can usually be treated with antibiotics, but your partner should get tested and treated to avoid a recurrence.

Keep in mind, however, that PID is not always sexually transmitted. For example, sex itself can sometimes allow bacteria to enter the reproductive system and infect your organs.

Reach Out to the Women’s Wellness Team

If you are experiencing painful sex, reach out to the women’s healthcare team at Raleigh Gynecology & Wellness to set up an appointment. Their highly trained gynecologists and nurses can help manage a broad range of gynecological conditions and issues.

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Under normal circumstances, your vaginal lining is lubricated with a fluid that keeps it elastic and thick. However, there are many reasons that the tissue in your vagina can sometimes become dry and thin, which can lead to significant discomfort during sex, while exercising, or even while sitting down. Here is a look at what can cause this frustrating problem and how you can address them through different treatment options for vaginal dryness.

What Can Cause Vaginal Dryness?

A woman in yellow tank top and white shorts experiencing vaginal dryness

Many times, vaginal dryness stems from a drop in a woman’s estrogen levels as one of this hormone’s many functions is helping the vagina maintain its natural lubrication. However, it can also be caused by medication and lifestyle-related behaviors.

Reduced Estrogen Production

Decreases in estrogen production can be caused by perimenopause, menopause, or surgical menopause. It may also result from menstruation, birth control pills, or antiestrogen medications. Pregnancy, childbirth, breastfeeding, and chemotherapy may also lead to reduced estrogen production.

Medication

Besides medications that specifically reduce estrogen production, such as Tamoxifen, other types of drugs can also lead to vaginal dryness. These include birth control pills, antihistamines, cold medications, antidepressants, asthma medication, and allergy medication.

Lifestyle

Vaginal dryness may also result from drinking alcohol, smoking cigarettes, douching, stress, or allergies to fragranced personal products such as detergents and toilet paper.

Treatments for Vaginal Dryness

A female doctor prescribing treatment to a woman inside the clinic

Because there are so many potential causes of vaginal dryness, it is essential to identify the reason you are experiencing this problem so you can address it properly. While vaginal dryness due to product allergies can be easy to correct, if you suspect it could be related to low estrogen, you will need a gynecologist to diagnose the problem and recommend treatment. Outlined below are the top treatment options for vaginal dryness.

Prescription Treatments for Vaginal Dryness

If you have low estrogen, your doctor might prescribe a low-risk topical form of estrogen therapy aimed at promoting lubrication and elasticity. Here are some examples.

Vaginal Cream

These prescription products use an applicator to deliver cream with a low dose of estrogen into the vagina.

Vaginal Ring

This is a flexible, soft ring that you insert into your vagina. It will remain there and steadily release low amounts of estrogen into the vaginal tissue for about three months, at which point you remove it and insert a new ring

Vaginal Tablet

This is a type of medication that is applied using an applicator that is similar to that of a tampon. Much like a vaginal ring, this tablet will slowly release low doses of estrogen into vaginal tissue.

Over-The-Counter Vaginal Dryness Treatments

There are some over-the-counter treatments for vaginal dryness that may be helpful in cases where the dryness is not linked to low estrogen levels.

Lubricants

A water-based personal lubricant can be used when you have sex to enhance moisture levels. Be sure to avoid oil-based lubricants, however, as they can cause irritation and make condoms prone to breakage.

Vaginal Moisturizers

Over-the-counter vaginal moisturizers are available that can be inserted every few days to replenish the natural moisture in your vagina.

Lifestyle Changes to Improve Vaginal Dryness

A woman enjoying the summer evening

Here are some recommendations for lifestyle changes that can help you restore your vagina’s natural moisture levels.

  • Avoid douching or using personal hygiene products formulated with dyes or fragrances.
  • Wear cotton underwear that allows your vagina to breathe, avoiding clingy fabrics and thongs that can worsen irritation.
  • Avoid using hot water to clean your vagina.
  • Have sex regularly with sufficient foreplay and arousal in order to stimulate your body’s natural vaginal moisture production.
  • Eat foods rich in phytoestrogens, such as soy, seeds, tofu, berries, and nuts.

How Long Does it Take to See Improvements?

If your vaginal dryness is not linked to estrogen production, it should return to normal not long after you have identified the cause and taken action to correct it.

Women in perimenopause and menopause may experience persistent vaginal dryness, in which case help from a gynecologist is needed.

For women who are breastfeeding, vaginal dryness may continue throughout nursing, although a doctor may be able to help you find some relief.

When to See a Doctor

If you have ruled out any lifestyle-related causes, such as irritating products, and your vaginal dryness persists, you should see a gynecologist. They can discuss your symptoms with you and make a diagnosis with a pelvic exam; they may also carry out blood tests depending on the suspected cause.

You should also see a doctor if your vaginal dryness is accompanied by any of the following symptoms:

  • Abnormal odor or discharge
  • Bleeding after sex
  • Painful sex
  • Persistent vaginal swelling
  • Severe itching

Reach Out to the Women’s Healthcare Team at Raleigh Gynecology & Wellness

Vaginal dryness can be very unpleasant, but there are lots of treatment options that can provide relief. The women’s healthcare team at Raleigh Gynecology & Wellness can help identify the cause of your vaginal dryness and recommend effective treatments. Contact them today to set up an appointment.

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