Ask Aunt ABby: the morning-after STD test

Time: Surprisingly complicated!

Spring has sprung here at Abortioneers HQ, and there's a new feature on the block! You've got questions. We've got answers. And we received a comment that may or may not deserve its own post.

After reading VV's post on the importance of Backing Up Your Birth Control, Virginia commented:
So much concern about getting pregnant and been able to terminate it...what about getting HIV and STDs while having unprotected sex, do you go check if you got those as fast as you go get a day after pill??


Dear Virginia,

It's hard to tell if you're being snarky or simply not very knowledgeable. Either way, welcome to our new advice column, and thanks for giving us an opportunity to clear up potential misconceptions!

Testing for STIs the morning after unprotected sex (especially HIV, which can take up to 6 months to be detectable) is like testing for pregnancy the morning after unprotected sex -- you won't get a positive result when you test that soon, even though you're not in the clear. So to directly answer your question: No, of course you don't "go check if you got those as fast as you go get a day after pill" [AKA the morning-after pill, emergency contraception, EC, the brand-name Plan B, or any number of generic-label names], as you put it. You literally CAN'T do it right away; whereas with the morning-after pill, you MUST.

That's why, instead of rushing out for a meaningless "morning-after HIV test," many people make it a habit to seek testing at regular intervals. I usually do mine at my yearly physical, because I consider it part of a complete checkup. Many providers suggest you only need to test when exposure is suspected, for example IF you had unprotected sex in the past 6 months or year and haven't yet had a test in that time.

Contraception, on the other hand, is important to seek out as soon as possible after unprotected sex, in order to prevent ovulation -- because that's how ALL birth control pills work, including emergency contraception. The longer you delay, the more time for ovulation to occur, and if it does, then EC won't work and you're left at risk for pregnancy. (This is why taking a regular birth control daily is still most effective -- you've targeted ovulation BEFORE the approach of sperm even begins.) If you miss that window and one of your ovaries does release an egg into its fallopian tube, then at that point all you can do is wait a couple weeks to see if a pregnancy does result, and if so, then (potentially) seek abortion care.

It's important to realize that the "morning after pill" is NOT the same as "getting pregnant and be[ing] able to terminate it." You can only use the morning-after pill to PREVENT pregnancy, and it's only effective in the first 5 days after unprotected sex; abortion, on the other hand, can only take place AFTER pregnancy has begun.

I sure do hope this helps, Virginia. Feel free to follow up with lingering questions, and definitely feel free to share this knowledge with your friends and family.

Yours,

Placenta Sandwich
VP of Taking You At Face Value
Head Know-It-All
Abortioneers

Las evidencias hablan por sí solas!

I attended a health conference yesterday and stopped by one of my favorite orgs, Ipas, to score some swag and some abortion news. I saw a small booklet entitled "Ten Facts About Abortion." Hooray! Now, I already knew those facts, could predict exactly what they would say and how they would be described, so I decided to challenge myself. I put it down and picked up "Diez Datos Sobre Aborto." Same info, but in Spanish! So I thought I'd share it with The Abortioneers, and also with our Spanish-speaking audience. It hadn't occurred to me just how much misinformation is out there to confuse and horrify non-English speakers that we simply aren't catching. So I present to any Spanish-speakers out there who are looking for information and not finding it:

Mito: El aborto ocasiona el “síndrome postaborto”.

Dato: El síndrome postaborto no es un diagnóstico psiquiátrico válido.

Mito: El aborto causa cáncer de mama.

Dato: No existe ninguna relación causal entre el aborto (ya sea espontáneo o inducido) y un aumento en el riesgo de que la mujer desarrolle cáncer de mama.

Mito: La anticoncepción de emergencia causa aborto.

Dato: La anticoncepción de emergencia evita el embarazo. Si la mujer ya está embarazada,

la anticoncepción de emergencia no tendrá ningún efecto en el embarazo y no causará un aborto.

Mito: El embarazo es más seguro que el aborto.

Dato: Los procedimientos

de aborto

efectuados por profesionales de la

salud capacitados, en condiciones

higiénicas, son mucho más seguros

que el embarazo y el parto.

Mito: La legalización del aborto no lo hace seguro.

Dato: Cuando las mujeres tienen acceso a servicios de aborto seguro, legal y a precios asequibles, se reducen drásticamente las tasas de muertes y lesiones maternas atribuibles al aborto inseguro.

Mito: Restringir el acceso a los servicios de aborto es la mejor manera de disminuir el índice

de abortos.

Dato: La mejor manera de disminuir el índice de abortos es reducir el número de embarazos no intencionales por medio de educación sexual integral, prevención de la violencia basada en género y acceso a métodos anticonceptivos eficaces centrados en la mujer.

Mito: El aborto con medicamentos es peligroso y puede causar la muerte de las mujeres.

Dato: El aborto con medicamentos

es una opción segura y eficaz para

la interrupción del embarazo en el

primer trimestre.

Mito: Si el aborto es legal, las mujeres lo utilizarán para el control de la natalidad.

Dato: Las mujeres que no tienen información y acceso a métodos anticonceptivos confiables se enfrentan con tasas más altas de embarazo no planeado y posiblemente recurran al aborto para interrumpir el embarazo, sin importar la legalidad del aborto.

Mito: El aborto es exportado por el Occidente imperialista a los países en desarrollo.

Dato: Desde el inicio de la historia documentada, las mujeres en todo el mundo han interrumpido embarazos no deseados. Esta práctica está bien documentada.

Mito: El aborto nunca es necesario para salvar la vida de una mujer.

Dato: El aborto para salvar la vida de una mujer o una niña es médicamente necesario en ciertas circunstancias y es muy aceptado por profesionales e instituciones como la Organización Mundial de la Salud.

The best thing about this resource is that it actually provides SCIENTIFIC EVIDENCE (DING DING DING!) to support these FACTS ABOUT ABORTION. Great empowerment for non-English speakers who may feel disenfranchised and under-informed in this country. Clinic workers/counselors/direct service Abortioneers, I encourage you to share this and other Ipas materials. Check their website!

Reserving all the judgment for ourselves

You know that saying: the best-laid plans of mice and men go oft awry? Well, because of our extensive experience with the going-awry, many of us abortioneers have pretty firm ideas of safer sexual practices, and some of us might have a certain trepidation about using anything other than "highly effective contraceptive methods" (see here for a ranked chart of options and explanation of its use in contraceptive counseling). 

At the same time, we all spend our days hearing every version of sexual history under the sun, and recognizing that women are not evil or dumb or fuckups when their practices or situations diverge from our own. We counsel clients about methods that are easier to remember or longer-lasting or invisible to an abusive partner; we brainstorm with them about ways to approach a partner about getting testing for STIs, condom negotiation, and respect for boundaries; we remind them about transmission methods of various infections and how to treat or manage existing diseases. We don't scold or scoff. The words "stupid" and "crazy" and "irresponsible" may exist in the world outside our walls, but not in here. 

But have you ever seen what happens when WE fuck up? 

This weekend I had a crazy, stupid, irresponsible experience: unprotected sex. The first of my life. I've been with my partner for ages, but we hadn't had sex in quite a while, and -- it seems crazy but -- somehow this time protection just slipped my mind. And afterward my partner asked if I had gone back on the pill, because he'd been expecting me to pause for condom-time but then I didn't. OMGWTFBBQ, said I. How can someone spend years and years trying so hard to avoid pregnancy, working in the world of unplanned pregnancy, and devoutly practicing protection habits -- then just FORGET? Needless to say, I was about as embarrassed and irritated at myself as your average patient who sheepishly tells you her story of one night of abandon, or one vomited pill. 

Well, I headed right to my medicine cabinet, looking for the pack of emergency contraception that I obtained nearly four years ago and set aside for just this purpose -- or more likely, I thought, for some friend who had a more unpredictable social life and might find herself unprepared. Ha. What was that I said about best-laid plans? I couldn't find the pack! I've moved three times since I first picked it up, and it must be in a box somewhere. So I texted a couple work friends, thinking they were likely to have a spare too -- but they didn't, and our clinic is closed on Sundays so it wouldn't be a snap to get it for cheap or free. No problem: I'll skip down to the pharmacy and buy it over-the-counter---Holy shit! I forgot the full price was fifty dollars. And my insurance doesn't have any coverage for non-prescription meds. 

It's so weird being one of the hoi polloi, the everywoman who faces everyday obstacles and needs to decide if she can afford to protect herself and has to deal with an awkward pharmacist. And really weird realizing I'm judging myself for being "such a dumbass" when I would never think that about someone else. 

Later that day, I heard from a friend: 

               um, how much do you know about herpes?

               i engaged in some high risk irresponsible behavior last night due to drunkeness

               ughhhhhh

               i feel like i need to kick myself out of my [sexual-health-related occupation]

My god! We all make mistakes sometimes, and here we are feeling like something is deeply wrong with us -- like we don't belong in the profession! -- now that we have joined the ranks of those who "should have known better [but presumably didn't]."

Well, good thing it was my turn to blog, said my friend: 

              write about how we in sex/repro health expect ourselves to be models of responsibility and healthy sexuality

               but get down on ourselves when we slip up

               you can talk about your plan b

               and my herpes!

Well, there you go. Turns out this unpleasant incident was a good reality-check: it only takes a weird moment of forgetfulness and some bad luck to end up in the patient's seat or the pharmacy, and I must have had some unacknowledged belief that I was "too smart" to wind up there, or maybe "too smart" to get a pass on making a mistake. 

I know some of us have had the good fortune (so to speak) of being in a "dumb" situation early on, and having lots of compassion as a result. If you'd like to tell that story, please do so in the comments...and I promise I won't think you're stupid!