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

It is time to celebrate "Back up your birth control Day"

So once upon a time I was denied access to emergency contraception by a medical provider. I hadn't had unprotected sex or missed a daily pill or was off on my Depo. Nope, I just wanted to be prepared for the future if I were to ever need Plan B. I'll save that story for another time...but the reality is, plenty of individuals and groups are being denied access which is a violation of basic human rights.

Recent news has focused on Native Americans: read here and teens: read here

So devoted readers, I ask you this: Have you ever been denied EC? Had an access problem (distance, time of day, cost, insurance coverage, etc)?

Finally, how are you celebrating today???

To Have an IUD or Not to Have an IUD (And then, which type?)

Desembarazarme’s recent post about IUDs here got me thinking. IUDs definitely are more popular. Not so much the ParaGard, but Mirena is. Women are often asking for it and providers are generally – in my experience – urging women to use it. I hope, too, that as long-term birth control methods become more available, that our community doesn’t swing their biases towards one method over another (but , this does seem to happen). The thing is, no method is the savior of all birth control for all women. We’re individual, unique people and different methods fit our needs: including abortion as birth control.

I’ve talked about my very own personal choice to not use hormonal birth control for over 15 years. With my current partner, we combine natural family planning with withdrawal and Plan B to control pregnancy. It’s worked for us. I’ve only become pregnant when I’ve wanted to. Despite this, I’ve actually been considering an IUD for years. When I recently discussed this with my Gynecologist and explained to him my reasons for considering the IUD, he told me that Mirena “is the birth control of choice for female OB/GYNs…even for themselves…so that tells you something,” and admitted that he’d recommend it over the ParaGard (which contains no hormones, but generally causes heavier, longer periods and cramps).

The doctor at my clinic loves the IUD, too, and inserts them immediately following an abortion for many of our clients. Many of our clients soon have them removed, though, because there is “nuisance” bleeding for a few months with the Mirena (which has a small level of progesterone) and then no period at all. (Some of us like to have our period to feel more certain we’re not pregnant, even though you can have bleeding and still be pregnant.) Personally, I’m still a bit on the fence about it and since it does cost so much money, I find it hard to just “play” with the method and see if it will work for me, only discover it doesn’t, after forking out over $500.

What do you guys think?

P.S. If you want the recipe for the IUD cookies (they are super cool!), then check out this blog here.

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!