When I watch needle injections on Instagram, YouTube, or TikTok I get an autonomous sensory meridian response (ASMR). This causes me to hurt myself sometimes with pens and tacks. Is it sterile? Should I stop?

Thank you for your question. ASMR is an autonomous sensory meridian response that leads to a tingling sensation in the crown of the head, caused by a range of audio-visual triggers, such as needle injections. Some people may find watching ASMR videos to be an outlet for stress relief, relaxation, and/or to help them fall asleep. ASMR videos are posted across sites like YouTube and cater to different sites and sounds of ASMR.

It sounds like you’re concerned about the things you’ve been doing outside of just watching these videos, such as when you’ve used different objects to hurt yourself. You’ve already noted some concerns you have about it, including that it may not be sterile. It’s great that you’ve been able to recognize this. It is a very valid concern, since the things you’re using to hurt yourself in fact may not be clean, sterile, or safe. Self-harm (when someone causes purposeful harm to themselves) can be a dangerous and difficult to stop, especially if you are doing it to help yourself cope with a problem.

It may be helpful to think about how you’re feeling before you hurt yourself, to start to identify other ways you may be able to cope. For example, are you feeling sad? Angry? Disconnected? Maybe something else completely? Whether you can identify the “Why” or not, ask for help! Reach out to a trusted adult– such as a parent, teacher, health care provider, or a therapist.

Remote learning is making me incredibly stressed, sad, miserable, furious, bipolar, and depressed. Sometimes even suicidal. How should I cope?


Thank you so much for your question. Remote learning can be a challenge, and there is a lot going on right now that can make it feel hard to cope – you’re definitely not alone in feeling this way! Reaching out about how you’re feeling was a great step to take.

Lots of different things can be helpful to people when they’re feeling stressed, sad, or angry, so you might want to try out a few things and see what feels right for you. To start with, you could think about what you’ve done in the past when you’ve felt anything similar – for some people, this might include favorite hobbies, reaching out to and talking with people you care about, or doing something relaxing.

Depending on what it is about remote learning that is bringing up these feelings for you, there are a lot of other things you could also do. If you find that you’re struggling with school and class-related stress, you can reach out to your teachers to let them know what you’re having trouble with. If you’re having a hard time with not being able to see your friends and classmates, setting up a time to hang out and catch up over Zoom or other virtual platform can be a great way to stay in touch or reconnect.

No matter what the cause, it can be a good idea to talk with a trusted adult in your life about starting therapy if you’re finding that these feelings stick around, feel hard to handle, or just to get some more support – lots of people go to therapy and it can be a great resource to have at times like this!
You mentioned that sometimes you have suicidal feelings as well – thank you for reaching out to ask about this, doing that shows a lot of courage. When you’re feeling suicidal or thinking of hurting yourself, it’s really important to reach out to an adult you trust and let them know how you’re feeling. You can also reach out to Crisis Text Line at any time, 24/7, by texting 741-741 to get free support from a trained volunteer Crisis Counselor. If you prefer to talk on the phone or by online chat, the National Suicide Prevention Lifeline can be reached 24/7 at 1-800-273-8255 and https://suicidepreventionlifeline.org/chat/.

MRKH: Preguntas Frecuentes

MRKH butterfly in handsSi no tengo un cuello del útero, ¿necesito una citología anual (prueba de Papanicolau)?

Es verdad que se hace una citología para detectar el cáncer cervical, pero el examen también puede detectar el cáncer vulvar y vaginal. Entonces, la mayoría de los ginecólogos recomiendan que tengas una citología anual de la vagina a partir de los 21 años.

¿Requiero un examen ginecológico anual?

Sí. Deberías tener un chequeo anual que incluye un examen pélvico o ultrasonido pélvico para que tu médico(/a) de cabecera o ginecólogo(/a) adulto(/a) pueda examinar sus ovarios, vagina y vulva.

¿Tengo que recibir la vacuna contra el VPH?

Sí. Por lo menos 1 en cada 2 mujeres jóvenes que son activas sexualmente ha tenido una infección genital por VPH. La vacuna contra el VPH protege a todas las mujeres que están vacunadas contra ciertos tipos del virus del papiloma humano. Hay tres vacunas diferentes contra el VPH. Gardasil® protege de cuatro tipos del VPH que causan verrugas genitales (tipos 6 y 11) y cánceres cervicales, vaginales, vulvares y anales (tipos 16 y 18). Cervarix® protege de dos tipos (16 y 18) y puede ofrecer protección contra tipos 31 y 45. Finalmente, Gardasil® 9 protege de tipos del VPH 6, 11, 16, 18, además de 31, 33, 45, 52 y 58. Desde mayo de 2017, Gardasil® 9 ha sido la única vacuna contra el VPH que es disponible en los Estados Unidos. Otros países todavía usan Cervarix® y Gardasil®. Si eres activa sexualmente, has tenido algún contacto sexual o estás pensando en tener contacto sexual, la protección mejor es evitar el contacto sexual hasta que estés vacunada. Aunque no tienes un cuello del útero, todavía estás en riesgo de verrugas genitales y cáncer vulvar o vaginal si o cuando te vuelves activa sexualmente, como cualquier otra mujer.

¿Por qué podría tener dolor pélvico (del vientre) alrededor del mismo tiempo cada mes?

En general, algunas mujeres saben cuando ovulan (crean un óvulo) cada mes porque sienten algo de incomodidad o una punzada en la parte baja de su vientre. La mayoría de las veces, este dolor ligero no es nada grave; es a causa de la ovulación normal. Algunas mujeres con MRKH pueden tener un útero minúsculo que se llama un “remanente uterino” o “cuerno uterino”. Este tipo de útero o matriz no es bastante grande para estar embarazada, pero a veces puede causar dolor pélvico si la sangre gotea en la cavidad pélvica. Si ese es el caso, tendrás que tomar pastillas hormonales (pastillas anticonceptivas) continuamente para parar la hemorragia hasta que una especialista de ginecología extirpe el útero minúsculo.

¿Es dañino esperar a crear una vagina hasta que sea mayor?

La elección de recibir tratamiento, cómo, cuándo, etc., DEPENDE DE TI. Como otra decisión importante, es esencial que obtengas toda la información antes de tomar la decisión de recibir tratamiento. ¡Recuerda que puedes crear una vagina EN CUALQUIER MOMENTO o no y aun así te sientes completa!

¿Cuándo debería informar a mi pareja sobre MRKH?

No hay una serie de reglas que funcione o sea apta para todas las mujeres, en todas las circunstancias. Compartir algo intimado con una pareja se deber basar en la confianza, el cariño y la posibilidad de una futura juntos, pero cada encuentro sexual no tiene estos tres componentes. Depende de ti usar tu buen juicio. Ya que tener MRKH viene con complicaciones de la fertilidad, algunas mujeres que quieren ser madres en algún momento pueden optar por tener una conversación con su pareja más pronto que tarde para que puedan hablar de sus opciones. Puede ser muy útil hablar con otras mujeres que tienen MRKH para aprender cómo ellas han tenido conversaciones similares con sus parejas.

¿Podré tener una vida sexual satisfactoria?

SÍ. La mayoría del placer sexual y orgasmo viene de estimulación al clítoris o coito y penetración vaginal puede mejorar la sensación. Ten en cuenta que cada mujer, sin importar su edad, sus problemas de salud o sus preferencias de pareja íntima, experimenta estimulación sexual y sensibilidad en diferentes maneras. Descubrir lo que disfrutas sexualmente es un proceso que evoluciona por toda su vida. Por lo tanto, todas las mujeres se animan a explorar su sexualidad consigo mismas y con su(s) pareja(s) para aprender lo que se siente cómodo y placentero. Tener MRKH no afecta tu placer sexual o tu capacidad de tener un orgasmo.

¿Si recibo tratamiento, se parecerá diferente mi vagina a mi pareja?

No. Después de crear una vagina usando dilatadores o cirugía, nadie sabrá que naciste con una vagina incompleta. Tu pareja no podrá sentir una diferencia.

¿Tendré dolor durante relaciones sexuales?

Si tienes relaciones sexuales vaginales antes de que se cree tu vagina usando dilatadores o cirugía, el sexo probablemente será muy doloroso. Puede causar un desgarro en tu vagina y hemorragia. Se puede crear una vagina con sexo, pero viene con riesgos y suele ser muy incómodo. Típicamente, las mujeres no sienten dolor con relaciones sexuales después de terminar tratamiento con dilatadores. Si sientes cualquier incomodidad después de tratamiento, es posible que tengas que usar un lubricante como K-Y Jelly antes del coito vaginal.

¿Todavía puedo contraer infecciones de transmisión sexual?

¡SÍ! Por favor, recuerda que siempre deberías usar protección de barrera como un condón femenino o masculino cada vez que tienes sexo para prevenir VIH y otras infecciones de transmisión sexual (ITS).

¿Es necesario que tenga relaciones sexuales para mantener mi vagina abierta?

No. No deberías sentirte presionada a tener relaciones sexuales hasta que estés lista. Puede impedir que tu vagina se haga más pequeña usando el dilatador más grande o un vibrador solamente una vez cada por semana por 15-20 minutos. Cuando tienes sexo o otros tipos de penetración vaginal regularmente (1 o más veces cada semana), ya no tienes que usar el dilatador.

¿Qué podría impedirme tener un orgasmo?

El orgasmo es el resultado de estimulación sexual que es una combinación de placer emocional, psicológico y físico. Hay muchas razones por las que mujeres no tienen un orgasmo en cualquier momento, pero no hay nada que directamente sean relacionadas con tener MRKH. Experimentar un orgasmo es un proceso muy personal y supone llegar a conocer tu cuerpo y tus respuestas cada vez que estés estimulada. Hay muchas distracciones que impiden que una mujer tenga un orgasmo (o acabe), como estar cansada, tener sentimientos negativos de tu cuerpo, ambivalencia hacia tu pareja o no “estar de humor”, etc. Muchas mujeres encuentran que el proceso de estimulación es tan excitante como el orgasmo en sí. Tu sexualidad y respuestas se desarrollarán por tu vida.

Hay diferentes cosas que pueden ayudar:

  • Habla de cualquier preocupación que tengas con tu pareja: ¡la comunicación es la forma de intimidad más poderosa!
  • Usa un lubricante como K-Y Jelly.
  • Aprende a tensar y relajar tus músculos pélvicos, también llamados ejercicios de Kegel. Estos músculos se contraen durante un orgasmo.
  • Aprende qué tipo de estimulación te excita y cómo disfrutar de tu cuerpo y compartir esta información con tu pareja.
  • Habla con tu equipo ginecológico si tienes preguntas o preocupaciones.

¿Cómo puedo saber si tengo que hablar con un(a) consejero(/a)?

Ponerte abrumada o angustiada por una situación es muy común para todos en algún momento u otro. A veces, los síntomas de depresión o ansiedad parecen inmanejables y en ese caso, la terapia podría ayudarte a abordar estos síntomas. Hay diferentes tipos de terapistas (trabajadores sociales clínicos, psicólogos, consejeros de salud mental, etc.) además de terapias (cognitiva conductual, psicodinámica, de conciencia plena, etc.), pero la meta es la misma: ayudarte a manejar tu vida y problemas con más facilidad. Si te encuentras al principio de sentirte abrumada o preocupada por algo, cuanto antes pedir ayuda, mejor. Puedes preguntar a tu médico(/a) de cabecera, enfermero(/a) o ginecólogo(/a) para un volante o buscar ayuda por tu centro de consejería escolar (si asistes la universidad), un(a) amigo(/a), familia o clero. Si alguna vez tienes pensamientos de autolesión, contacta a un(a) amigo(/a) o pariente leal inmediatamente y ve a la sala de emergencia más cercana para asegurar tu seguridad.

My mom is insisting I go see a gynecologist. She really wants me to see our ‘family’ gynecologist, but he’s male and this makes me really uncomfortable. My mom thinks it’s silly I am uncomfortable, but I don’t know what to do. Should I just accept it and go to the appointment?

Great question! It can be a little awkward to think about seeing a new doctor, whether male or female.  As a start, ask your mom why she thinks you need the appointment. Reasons might be a vaginal infection, bad cramps, contraception, or other health issue. For many complaints including routine check-ups, your primary care provider may have the training and experience to address these issues.  You may be more comfortable with a male or a female doctor, but there are a few things you should keep in mind before you make a final decision. Do they come highly recommended? Do they have good reviews? Do they have lots of experience with people your age? Do you feel comfortable?  If your primary care agrees that you need an evaluation with a gynecologist, then ask for some names of male and female gynecologists. There may be a female GYN in the same office as your mom’s doctor.  What is important is that you are comfortable with the gynecologist you see. You might want to have an interview with the new doctor first before deciding about an exam.  Recommendations are important, but so is your comfort and this goes for all health care providers male or female. Good luck!

MRKH: Opciones de Tratamiento

MRKH butterfly in handsSi se te ha dicho que tienes MRKH y que tu vagina es incompleta o ausente, tienes las siguientes opciones:

  1. No tienes que hacer nada.
  2. Puedes crear una vagina sin cirugía, usando dilatadores que expanden y estiran tu vagina existente con el tiempo, usando presión intermitente. Es un procedimiento no quirúrgico y un enfoque natural sin efectos secundarios.
  3. Puedes tener un procedimiento quirúrgico (la vaginoplastia) o una combinación de cirugía y dilatación.

Recuerde que tienes el control de tu propio cuerpo. La decisión de crear o no crear una vagina debe ser tuya y si decides que quieres hacerlo, ¡cuándo lo haces debe ser tu decisión también! Si no estás planeando tener relaciones sexuales vaginales, no es algo que tengas que hacer. Si planeas tener relaciones sexuales vaginales ahora o en el futuro, creando una vagina es algo que tal vez quieras considerar.

Aparte de no hacer nada, hay tres enfoques básicos para ayudarte a expandir o crear una vagina. Si estás pensando en el tratamiento, te recomendamos que consideres usar los dilatadores primero. Todas las opciones quirúrgicas requieren anestesia general y el uso de dilatadores después de la operación; entonces, la cirugía no es una solución rápida ni una manera de evitar la necesidad de usar dilatadores.

Las normas aceptadas de atención

El Colegio Americano de Obstetras y Ginecólogos recomienda dilatadores vaginales sin cirugía como el tratamiento óptimo para crear una vagina. Los proveedores de servicios médicos reconocen que este tratamiento es muy efectivo, no invasivo y no tiene los riesgos asociados con la cirugía y la anestesia.

Dilatadores: A veces, el uso de dilatadores se refiere como el Método de Frank, el cual lleva el nombre del primer proveedor de servicios médicos que se hizo famoso por introducir un tratamiento que una mujer joven podía hacer sola, en la privacidad de su propio hogar. Los dilatadores originales estaban hechos de vidrio. A principios de los años 1980, otro proveedor llamado Dr. Ingram creó dilatadores plásticos de varios tamaños que fijaban a un asiento de bicicleta. A las mujeres jóvenes se les enseño a dilatar usando este asiento especial en una bicicleta estática. El Programa de Ginecología en el Hospital Infantil de Boston no recomienda el Método de Ingram porque es difícil e incómodo usarlo.

Hoy, los dilatadores de plástico duro han reemplazado los dilatadores de vidrio. Hay diferentes tipos de dilatadores que son disponibles, pero los más recetados vienen en un conjunto con diferentes tamaños entre XS-L. El dilatador más pequeño es similar al tamaño de un tampón delgado. Empezando con el más pequeño, una mujer joven aprende a sostenerlo y aplicar presión para expandir su vagina. Al principio, se usa la mayoría del dilatador como un “mango” (ya que no mucho puede entrar). Luego, mientras la vagina expande, se puede insertar más del dilatador en la vagina. Si eres una paciente en el Hospital Infantil de Boston y eliges este método de tratamiento, un(a) clínico(/a) calificado(/a) te enseñará a usar los dilatadores. Te llevarás un dilatador a casa y deberías planear usarlo dos veces al día por unos 15-20 minutos.

¿Tiene éxito el tratamiento con dilatador?

El tratamiento del dilatador tiene mucho éxito. Sin embargo, puede haber diferencias en el éxito del tratamiento, principalmente relacionadas con la enseñanza y la pericia de los proveedores de servicios médicos que enseñan este método a sus pacientes.

Asegúrate de que trabajes con un programa de ginecología que tiene una tasa de éxito de por lo menos 85-95% para ayudar a sus pacientes a crear una vagina funcional. Deberías preguntar al ginecólogo(/a) a cuántas pacientes trata por mes/año que tienen agenesia vaginal (una vagina incompleta o ausente) y su tasa de éxito. Si el programa o proveedor(a) de servicios médicos con el que trabajas tiene una tasa de éxito baja, es probable que te frustres durante el tratamiento, tengas una mala probabilidad de éxito y por lo tanto estés en alto riesgo de requerir un procedimiento quirúrgico.

¿Con qué frecuencia tengo que ver a mi ginecólogo(/a)?

Si decides usar los dilatadores para crear tu vagina, se te programará para regresar alrededor de una vez cada 1-2 meses, depende de si tienes que viajar lejos. En el Hospital Infantil de Boston, ofrecemos la opción de seguimientos de Telesalud para pacientes que son elegibles. Es MUY importante mantener tus citas con tu ginecólogo(/a) para que él/ella pueda evaluar tu progreso para ver si estás aplicando presión en el lugar y ángulo correcto. A medida que tu vagina extienda, tu ginecólogo(/a) te dará el siguiente (un poco más grande) dilatador.

¿Cuáles son las opciones quirúrgicas para crear una vagina?

La intervención quirúrgica para crear una vagina, también conocida como la vaginoplastia, supone el uso de tejido o piel de otra parte de tu cuerpo (como el intestino o las nalgas) para crear una vagina.

  • El procedimiento de McIndoe: Se crea una vagina con un injerto de piel, usualmente de las nalgas o de un material especial parecido a piel y un molde vaginal. Las mujeres jóvenes que se someten a este procedimiento tienen que guardar cama en el hospital por una semana después para que la vagina recién creada se sane. Después de la operación, tienen que usar un dilatador blando todo el tiempo por unos 3-6 meses, extrayéndolo solo para usar el baño. Aunque se crea la vagina más rápidamente con la cirugía, todavía es necesario usar un dilatador después.
  • El procedimiento de Williams: Este procedimiento supone la creación de una “bolsa” vaginal. A veces se usa cuando otros procedimientos quirúrgicos han fracasado. Es más popular en Europa que en los Estados Unidos. Los dilatadores son necesarios después del procedimiento, pero solo por unas 3-4 semanas, en vez de hasta 6 meses (que es más típico con el procedimiento de McIndoe). Lo malo de este procedimiento es que el ángulo de la vagina recién creada puede ser anormal y el aspecto cosmético puede ser no ideal.
  • La vagina intestinal: Es una operación importante que supone la creación de una vagina usando una sección del intestino. La recuperación requiere 4-6 semanas de curación de la cirugía y es necesario usar un dilatador después. Las mujeres jóvenes que se someten a este procedimiento usualmente sufren flujo vaginal crónico, requiriendo que usen una compresa todo el tiempo.
  • La laparoscopia – El procedimiento de Vecchietti: El procedimiento de Vecchietti combina el uso de dilatadores y una intervención quirúrgica. Esta técnica (que lleva el nombre del médico que lo desarrolló) supone la aplicación de un aparato de tracción al abdomen exterior (el estómago) de una joven. Esto se hace durante una laparoscopia mientras la paciente está anestesiada. Al mismo tiempo, se pone una cuenta plástica (más o menos el tamaño de una oliva) en el espacio vaginal y se sostiene con un cordel que pasa por la vagina, por la cavidad abdominal, hasta el aparato de tracción (el cual está fijado a la piel fuera del abdomen). Se forma la vagina usando presión continua, 24 horas cada día. Se pone la tensión girando la “manivela” que está en el exterior de la pared abdominal. La tensión tira de la cuenta plástica hacia arriba, alargando la vagina. La vagina puede ser creada en unos 7-10 días, pero requiere una hospitalización larga para terminar el proceso. Después, un procedimiento secundario con anestesia es necesario para quitar el equipo. Es muy importante comprender que este procedimiento también requiere el uso de dilatadores vaginales. Además, el mecanismo de tracción es aparatoso y a menudo incómodo. El procedimiento de Vecchiette es popular en Europa, pero no se practica frecuentemente en los Estados Unidos.
  • El procedimiento de Davydov: El procedimiento de Davydov es un tipo de procedimiento quirúrgico para crear una vagina usando el propio revestimiento peritoneal de la paciente. El peritoneo es una membrana que reviste las paredes de las cavidades abdominales y pélvicas. Mientras la paciente está anestesiada, se hace una incisión (un corte) donde la abertura vaginal debe estar. Se hace(n) otra(s) incisión(es) cerca del ombligo para permitir la inserción de un instrumento delgado en la cavidad peritoneal. El revestimiento peritoneal se baja y se sutura en su lugar en la abertura vaginal. Se sutura cerrada la parte superior del recién creado canal vaginal. Se rellena el espacio vaginal con gasa. Se quita la gasa típicamente dos días después de la operación. Después de quitar la gasa, la paciente tiene que usar dilatadores vaginales de varios tamaños unas veces al día por varios meses o hasta que se vuelva sexualmente activa. El objetivo no es obtener longitud o anchura adicional sino mantener la (recién creada) vagina y prevenir la cicatrización. La mayoría de las mujeres que se someten a este procedimiento se queda en el hospital durante la noche en observación y luego regresa para seguimientos dentro de 7-10 días después de la cirugía.
Asegúrate de que trabajes con un equipo de profesionales médicos experimentados que son sensibles a tus sentimientos y preocupaciones. Cuando estás decidiendo qué tratamiento es mejor para ti, es importante recordar que los dilatadores son la norma de atención y deben ser probados antes de que se considere la cirugía. Dicho esto, nunca deberías sentirte presionada para crear una vagina. ¡La elección de ponerte en tratamiento o no siempre debe ser tuya!

 

I have been fat since childhood. I think I might have an eating disorder. I feel guilty after eating my meal, and then weigh myself like 100 times in an hour. I want to lose about 10 kg. What is your advice?

It sounds like you could benefit from meeting with a qualified mental health provider to discuss the feelings of guilt you have around eating as well as working to improve your body image. If you are feeling guilty when you eat and weighing yourself often, that’s not a time that you want to be trying to lose weight because chances are that you will do so in an unhealthy or even dangerous way. Try to eat regular, balanced meals with a focus the nourishment you are providing your body, find some type of movement that you enjoy doing, and working on your mental health. You can also work with a Registered Dietitian who specializes in eating disorders to help you approach your relationship to food in a healthy way.

Preparing for Your Virtual Gynecology Visit

Due to the COVID-19 pandemic, many health care providers including gynecologists are now seeing their patients virtually either with Zoom or another web-conferencing platform. Many teens have never had a virtual doctor’s appointment so it’s completely normal to feel a bit stressed the first time. Some teens might assume that since they are not actually going to their provider’s office, they don’t have to take it seriously, but that isn’t the case. It’s actually super important to understand that your virtual visit is just as important, and to prepare for it. Being prepared for your virtual visit will make you feel less stressed and more in control.  

How can a gynecology appointment be virtual?

You are most likely used to seeing your gynecologist in-person; however, many offices are now offering virtual visits for safety reasons. The good news is, many gynecology concerns don’t really need to be addressed in person. Examples of some concerns that are perfect for a virtual visit include: birth control pill refills and period problems. Other issues may require an in-person visit for an exam, such as a new vaginal discharge. If you feel that your concerns would be better addressed in-person, ask to speak with a nurse. The staff will figure out the best way for your needs to be met.

What should I do to prepare for my virtual appointment?

It’s very important that you and your parent/guardian (if you are under 18 years old) are prepared ahead of time for your virtual visit. You should receive an email 24-48 hours before your appointment that confirms the date/time and name of the provider. This email will contain everything you need to know for your virtual visit. It’s very important that you don’t delete the email because it contains: the web address, appointment ID number (similar to a username), and the appointment password. Make sure that you save the email or print it and keep it in a safe place so it’s handy on the day of your appointment. If you are unfamiliar with the web-platform that your provider is using, instructions will be included in your confirmation email.  

Here are some helpful tips on how to prepare for your Virtual GYN Visit:

  • Check your internet connection – Test out your internet connection with a friend or family member ahead of time. Choose a space in your home (for the visit) where you have a strong internet signal.
  • Choose a quiet location – Treat your virtual visit like an in-person visit. Try to avoid any distractions in the background such as loud noises, other people and pets. This is your visit, make the most of it.
  • Privacy – Make sure to pick a quiet and private place in your home, before your virtual visit starts. If you are under 18 years old, your Gynecologist may want to speak with you alone, before they invite your parent or guardian to join. Use this opportunity to ask confidential questions. Your provider will tell you when you can invite your parent or guardian to join the virtual visit.
  • Bring questions – Just like an in-person visit, it’s a good idea to write down any questions you might have for your Gynecologist before your appointment.
  • Be ready – Make sure you are awake, dressed, and ready for your appointment. Your provider may only wait a certain amount of time until you are considered late, or a “no show.”
  • Join the virtual appointment early – You should be able to join your virtual visit before the actual start time. Try to log on about 5 to 10 minutes before the appointment. If you have any trouble, call the GYN office right away so they can trouble shoot the issue as quickly as possible.

What else can I accomplish virtually?

Appointments are not the only virtual aspect in healthcare! Many providers are now using an electronic medical record system that includes a patient portal. Through a patient portal, you can look up laboratory or imaging results, your medication list, and healthcare summaries. You can also message the schedulers, nurses, or your providers. If you are interested, ask how you can sign up and access the patient portal.

How can I stay motivated to eat healthily and the right way for PCOS? Sometimes I feel restricted and just want to eat whatever I want and then my body fights back. I am not sure how to change my mindset around food and eating for PCOS. Please help!

PCOS iconsGreat question! It sounds like you’re aware that your body feels better when you are making healthier choices which is good motivation right there. However, the more restricted you feel around the foods that you want to eat, the more likely you are to crave them and overindulge when you do “allow” yourself to have them. In order to prevent this from happening, try to figure out ways to work your preferred foods into your daily life in a way that will be satisfying but not cause your body to “fight back.”

For example, if there is a sweet treat food that you’d like to enjoy, make sure to have it immediately after a meal in order to decrease the effect on your blood sugar (and enjoying it when you’re not too hungry might also cause you to eat less of it). Or, you can try to find a healthier alternative to the food that you crave such as whole fruit instead of juice, frozen greek yogurt instead of ice cream, or baked potato wedges instead of french fries. It might also help to try to eat your preferred foods in a mindful way in order to really savor them so that you can enjoy them without eating them in excess if that causes your body to react in a negative way.

Can I get pregnant from humping a blanket that might have had sperm on it?

Thank you for your question! It’s super important to mention that anytime a woman has unprotected sexual contact, which includes touching, rubbing, or penetration with a penis, she may run the risk of becoming pregnant. For example, if you and your partner are dry humping, meaning your vagina is rubbing against his penis without protection, you can become pregnant. Anytime the penis penetrates or touches the vagina (unprotected), even if your partner doesn’t think he ejaculated (“cum”), there is a risk for pregnancy. Although very unlikely to cause a pregnancy, wet semen on a blanket could have sperm on it.  It’s very important that if you think you are pregnant you consult visit a women’s health clinic such as Planned Parenthood or you schedule an appointment with your health care provider (HCP) to test you for pregnancy.

Transgender Terminology

We used to think that the gender people were given at birth was the one they would have their whole life. But many people grow up and identify as a different gender than what their doctors or parents guessed when they were young. That’s okay!

What is gender identity?

Gender identity is a person’s internal feelings of being a woman, man, both, neither, or someone else. Many people have a gender identity and/or gender expression (how a person shows their gender through their appearance or behavior) that matches their sex assigned at birth. However, some people have a gender identity or gender expression that is different from their sex assigned at birth; these people might use the term “transgender” or “nonbinary” to describe their gender identity.

Some people might think that gender identity is similar to sexual orientation, but these are two different parts of a person. Gender identity is how a person identifies their gender, and sexual orientation is who a person is attracted to, the terms they use to identify their attractions (for example: lesbian, gay, bisexual), and with whom they have sex.

For some people, their gender identity might change over time. They might identify with one gender when they are younger and with another gender when they are older.

What does transgender mean? 

Transgender (or trans) is a term used by people who identify with a gender that is different than their sex assigned at birth. They may identify as a transgender woman or man. Or they may identify with any of the other terms below that is not cisgender. For example, Uri identifies as a woman, and was assigned male at birth. Uri chooses to identify as a transgender woman. Other people like Uri might just identify as a woman without identifying as transgender.

Transgender can also be an umbrella term used to describe the community of people who don’t identify as cisgender.

What does cisgender mean? 

Cisgender is a term used to describe people whose gender identity matches their sex assigned at birth. For example, Alex’s sex assigned at birth was female and she identifies as a woman, so she is cisgender.

What does nonbinary mean?

Nonbinary is a term used to describe either gender identity OR gender expression that is not fully woman or man, or masculine or feminine.

Some people who use this term may feel like both a boy and a girl, neither gender or another gender. For example, Eli was designated male at birth, but doesn’t identify as a girl or boy and prefers the term nonbinary. Some people like Eli might identify with a term other than nonbinary, such as one of the terms below.

Some people may also attach this term to other gender identities such as a nonbinary transgender man, to express that they identify as a man and their gender expression is not fully masculine.

Additional terms which a person may use when describing their sex or gender identity:

Gender is cultural. That means people from different cultures may use different terms to describe gender. People may use a term to describe their gender that is not listed here. That’s okay! It’s always important, regardless of the term to respect a person’s gender identity.

  • Agender: Someone who does not identify with gender.
  • Bigender: Someone who identifies as two genders, usually as both a man and a woman.
  • Gender fluid: A person whose gender identity isn’t permanent. They may sometimes identify or express themselves as one gender and at other times identify or express themselves as another gender, or they may feel a mix of genders at one time.
  • Gender nonconforming: People who identify with this term may express their gender (how they show their gender through appearance and behavior) in a way that doesn’t match typical male and female cultural norms. Some people may identify their gender as simply gender nonconforming, other people may use this term with another gender identity, such as “gender nonconforming man” because they identify as a man but do not express their gender in typical male ways.
  • Genderqueer: Genderqueer is a term used by people who identify with a gender that is not fully woman or man. They may feel like both a boy and a girl, n gender, or another gender.
  • Intersex: Intersex is an umbrella term for all the unique variations that can happen in reproductive or genital parts of the body. Variation can occur in several different areas such as a person’s DNA, genitals or internal organs (testes or ovaries), or the hormones they produce. Intersex people sometimes face discrimination because of their variations, but intersex people have always existed. There are over thirty different kinds of medical terms for different intersex variations. Sometimes intersex is called disorders of sex development (DSD).
  • Nonbinary: Someone who does not identify as a woman or man. Some nonbinary people identify as transgender and others do not.
  • Two-spirit: This term is used by some native and first nation communities to encompass a number of gender identities and sexual orientations amongst native communities.

What is transitioning?

Transitioning is the way in which a person might choose to express their gender identity when it is different from their designated sex at birth. This can include changing the way they dress, their name, pronouns that they use (see below for more on what pronouns are), or using medical (such as using hormones to change their body to align with their sense of gender) or surgical (such as changing their chest or breast tissue) therapies.

Not everyone transitions in the same way. Everyone is different. Just as you and your friends might all express and identify with your gender in different ways (some of you might wear dresses or baseball caps, others might have long hair or not wear makeup), not all transgender people may feel the need to transition in the same way. Some people might want to use hormones, others might not. Some people might want to have surgery, others might not. Some may have surgery and later start hormones. Some may use hormones first. Regardless of what a person does in their transition, they should still be treated with respect, as only they can know what they need to affirm their gender. Some people may not know what they want when they’re younger, and that’s okay. There’s no one right way to transition. Because most medical therapies and surgeries require a parent to agree if the person is still a child or teenager, some people may want certain therapies and surgeries but not be able to get them. We know this can be hard if this is your experience, or the experience of a friend of yours. Having a safe and trusted doctor with whom you can talk to about these things is important.

What are pronouns?

On most days, you probably don’t notice that when you’re talking about your friend or a family member, instead of using their name you might say “he”, “she”, or “they”, which are what the English language calls pronouns. English language pronouns are she/her/hers, he/him/his, or they/them/theirs. The pronouns ze/hir are popular gender neutral pronouns used in different languages around the world. If you don’t know someone’s pronouns, just ask!  If you don’t feel comfortable asking, you can use gender neutral pronouns such as “they/them” to start. Not everyone with the same gender identity uses the same pronouns, and you can’t tell what pronouns someone uses by the way they look. The only way to know someone’s pronouns is to ask them.

Why are pronouns important?

Growing up, you probably used pronouns based on a person’s gender expression. Most of the time you probably got it right, but sometimes you might be corrected and told “no, she’s actually a girl” when you used “he” to describe her. While it’s okay for this to happen every once in a while, it can be hard for the person who doesn’t associate with the pronouns typically associated with their gender expression. Sometimes, people express transphobia by choosing to use the wrong pronouns to refer to a person to make them feel uncomfortable or hurt. For example, imagine your name is Jennifer, but every time you see your cousin, they call you Sarah. Even when you correct them, they keep calling you Sarah every time. This would likely feel annoying, but more importantly, you might also feel like your cousin isn’t really seeing you for you who are.  This is why it’s important to ask people their pronouns and use the correct ones when referring to them. Just remember, not only transgender people have pronouns, we all have them!

A great way to show off your pronouns is by adding them to your email signature or putting them on your social media profile! You may also notice some people wear a button with their pronouns on it to make others aware when they are in public.

People who are transgender may have two different names. A legal name is a name that a person has on legal documentation, such as their driver’s license, school transcript, or medical record. It’s important to remember that a person’s legal name might not match the name they use. A great way to ask might be to say, “Is this the name you go by?” or “Is this the name you use?” The other name that someone might have is a chosen name, which is a name that a person uses in their day to day life. Transgender people are not the only people with chosen names. Some people might not like their given name and decide to use another name (for example, people who go by their middle name instead of their first name). When referring (to anyone) you should always use their chosen name.

What is a dead name?

A transgender person might use a chosen name that’s different from their legal name. Many transgender people refer to their legal name as a “dead” name. Their dead name no longer represents who they are, and they don’t want to be called by that name. If your dead name is still on official documentation, please let your doctors or your teachers know the name you want to be called. This should discourage them from calling you by your dead name. If someone else has told you they use a different name than what you see on their ID or other documentation, it’s important to always use their chosen name.

What is transphobia?

Transphobia is a term used to describe negative feelings and attitudes toward people who identify with any terms other than cisgender, including people who are transgender and/or non-binary. Negative feelings and attitudes about transgender people can be shown in different ways.

Examples of obvious and intentional transphobic behaviors: 

  • Direct insults
  • Threats
  • Bullying
  • Physical harm or violence
  • Discrimination

Examples of non-obvious forms of transphobic behaviors:

  • Using slurs or words in an unintentional way
  • Excluding transgender people from group activities or events
  • Avoid discussions regarding transgender issues

It’s important to remember all types of transphobic attitudes and behaviors can be hurtful and sometimes dangerous to transgender people.

Why does transphobia exist?

There is no easy answer to this question! The best way to understand transphobia it is to realize that people often feel uncomfortable with differences, such as differences between people in the most common group (the dominant group: cisgender people) and people in other groups (minority groups: transgender and/or nonbinary people) who experience disadvantages in life more than the dominant group. Other minorities, such as racial/ethnic groups, are also discriminated against. Some transgender people may be discriminated against because they are transgender and because they are another type of minority; for example, someone who is transgender and Black or someone who is nonbinary, Asian, and gay. The good news is that through advocacy and social change, people are becoming more welcoming and inclusive of diverse people. Hopefully transphobic behaviors will become less common in the future. Even if you do not identify as transgender, you can help support your friends who are by ensuring they feel welcome.

How can I be supportive of someone’s gender?

There are many ways you can be supportive of someone’s gender!

  • Always use their chosen name and pronouns. If you use the wrong name or pronouns, apologize. If you hear others using the wrong name or pronouns, correct them.
  • If you hear or see someone being transphobic, offer support to the person being bullied and tell a trusted adult who can help you.
  • Talk to your friends, classmates and family about gender diversity. Helping others to learn about the transgender community will help create a warm and welcoming environment for everyone. Sometimes this means finding a trusted adult who can help you have these conversations, including holding workshops or lectures about gender diversity and the transgender community.
  • Talk to your school, place of work, or places where you volunteer or hang out about making the spaces welcoming, safe and inclusive for people who don’t identify as cisgender. This can include:
    • making sure there are bathrooms and locker rooms available for people who don’t identify as boys or girls (such as gender neutral bathrooms),
    • making sure that name tags allow people to write in their chosen name and pronouns (or letting people wear pronoun buttons)
    • making sure dress codes are not linked to a person’s sex assigned at birth (such as only girls being able to wear makeup or skirts)

Gender Identity

As our world continues to grow and we begin to recognize the diversity of people in our communities, part of this has been understanding that gender is not just the male and female that we may have been taught when we were younger.

What is gender identity?

Gender identity is a person’s internal feelings of being a woman, man, both, neither or something else. Many people have a gender identity and/or gender expression (how a person shows their gender through their appearance or behavior) that matches their sex assigned at birth. However, some people have a gender identity or gender expression that is different from their sex assigned at birth; these people might use the term “transgender” or “gender nonconforming” to describe their gender identity.

What is gender dysphoria?

Dysphoria is when someone experiences great distress or general unhappiness associated with the mismatch between their body and their gender identity. Not all people who identify as trans experience gender dysphoria. Gender dysphoria may include emotions such as sadness or anger, but can also include feelings such as a desire to change the way their face, chest or genitals appear, for example.

Why are gender identity and sex different?

While sex is something you were assigned when you were born, gender is something you can choose or identify with. When people are first born, they are too young to express their gender identity independently, so people often presume their gender identity as the same as their sex. However, as a child grows they are able to make their own choices about how to express themselves. Some parents are raising their children with a non-binary gender identity. When these children grow up, they may choose a different gender when they are older.

What are different genders?

There are many different gender identities in our world today, even more than we have listed below! Gender is self-defined and impacted by a person’s culture and values. New genders are being discussed every day! Below are a few of the most common.

Below is a growing list of gender terms:

  • Girl/Woman
  • Boy/Man
  • Genderqueer
  • Agender
  • Bigender
  • Gender-fluid

How do people express their gender identity?

Gender can be expressed in many ways: through our clothes, speech, activities, hobbies, and our behaviors. It’s ok for any of these things to change at different times, or in different situations, depending on what feels comfortable. Not all people who share a gender identity express it in the same way. For example, someone can identify as male and wear dresses. Someone can identify as nonbinary and wear dresses. It’s always important to ask someone their pronouns. Some examples of pronouns may be,  “He/him/his, or she/her/hers or they/them/theirs.”

What’s the difference between gender identity and sexual orientation?

Many people confuse the two, but here is a simple way to understand the difference: gender identity is more about “who you are” (boy, girl, both, neither, or something else) and sexual orientation is about “who you have a crush on.”

What does transgender mean?

Transgender people have a gender identity that doesn’t match the sex they were assigned at birth (female or male or intersex). For example, a transgender person who is assigned female at birth may feel like a boy, or a transgender person who is assigned male at birth may feel like a girl. Transgender people may seek medical therapies such as hormones or surgical procedures to help change their body to better match their gender. However, some people express their gender through their appearance and/or behavior, without changing their body.

Transgender is also an umbrella term used to describe the whole community of people who identify as a gender different then their sex assigned at birth. So, for example a genderqueer person (someone who identifies as a gender that is not 100% male or female) may identify as part of  the transgender community. To try and make sure that everyone feels included, the community generally tries to broaden terms used to include  the “transgender and gender diverse” community or “transgender and gender nonconforming” community.”

Is it OK to be transgender?

Absolutely! As with LGBQ people, some people with traditional beliefs may feel uncomfortable with people who express these feelings, but professional medical, psychological, and psychiatric organizations agree that it is better to express who you are, even if it makes other people a little uncomfortable.

Can I be both transgender and LGBQ? What about transgender and straight?

Yes and yes. Being transgender is about gender identity, not sexual orientation. Everyone has a sexual orientation, regardless of what their gender identity is. Transgender people may be attracted to people of the same gender based on their own gender identity, attracted to people of a different gender based on their own gender identity, or they may be attracted to more than one gender.

I was told I needed to get clearance from a pediatric cardiologist, before I start cross country, due to my fast heart rate. My appointment is next week and I am a little nervous. What should I expect? Will anything hurt?

This is a great question! It’s smart that you are having your fast heart rate checked out by a pediatric cardiologist (a doctor who specializes on hearts in children and teens), before you start cross country. You shouldn’t experience any pain or discomfort during the cardiology appointment. A lot of time during your appointment will be talking with the cardiologist. They will ask you and your parent/guardian questions about your medical history as well as your family’s medical history (i.e. your parents, siblings, and grandparents). It’s good before you go to the visit to ask these relatives if anyone has had heart problems, fainting episodes, or sudden deaths before age 50 years old. If you are being seen for an in-person rather than a “virtual” visit, the cardiologist will then do a physical assessment, checking your height, weight, blood pressure, and pulse rate and listening to your heart and lungs.

Once your history and assessment is complete, the cardiologist may recommend no further tests or tests such as a blood count and thyroid levels, an EKG and sometimes a rhythm monitor or ECHO.   These are all safe and painless tests. An electrocardiogram (EKG) helps your doctor see the electricity of the heart, read heart rhythms, and picks up on changes. The test is done by attaching stickers with wires to your chest, arms, and legs and it lasts about 3-5min. If your doctor can’t capture your fast heart rate during this test, they may send you home with a portable EKG machine, also known as a Holter monitor. A Holter monitor is a 24-hour EKG that you can wear at home around your chest (with a strap) and it does the same exact thing as normal EKG, but gathers more data over a longer period of time. There is also a very small adhesive patch monitor (such as the Zio Patch) that can record your heart rhythms for 14 days!  You might be requested to have an echocardiogram (ECHO), which looks at the structure and function of your heart using an ultrasound machine. It’s a very common test used for people of all ages and completely painless.  Remember the cardiologist will listen closely to the symptoms you have had and may decide that you don’t need any tests! Also, it’s important to write down any questions you may have for the cardiologist, before your appointment. It also may be helpful to know exactly when you feel your heart rate speeding up so that your doctor can best help you. Good luck!