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The key to getting what you want -- and need -- is knowing your body, and feeling comfortable asking questions if you don't. And that's where too many of us fall short. In a recent Association of Reproductive Health Professionals survey, only 51 percent of women said they felt extremely knowledgeable about their vaginas. Many women don't have all the facts about hormones, libido, sexually transmitted diseases (STDs), fertility, or birth control. Here it is -- the latest news. Feel free to share.What You Need to Know About Your Sexual Health
In your 20s: Your risk of STDs is at an all-time high. Almost half of sexually transmitted diseases occur in people 24 and younger, according to the Centers for Disease Control and Prevention. "Young people tend to have more sexual partners, which exposes them to more bugs," says Hilda Hutcherson, MD, an assistant professor of obstetrics and gynecology at Columbia University Medical Center and author of Pleasure: A Woman's Guide to Getting the Sex You Want, Need, and Deserve. In your 20s, the cells of your outer cervix are more fragile and susceptible to infection. The two STDs you should be most concerned about: chlamydia and human papillomavirus (HPV). If left untreated, chlamydia can scar your fallopian tubes, causing infertility -- and 75 percent of the time, the disease has no symptoms. Ask your doctor to test you annually. "If you test positive, your partner needs to be screened too, or you'll be reinfected the next time you have unprotected sex," says Sarah de la Torre, MD, an obstetrician and gynecologist in Seattle. Treatment consists of a round of antibiotics and a follow-up test three months later.
Get the HPV vaccine, but don't ditch your Pap. And keep using condoms to protect against the virus. The vaccine, given as three shots over six months, is the most significant sexual- health advance in years, but it protects against only 70 percent of all HPV strains that can lead to cervical cancer.
In your 30s: Pay attention to new symptoms. Heavy periods and pain during sex, for instance, can be signs of uterine fibroids, usually benign tumors that affect approximately two in five women in their 30s that can increase the risk of miscarriage. Experts say that fibroids are also the most common reason premenopausal women have hysterectomies -- a drastic, often unnecessary step. "If the fibroids are small, oral contraceptives may alleviate symptoms of pain and bleeding," says Dr. Hutcherson. If they're large, you may need a myomectomy, a surgical procedure that removes the tumors without taking out the healthy tissue in your uterus, or a uterine fibroid embolization (UAE), a treatment that shrinks fibroids by cutting off their blood supply.
In your 40s: Don't put up with hormonal havoc. Many women assume that they just have to ride out symptoms of perimenopause, such as vaginal dryness and urinary incontinence caused by fluctuating estrogen levels, but there a lot you can do to feel better, says Suzanne Trupin, MD, a clinical professor of obstetrics and gynecology at the University of Illinois College of Medicine in Champaign. For dryness, try a water-based lubricant or an estrogen cream, which is safer than taking the hormone orally since you apply it directly to a small area. And make love often. "Research suggests that women who have sex frequently lubricate more easily," says Sandra Leiblum, PhD, director of the Center for Sexual and Relationship Health at the Robert Wood Johnson Medical School in Piscataway, New Jersey, and author of Getting the Sex You Want: A Woman's Guide to Becoming Proud, Passionate, and Pleased in Bed. Try Kegels (exercises in which you tighten and release the vaginal muscles) to help with leakage issues. (Go to kegel-exercises.com for details.) If those don't help, ask your doctor about biofeedback, says Dr. Hutcherson.
In your 20s: All the stats are on your side. You have a 25 percent chance of conceiving each month. If you're younger than 25, you have a 98 percent chance of getting pregnant within a year, and the odds are still a healthy 84 percent until age 30. You're also less likely to have a miscarriage.
Just a little smoking can do big damage. "Five or six cigarettes on the weekend may affect your future ability to conceive by decreasing the oxygen supply to your eggs," says Sherman Silber, MD, director of the Infertility Center of St. Louis and author of How to Get Pregnant: The Classic Guide to Overcoming Infertility. Additionally, a British Medical Association report found that smoking can not only delay conception but can also be a primary cause of infertility.
In your 30s: Time sex right. Doing it the two days prior to ovulation gives you the greatest chance of conceiving. An ovulation-predictor kit (available in drugstores) can tell you when you're good to go by detecting surging levels of luteinizing hormone in your urine. Don't panic if you don't get pregnant right away. A 30-year-old woman has a 20 percent chance of success every month and a 65 to 75 percent chance within a year.
Weight matters. The most fertile BMI is 20 to 25. "Being underweight or overweight can make it more difficult to conceive, because body fat produces estrogen, and too little or too much can affect your fertility," says Dr. Trupin. One percent of women run out of eggs before age 40. If you're not ready for a baby yet, consider getting a follicle count from a fertility specialist. (Go to the Association of Reproductive Health Professionals at arhp.org to find an accredited one in your area.) "A vaginal ultrasound can show the number of follicles in the development stage, and that can help your doctor estimate how many eggs you have left," says Dr. Silber. A count of 15 to 30 is considered healthy. "If yours is lower than 14 and you're not planning to get pregnant within a year, consider freezing some of your eggs for future use." The test costs about $175 and typically isn't covered by insurance.
In your 40s: Every month counts. We see so many older moms these days, it's easy to think that the fertility window is still wide open. But only 5 percent of women 40 and older conceive in a month, and just 40 to 50 percent are successful after a year. Wait no longer than a few months before consulting a fertility expert. "Older eggs are more likely to have chromosomal abnormalities," says Dr. Silber. Even if you get pregnant, you have a greater chance of miscarrying. The rate rises from 34 percent in your early 40s to 53 percent after 45. The news isn't all bad. "Donor eggs are a great option, because your uterus is probably as healthy as ever," says Dr. Silber.
In your 20s: Keep emergency contraception (EC) on hand. Even though EC is technically available over the counter, you still have to ask the pharmacist for it, and some may not be willing to sell it for religious or personal reasons. Getting a prescription filled now and stashing EC in your medicine cabinet can prevent a last-minute crisis. NuvaRing can eliminate the oops-I-forgot-to-take-my-pill factor. "Most birth control pills are so low-dose, you can ovulate or have irregular bleeding or spotting if you take it even a few hours late," says Dr. Hutcherson. NuvaRing is inserted into the vagina (where it releases hormones that prevent ovulation) once a month for three weeks, with one week each month off.
In your 30s: Oral contraceptives can raise your risk of blood clots if you're over 35 -- especially if you smoke. To be safe, or if you've just had a baby and want to get pregnant again soon, experts recommend opting for a nonhormonal method, such as condoms or a diaphragm.
In your 40s: Tubal ligation (or a vasectomy for him) is a great option if you don't want more kids. These procedures may sound scary, but they're goof-proof and can be safer than using hormones at this point in your life, says Dr. Silber. Not ready for such a permanent step? "Consider the IUD," says Dr. Hutcherson. If you have painful periods, choose one that secretes progesterone -- it will reduce or eliminate your period by shrinking the uterine lining.
In your 20s: Tell him what you want. A recent study of college students found that couples who talked about their sexual likes and dislikes had happier relationships and more satisfying sex. "The key to sexual pleasure is knowing what you want and saying it," says Valerie Davis Raskin, MD, a psychiatrist in Chicago and author of Great Sex for Moms.
In your 30s: Exercise. Pregnancy and childbirth do a real number on your body, mind, and libido. In a study of first-time parents, over half of the women surveyed said that their changed body image affected their sex life. Another study found that women who worked out regularly during pregnancy were more satisfied with their bodies. "Feeling fit, strong, and flexible helps takes the focus off whether you're back to your pre-pregnancy shape," says Dr. Raskin. (See "Why Fit Women Have Better Sex," below, for more of the sexual perks of staying fit.)
In your 40s: Kissing is key. Finally, science proves our need for foreplay! The idea that you become aroused first, then seek out sex is based on -- surprise, surprise -- studies of men. For women, the latest research shows that many of us don't feel in the mood until after we start kissing and caressing.
Make time to unwind. Stress plays a big role in that not-tonight feeling. "Women in their 40s are often squeezed by the demands of kids, career, and aging parents," says Dr. Hutcherson. "And it can have a major impact in the bedroom." Anything that helps you relax -- exercise, yoga, meditation, leisurely baths, funny movies -- helps keep your libido strong.
Can't get motivated to work out? Try thinking about all the great sex you'll have afterward! Research has shown that regular exercise plays a more important role in sexual satisfaction than many other factors, including testosterone levels, stress, or even the quality of your relationship. Basically, the more you work out, the happier you are sexually. Likewise, Finnish researchers recently found that 42- to 46-year-old women who work out strenuously have more orgasms than those who don't. Here's why:
Originally published in FITNESS magazine, May 2007.