Taking Charge of Your Fertility

by Toni Weschler

  Nabothian cysts on cervix

  PAIN OR STINGING DURING INTERCOURSE

  You may occasionally feel a deep pain during intercourse, depending on the sexual position you use and where you are in your cycle. When a woman is in her infertile phase, the cervix sits at its lowest point and can actually be tapped by her partner’s penis during intercourse, especially if she straddles atop him. That’s because this position tends to push the cervix down to its lowest point. Even the slightest tapping of the already tender ovary about to release an egg or a full bladder could cause pain during intercourse. Simply be aware of how high your cervix is on any given day and avoid the position that causes discomfort.

  However, if the pain is deep and intense, it could be a sign of an ovarian cyst that is twisting on itself. In addition, adhesions caused by endometriosis can often cause a deep pain during sex.

  Finally, if you feel vaginal pain or stinging, the causes may include a vaginal infection, lack of lubrication, or an allergy to latex, spermicide, or soap. But you may have something requiring much more patience to both diagnose and treat, including any one of the three Vs which can cause much more intense pain or stinging: Vaginismus, Vulvodynia, and Vestibulitis, all of which are discussed here.

  Uncomfortable intercourse

  SPOTTING AFTER INTERCOURSE

  Some women will notice occasional spotting after making love. It’s usually due to the cervix being tapped by the penis. This is especially likely when the cervix is lowest and most vulnerable to being hit during your postovulatory phase.

  It can also be caused by such conditions as cervicitis (an inflammation of the cervix), cervical polyps (a common protruding growth from the cervix), or a vaginal infection. All of these are fairly benign. Regardless, you should be checked by a physician, especially if the bleeding is heavy or occurs often, to rule out anything more serious, such as cervical cancer.

  Spotting after intercourse

  APPENDIX B

  Frequently Asked Questions

  As a FAM instructor, I have been asked just about every possible question regarding fertility. I have chosen to address the most frequently asked among them in this appendix. They are categorized by subject, but are more thoroughly discussed in relevant sections of the book. These pages simply serve as a review, or perhaps as an introduction for your friends, who may want to know more about such a fundamental aspect of their lives.

  THE FERTILITY AWARENESS METHOD (FAM)

  How effective is FAM for birth control?

  What is the difference between FAM and the Rhythm Method?

  Is FAM a good method for everybody?

  How many days do you have to abstain when using FAM for birth control?

  Is there really a risk of pregnancy if I only have sticky (non-wet) cervical fluid?

  Do women ever have truly “dry” days?

  How much time is required to learn and use the method?

  Do I have to wake up every day at the same time to take my temperature?

  How can temperatures be relied upon if I sometimes get a fever?

  Is it worth checking my cervical position?

  Is it possible to conceive without observing slippery eggwhite-quality cervical fluid?

  OVULATION

  Do women always ovulate on Day 14 of their cycle?

  Can you “feel” ovulation happen?

  Can a woman ovulate more than once per cycle?

  What is multiple ovulation?

  Do women feel more sexual around ovulation?

  Can orgasm trigger ovulation?

  FERTILITY AND CYCLES

  What percent of a woman’s cycle is fertile?

  What are your chances of conceiving in any given cycle?

  Can a woman get pregnant during her period?

  Is it true that a woman can get pregnant anytime?

  Can a woman get pregnant if she hasn’t been menstruating?

  Can you have a cycle in which you don’t ovulate but you still get your period?

  How does the Pill work?

  Can stress affect your fertility?

  How many days can sperm survive?

  How long can a human egg survive?

  What should I look for now that might help identify a potential fertility problem in the future?

  THE FERTILITY AWARENESS METHOD (FAM)

  HOW EFFECTIVE IS FAM FOR BIRTH CONTROL?

  If used correctly every cycle, and you abstain during the fertile phase, the FAM rules taught in this book have a failure rate of approximately 2% per year. This is considered lower than any barrier method except the condom, which is also 2%. (Sterilization and chemical methods such as Depo-Provera and the Pill have an even lower equivalent failure rate of 1% or less.) However, for those couples who choose to have sex during the fertile phase while using a barrier method, the overall failure rate will naturally be no lower than the rate of the barrier the couple chooses to use. Of course, you can dramatically improve those rates by using two barriers during the fertile phase.

  In actual use, studies show that failure rates vary greatly, from about 1% to 20% per year, with most of the variance being a direct function of the motivation of the couples involved. For a more thorough discussion of Fertility Awareness and contraceptive effectiveness, see Appendix D.

  WHAT IS THE DIFFERENCE BETWEEN FAM AND THE RHYTHM METHOD?

  Probably a more appropriate question is: What do they have in common? The only thing is that they are both natural methods of birth control. However, the Rhythm Method is an obsolete, ineffective method of identifying the fertile phase using statistical prediction based on past cycles to predict future fertility. The Fertility Awareness Method, on the other hand, is a scientifically validated method involving the observation of the three primary fertility signs: cervical fluid, waking temperature, and optionally, cervical position. Unlike Rhythm, FAM is very effective because the woman’s fertility is determined each and every day.

  IS FAM A GOOD METHOD FOR EVERYBODY?

  No, not as a method of birth control. It’s recommended only for monogamous and married couples, given the danger of AIDS and other STIs. In addition, it’s only appropriate for those women who have the discipline to learn the method well, and then to follow the rules once they have internalized them.

  However, as a method of pregnancy achievement, it should be the first step that every couple takes to maximize their chances of conception, and to determine if there may be anything impeding their ability to get pregnant. In addition, it can be very helpful for couples desiring to plan the timing of their baby’s birth.

  FAM is also highly beneficial for all women who simply want to educate themselves about their own bodies. So even if you have no interest in using the method for avoiding or achieving pregnancy, it’s an empowering means of taking control of your gynecological health and developing true body literacy.

  HOW MANY DAYS DO YOU HAVE TO ABSTAIN WHEN USING FAM FOR BIRTH CONTROL?

  You never have to abstain when using the Fertility Awareness Method. This is different than Natural Family Planning, which does require abstinence during the fertile phase. However, if you have intercourse when you are potentially fertile, you should ideally use two barrier methods of contraception simultaneously. The fertile phase will vary, but in practice this means that the average couple would have to use barriers about 8 to 10 days per cycle, or about 30% of the time.

  IS THERE REALLY A RISK OF PREGNANCY IF I ONLY HAVE STICKY (NON-WET) CERVICAL FLUID?

  Yes. While sticky cervical fluid is certainly much less fertile than creamy or eggwhite, it’s still possible to conceive from preovulatory intercourse on a sticky day, which is why it’s considered fertile before ovulation.

  DO WOMEN EVER HAVE TRULY “DRY” DAYS?

  When a woman charts, she identifies her cervical fluid by various degrees of wetness, and records a dash if no cervical fluid is present at the vaginal opening. This symbol for dry refers to a lack of cervical fluid outside of her vagina, and not to internal vagin
al moisture, which is present to some degree all of the time.

  It’s easy to distinguish between cervical fluid and vaginal moisture. Cervical fluid on your finger will stay moist for minutes or longer, whereas vaginal moisture, like that inside your mouth, will dissipate from your finger within seconds. If you don’t have any cervical fluid, you will usually have a distinct feeling of dryness.

  HOW MUCH TIME IS REQUIRED TO LEARN AND USE THE METHOD?

  How long it takes to learn the method will vary with each woman. I hope that many of you will be able to assimilate all you need to know by thoroughly reading the relevant chapters of this book. Others will also want to consult with a FAM counselor, or take a class from a qualified instructor, which often includes individual follow-up consultations. It’s also worth noting that it usually takes about two or three cycles of observing your fertility signs to feel confident enough to rely on FAM for birth control.

  Charting usually requires about 2 minutes per day: about 1 minute to take your temperature with a digital thermometer upon awakening, and about a minute or so to check and record the other fertility signs. If you eventually use the shortcut method as described in Chapter 12, you will only need to chart about 10 days per cycle. However, I should reiterate here that while it is true that the shortcut method does not compromise contraceptive efficacy, for simple continuity I personally recommend charting every day of your cycle (outside menstruation), especially for the first few cycles that you chart.

  I should also point out that some women may not be able to use digital thermometers if they do not observe an obvious temperature pattern reflecting ovulation. In that case, those women would want to use a glass basal body thermometer, which requires five minutes upon awakening.

  DO I HAVE TO WAKE UP EVERY DAY AT THE SAME TIME TO TAKE MY TEMPERATURE?

  You should try to be as consistent as possible. In general, waking temperatures tend to creep up every hour you sleep in. Thus, if you take it substantially later than usual, it may result in a reading that is outside the range of your usual pattern. If you wake up earlier than usual, you can take your temperature upon awakening, but if you notice that your temperatures don’t follow an obvious pattern, try to take it about the same time.

  Regardless, an occasional aberrant temperature can easily be dealt with by following the Rule of Thumb. And as discussed in Chapter 12, if taking your temperature feels like a burden, you can, in fact, take it for only about a third of the cycle without sacrificing contraceptive efficacy.

  HOW CAN TEMPERATURES BE RELIED UPON IF I SOMETIMES GET A FEVER?

  There may be several factors, from fever to alcohol to lack of sleep, that could affect your waking temperatures. Yet this doesn’t compromise your ability to rely on them while charting, because you ultimately want to identify a pattern of low and high temperatures, rather than focusing on individual ones.

  Outlying temperatures can be effectively dealt with by using the Rule of Thumb discussed here, which usually allows you to ignore them in interpreting your chart. In addition, you will always be able to rely on your other two fertility signs of cervical fluid and cervical position to cross-check your fertility in ambiguous situations such as these.

  IS IT WORTH CHECKING MY CERVICAL POSITION?

  Although it is not necessary to check your cervix in order to practice FAM effectively, I encourage you to learn how to do so. At a minimum, you may want to start learning by practicing checking in the days leading up to and just following ovulation, when the changes are the most dramatic, at least for the first few cycles that you’re learning the method. Once you recognize how your cervical position reflects your fertility, you will always be able to use it as a cross-check whenever you find the slightest ambiguity in your other two fertility signs.

  The bottom line is that complete familiarity with the changes in your cervix will greatly increase the confidence with which you observe your fertility and overall gynecological health. And since it takes only seconds a day to check, my attitude is that for those few relevant days per cycle, just do it!

  A distinct but closely related question is whether those women using FAM for contraception should ever check their cervical fluid at the cervix. The short answer is that it isn’t necessary to do so, although if you want to be even more conservative than the FAM rules require, or if you simply want to know your cervical fluid status ahead of time, you can learn how to do so by reading Appendix G.

  IS IT POSSIBLE TO CONCEIVE WITHOUT OBSERVING SLIPPERY EGGWHITE-QUALITY CERVICAL FLUID?

  If you are trying to conceive, you shouldn’t get discouraged if you don’t see eggwhite. It doesn’t mean there is necessarily anything wrong, and as long as you have some type of wet-quality cervical fluid, the sperm should still be able to swim through the cervix to ultimately reach the egg.

  Think of cervical fluid on a continuum from the extremes of dry to eggwhite, with successively wetter cervical fluid in the middle. As you can imagine, the ideal quality would be the wettest and most slippery, since this is the type that most closely resembles the man’s seminal fluid. Still, if you don’t notice the eggwhite quality, it probably just means that your “window of fertility” is shorter than those women who do produce it.

  Regardless, there are a number of things you can do to increase your chances of conceiving. Most importantly, you want to be sure to time intercourse for the last day of whatever is your wettest day or vaginal sensation, even if that means only a quality such as creamy cervical fluid. In addition, I have listed some practical ways to increase the quality and fluidity of your cervical fluid here.

  OVULATION

  DO WOMEN ALWAYS OVULATE ON DAY 14 OF THEIR CYCLE?

  No! The day of ovulation can vary among women as well as within each individual woman. However, once a woman ovulates, the time between ovulation and her menstruation is consistent, almost always between 12 and 16 days. Within most individual women, this length of time generally doesn’t change by more than a day or two. In other words, if there is going to be variation in the cycle, it is the first preovulatory phase that may vary. The second (postovulatory) phase generally remains constant.

  CAN YOU “FEEL” OVULATION HAPPEN?

  Some women can. It is called mittelschmerz (or “middle pain”) and is a mild pain or achiness near the ovaries. It may be due to the egg actually passing through the ovarian wall, but it could also be caused by swelling within the ovary before ovulation or even a small amount of blood irritating the pelvic walls after ovulation.

  But the most obvious outward sign of impending ovulation is increasing wet and slippery cervical fluid. In fact, it can be so abundant that women may notice a string of cervical fluid literally hang down when they are using the toilet. (Yikes!) If she does notice this, she should assume that ovulation is likely to happen within a day or two, and perhaps even within the following few hours.

  Of course, cervical fluid is one of the primary fertility signs. Some women are lucky enough to notice other signs on a regular basis, such as the mittelschmerz mentioned above, all of which are very helpful in being able to further understand their cycles. They are called secondary fertility signs because they don’t necessarily occur in all women, or in every cycle in individual women. Yet they are still very practical for giving women additional information to identify their fertile and infertile phases.

  Secondary signs around ovulation may include:

  •midcycle spotting

  •ovarian pain or achiness

  •increased sexual feelings

  •fuller vaginal lips

  •abdominal bloating

  •water retention

  •increased energy level

  •heightened sense of vision, smell, and taste

  •increased sensitivity in breasts and skin

  •breast tenderness

  CAN A WOMAN OVULATE MORE THAN ONCE PER CYCLE?

  No. Think about it. Have you ever heard of a woman getting pregnant on Monday, and then again that following Friday, and
then two weeks later on Thursday? Certainly not, because once a woman ovulates, her body cannot release any more eggs that cycle. Ovulation can take place over 24 hours, though, during which time one or more eggs may be released (as in the case of fraternal twins). But once ovulation has occurred, it is virtually impossible for a woman to release another egg until the next cycle.

  WHAT IS MULTIPLE OVULATION?

  Multiple ovulation is the release of two or more eggs in a single cycle. It occurs within 24 hours or less, after which no more eggs can be released until the following cycle. It’s responsible for fraternal twins, as opposed to identical twins, which are the result of a single egg that divides after fertilization.

  Multiple ovulation appears to be more common than once thought. While it is true that about 1 in 60 naturally conceived births are fraternal twins, researchers now realize that there may be many more fraternal conceptions. Most of these second fetuses miscarry in what is called the “vanishing twin phenomenon.”

  DO WOMEN FEEL MORE SEXUAL AROUND OVULATION?

  Many women do. Because estrogen peaks around ovulation, women typically experience a wet, slippery sensation due to the fertile cervical fluid they produce. This cervical fluid feels similar to sexual lubrication, and can therefore be experienced as a sexual feeling. A woman who practices FAM needn’t worry about confusing the two, though, because cervical fluid is checked periodically throughout the day, and not when she is sexually aroused.

  CAN ORGASM TRIGGER OVULATION?