Cost Of Raising a Kid For a middle-income family to raise a child born in 2015 through the age of 17, the cost of rearing a child has hit $233,610, according to the report. The price jump is a 3% increase from the previous year, according to the report, with housing taking up a bulk of the expense at 29% of the cost. Food took the second biggest expense at 18%, according to the report. The report, which tracks seven categories of family spending, including housing, transportation and clothing, helps court systems and government agencies determine the costs of child-support. The report does not track payments for college or financial contributions from non-parental sources, including government aid, Bloomberg reported. The increase this year falls below the historic average annual increase of 4.3%, according to Bloomberg. Transportation expenses, driving in particular, have fallen due to lower projected energy costs. Among upper-income families, costs for childcare and education have increased. The report classifies middle-class families as having a before-tax income of $59,200 to $107,000. Families with lower incomes are expected to spend $174,690, while families with higher incomes will likely spend $372,210.

Hepatitis A Hepatitis A is a contagious liver infection caused by the hepatitis A virus. Hepatitis A can be prevented with a vaccine. People who get hepatitis A may feel sick for a few weeks to several months but usually recover completely and do not have lasting liver damage. In rare cases, hepatitis A can cause liver failure and even death; this is more common in older people and in people with other serious health issues, such as chronic liver disease. How common is hepatitis A? Since the hepatitis A vaccine was first recommended in 1996, cases of hepatitis A in the United States have declined dramatically. Unfortunately, in recent years the number of people infected has been increasing because there have been multiple outbreaks of hepatitis A in the United States. These outbreaks have primarily been from person-to-person contact, especially among people who use drugs, people experiencing homelessness, and men who have sex with men. How is hepatitis A spread? The hepatitis A virus is found in the stool and blood of people who are infected. The hepatitis A virus is spread when someone ingests the virus, usually through: personal contact with an infected person, such as through having sex, caring for someone who is ill, using drugs with others, or through food. Contamination of food with the hepatitis A virus can happen at any point: growing, harvesting, processing, handling, and even after cooking. Contamination of food and water happens more often in countries where hepatitis A is common. Although uncommon, forborne outbreaks have occurred in the United States from people eating contaminated fresh and frozen imported food products. Hepatitis A is very contagious, and people can even spread the virus before they feel sick. Vaccination is the best way to prevent hepatitis A. The hepatitis A vaccine is safe and effective. The vaccine series usually consists of 2 shots, given 6 months apart. Getting both shots provides the best protection against hepatitis A. Hepatitis A vaccination is recommended for: • All children at age 1 year • Travelers to countries where hepatitis A is common • Family and caregivers of adoptees from countries where hepatitis A is common • Men who have sexual encounters with other men • People who use or inject drugs • People with chronic or long-term liver disease, including hepatitis B or hepatitis C • People with clotting factor disorders • People with direct contact with others who have hepatitis A • People experiencing homelessness You can prevent infection even after you have been exposed. If you have been exposed to the hepatitis A virus in the last 2 weeks, talk to your doctor about getting vaccinated. A single shot of the hepatitis A vaccine can help prevent hepatitis A if given within 2 weeks of exposure. Depending upon your age and health, your doctor may recommend immune globulin in addition to the hepatitis A vaccine. Hand washing plays an important role in prevention. Practicing good hand hygiene—including thoroughly washing hands with soap and warm water after using the bathroom, changing diapers, and before preparing or eating food—plays an important role in preventing the spread of many illnesses, including hepatitis A. Symptoms Not everyone with hepatitis A has symptoms. Adults are more likely to have symptoms than children. If symptoms develop, they usually appear 2 to 7 weeks after infection and can include: Yellow skin or eyes Not wanting to eat Upset stomach Stomach pain Throwing up Fever Dark urine or light colored stools Joint pain Diarrhea Feeling tired Symptoms usually last less than 2 months, although some people can be ill for as long as 6 months. Diagnosis and treatment A doctor can determine if you have hepatitis A by discussing your symptoms and taking a blood sample. To treat the symptoms of hepatitis A, doctors usually recommend rest, adequate nutrition, and fluids. Some people will need medical care in a hospital. International travel and hepatitis A If you are planning to travel to countries where hepatitis A is common, talk to your doctor about getting vaccinated before you travel. Travelers to urban areas, resorts, and luxury hotels in countries where hepatitis A is common are still at risk. International travelers have been infected, even though they regularly washed their hands and were careful about what they drank and ate. < Previous Next >

Syphilis Syphilis is a sexually transmitted infection (STI) that can have very serious complications when left untreated, but it is simple to cure with the right treatment. What is syphilis? Syphilis is a sexually transmitted infection that can cause serious health problems if it is not treated. Syphilis is divided into stages (primary, secondary, latent, and tertiary). There are different signs and symptoms associated with each stage. How is syphilis spread? You can get syphilis by direct contact with a syphilis sore during vaginal, anal, or oral sex. You can find sores on or around the penis, vagina, or anus, or in the rectum, on the lips, or in the mouth. Syphilis can spread from an infected mother to her unborn baby. What does syphilis look like? Syphilis is divided into stages (primary, secondary, latent, and tertiary), with different signs and symptoms associated with each stage. A person with primary syphilis generally has a sore or sores at the original site of infection. These sores usually occur on or around the genitals, around the anus or in the rectum, or in or around the mouth. These sores are usually (but not always) firm, round, and painless. Symptoms of secondary syphilis include skin rash, swollen lymph nodes, and fever. The signs and symptoms of primary and secondary syphilis can be mild, and they might not be noticed. During the latent stage, there are no signs or symptoms. Tertiary syphilis is associated with severe medical problems. A doctor can usually diagnose tertiary syphilis with the help of multiple tests. It can affect the heart, brain, and other organs of the body. How can I reduce my risk of getting syphilis? The only way to avoid STDs is to not have vaginal, anal, or oral sex. If you are sexually active, you can do the following things to lower your chances of getting syphilis: Being in a long-term mutually monogamous relationship with a partner who has been tested for syphilis and does not have syphilis; Using latex condoms the right way every time you have sex. Condoms prevent transmission of syphilis by preventing contact with a sore. Sometimes sores occur in areas not covered by a condom. Contact with these sores can still transmit syphilis. Am I at risk for syphilis? Any sexually active person can get syphilis through unprotected vaginal, anal, or oral sex. Have an honest and open talk with your health care provider and ask whether you should be tested for syphilis or other STDs. All pregnant women should be tested for syphilis at their first prenatal visit. You should get tested regularly for syphilis if you are sexually active and are a man who has sex with men; are living with HIV; or have partner(s) who have tested positive for syphilis. I’m pregnant. How does syphilis affect my baby? If you are pregnant and have syphilis, you can give the infection to your unborn baby. Having syphilis can lead to a low birth weight baby. It can also make it more likely you will deliver your baby too early or stillborn (a baby born dead). To protect your baby, you should be tested for syphilis at least once during your pregnancy. Receive immediate treatment if you test positive. An infected baby may be born without signs or symptoms of disease. However, if not treated immediately, the baby may develop serious problems within a few weeks. Untreated babies can have health problems such as cataracts, deafness, or seizures, and can die. What are the signs and symptoms of syphilis? Symptoms of syphilis in adults vary by stage: Primary Stage During the first (primary) stage of syphilis, you may notice a single sore or multiple sores. The sore is the location where syphilis entered your body. Sores are usually (but not always) firm, round, and painless. Because the sore is painless, it can easily go unnoticed. The sore usually lasts 3 to 6 weeks and heals regardless of whether or not you receive treatment. Even after the sore goes away, you must still receive treatment. This will stop your infection from moving to the secondary stage. Secondary Stage During the secondary stage, you may have skin rashes and/or mucous membrane lesions. Mucous membrane lesions are sores in your mouth, vagina, or anus. This stage usually starts with a rash on one or more areas of your body. The rash can show up when your primary sore is healing or several weeks after the sore has healed. The rash can look like rough, red, or reddish brown spots on the palms of your hands and/or the bottoms of your feet. The rash usually won’t itch and it is sometimes so faint that you won’t notice it. Other symptoms you may have can include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue (feeling very tired). The symptoms from this stage will go away whether or not you receive treatment. Without the right treatment, your infection will move to the latent and possibly tertiary stages of syphilis. Latent Stage The latent stage of syphilis is a period of time when there are no visible signs or symptoms of syphilis. If you do not receive treatment, you can continue to have syphilis in your body for years without any signs or symptoms. Tertiary Stage Most people with untreated syphilis do not develop tertiary syphilis. However, when it does happen it can affect many different organ systems. These include the heart and blood vessels, and the brain and nervous system. Tertiary syphilis is very serious and would occur 10–30 years after your infection began. In tertiary syphilis, the disease damages your internal organs and can result in death. Neurosyphilis and Ocular Syphilis Without treatment, syphilis can spread to the brain and nervous system (neurosyphilis) or to the eye (ocular syphilis). This can happen during any of the stages described above. Symptoms of neurosyphilis include: severe headache; difficulty coordinating muscle movements; paralysis (not able to move certain parts of your body); numbness; and dementia (mental disorder). Symptoms of ocular syphilis include changes in your vision and even blindness. How will I or my doctor know if I have syphilis? Most of the time, a blood test is used to test for syphilis. Some health care providers will diagnose syphilis by testing fluid from a syphilis sore. Can syphilis be cured? Yes, syphilis can be cured with the right antibiotics from your healthcare provider. However, treatment might not undo any damage that the infection has already done. I’ve been treated. Can I get syphilis again? Having syphilis once does not protect you from getting it again. Even after you’ve been successfully treated, you can still be re-infected. Only laboratory tests can confirm whether you have syphilis. Follow-up testing by your healthcare provider is recommended to make sure that your treatment was successful. It may not be obvious that a sex partner has syphilis. This is because syphilis sores can be hidden in the vagina, anus, under the foreskin of the penis, or in the mouth. Unless you know that your sex partner(s) has been tested and treated, you may be at risk of getting syphilis again from an infected sex partner. < Previous Next >

Prep Pre-exposure prophylaxis (or PrEP) is when people at very high risk for HIV take daily medicine to prevent HIV. PrEP can stop HIV from taking hold and spreading throughout your body. When taken daily, PrEP is highly effective for preventing HIV from sex or injection drug use. PrEP is much less effective when it is not taken consistently. Pre-exposure prophylaxis (or PrEP) is when people at very high risk for HIV take HIV medicines daily to lower their chances of getting infected. A combination of two HIV medicines (tenofovir and emtricitabine), sold under the name Truvada® (pronounced tru vá duh), is approved for daily use as PrEP to help prevent an HIV-negative person from getting HIV from a sexual or injection-drug-using partner who’s positive. Studies have shown that PrEP is highly effective for preventing HIV if it is used as prescribed. PrEP is much less effective when it is not taken consistently. Local Clinics

STI Treatment If your sexual history and current signs and symptoms suggest that you have a sexually transmitted infection, contact a medical professional to get tested and treated. Treatment Sexually transmitted diseases (STDs) or sexually transmitted infections (STIs) caused by bacteria are generally easier to treat. Viral infections can be managed but not always cured. If you are pregnant and have an STI, getting treatment right away can prevent or reduce the risk of your baby becoming infected. Treatment for STIs usually consists of one of the following, depending on the infection: Antibiotics. Antibiotics, often in a single dose, can cure many sexually transmitted bacterial and parasitic infections, including gonorrhea, syphilis, chlamydia and trichomoniasis. Typically, you'll be treated for gonorrhea and chlamydia at the same time because the two infections often appear together. Once you start antibiotic treatment, it's necessary to follow through. If you don't think you'll be able to take medication as prescribed, tell your doctor. A shorter, simpler course of treatment may be available. In addition, it's important to abstain from sex until seven days after you've completed antibiotic treatment and any sores have healed. Experts also suggest women be retested in about three months because there's high chance of reinfection. Antiviral drugs. If you have herpes or HIV, you'll be prescribed an antiviral drug. You'll have fewer herpes recurrences if you take daily suppressive therapy with a prescription antiviral drug. However, it's still possible to give your partner herpes. Antiviral drugs can keep HIV infection in check for many years. But you will still carry the virus and can still transmit it, though the risk is lower. The sooner you start treatment, the more effective it is. If you take your medications exactly as directed, it's possible to reduce your virus count so low that it can hardly be detected. If you've had an STI, ask your doctor how long after treatment you need to be retested. Getting retested will ensure that the treatment worked and that you haven't been reinfected. Coping and support It can be traumatic to find out you have a sexually transmitted disease (STD) or a sexually transmitted infection (STI). You might be angry if you feel you've been betrayed or ashamed if you might have infected others. At worst, an STI can cause chronic illness and death, even with the best care that's available. These suggestions may help you cope: Hold off placing blame. Don't assume that your partner has been unfaithful to you. One (or both) of you may have been infected by a past partner. Be honest with health care workers. Their job is not to judge you, but to provide treatment and stop STIs from spreading. Anything you tell them remains confidential. Contact your health department. Although they may not have the staff and funds to offer every service, local health departments have STI programs that provide confidential testing, treatment and partner services. Preparing for your appointment Most people don't feel comfortable sharing the details of their sexual experiences, but the doctor's office is one place where you have to provide this information so that you can get the right care. What you can do Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance. Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment. Make a list of all medications, vitamins or supplements you're taking. Write down questions to ask your doctor. Some basic questions to ask your doctor include: What's the medical name of the infection or infections I have? How, exactly, is it transmitted? Will it keep me from having children? If I get pregnant, could I give it to my baby? Is it possible to catch this again? Could I have caught this from someone I had sex with only once? Could I give this to someone by having sex with that person just once? How long have I had it? I have other health conditions. How can I best manage them together? Should I not be sexually active while I'm being treated? Does my partner have to go to a doctor to be treated? What to expect from your doctor Giving your doctor a complete report of your symptoms and sexual history will help your doctor determine how to best care for you. Here are some of the things your doctor may ask: What symptoms made you decide to come in? How long have you had these symptoms? Are you sexually active with men, women or both? Do you currently have one sex partner or more than one? How long have you been with your current partner or partners? Have you ever injected yourself with drugs? Have you ever had sex with someone who has injected drugs? What do you do to protect yourself from STIs? What do you do to prevent pregnancy? Has a doctor or nurse ever told you that you have chlamydia, herpes, gonorrhea, syphilis or HIV? Have you ever been treated for a genital discharge, genital sores, painful urination or an infection of your sex organs? How many sex partners have you had in the past year? In the past two months? When was your most recent sexual encounter? What you can do in the meantime If you think you might have an STI, it's best to not to be sexually active until you've talked with your doctor. If you do engage in sexual activity before seeing your doctor, be sure to follow safe sex practices, such as using a condom. Local Clinics

What Is Outercourse? Outercourse is a term that can be used to encompass a wide variety of sexual behaviors. Outtercourse is often used to describe frottage (dry humping), tribadism (tribbing, scissoring), or other types of sexual body rubbing that do not involve penetration. It can also include kissing, mutual masturbation, talking about sexual fantasies, and similar activities. In addition to sexual body rubbing, outercourse may also be used to describe the act of a male partner thrusting his penis to orgasm between his partner's thighs, breasts, butt cheeks, or other body parts as a simulation of intercourse. Once again, the defining factor is the lack of penetration of the vagina, mouth, or anus. This type of behavior is sometimes referred to as "dry humping." Outercourse vs Abstinence In some communities, outercourse can be used to describe any type of sexual act that does not involve vaginal penetration and thus carries little risk of pregnancy. In this way, outercourse is similar to abstinence. Abstinence also has variable definitions. For some people, abstinence is no sexual interaction at all. For others, it's anything that can't get you pregnant. As such, outercourse and abstinence are sometimes considered to be the same thing. For people who define the act of outercourse solely in terms of pregnancy risk, outercourse may include the possibility of oral and/or anal sex. Most sex educators and sexuality professionals do not use the term in this manner. Similarly, most sex educators wouldn't consider abstinence to include oral and anal sex. However, some people disagree. Benefits of Outercourse Some people use outercourse as a way to interact sexually with someone without a risk of pregnancy. It is, indeed a very good way to do that. At least, the pregnancy risk is low as long as heterosexual couples are careful about the male partner ejaculating near the vagina. (Non-male/female couples practicing outercourse aren't at risk for pregnancy, regardless.) Indeed, for some couples who practice abstinence (until marriage or just at some stage of their relationship), outercourse is sometimes a good sexual option. Body rubbing can potentially be fun and even lead to orgasm, without violating any religious strictures. That depends on the beliefs and practices in question, of course, but it can be a pleasurable activity for people whose sexual activities are restricted for religious or other reasons. Outercourse can also be an enjoyable activity for people who aren't worried about pregnancy or abstinent. People may enjoy body rubbing and other outercourse activities as either foreplay or the main event. Some people are not particularly interested in penetrative sex. Others enjoy outercourse for variety. It can be a fun way to interact with a partner who is new or old. Outercourse can also be a relatively safe form of sex for people who don't want to engage in a long safe-sex negotiation. Drawbacks of Outercourse Although body rubbing is a relatively low-risk activity, it's not completely safe sex. Outercourse can still put you at risk of certain sexually transmitted diseases that spread from skin to skin. Outercourse can be made safer with the use of condoms or other barriers. In addition, many of the activities that fall into the category of outercourse can be done with clothing on. Even naked, however, outercourse is a relatively safe activity. Skin infections can be transmitted, but compared to vaginal, oral, or anal sex, it's pretty low risk. It's even used as a risk-reduction technique for individuals with HIV. That said, before engaging in outercourse with a new partner, it's a good idea to negotiate your preferences and boundaries. Not everyone agrees on what outercourse is, so it's a good idea to be sure what both of you are interested in and agreeing to. Fully clothed frottage is a very different level of intimacy from simulated intercourse between the thighs, buttocks, or other body parts. Can Outercourse Lead to Intercourse? Some people claim that one of the drawbacks of outercourse is that it can lead to intercourse. It's true that some sexual enjoyment may lead to people wanting more. However, the idea that one activity automatically leads to another is highly problematic. It makes it seem as though people don't have any sexual agency. The truth is, even if outercourse leads you to wanting intercourse, you can choose whether or not you want to have intercourse. (That's also true if you're not having outercourse!) The idea that intercourse is a risk of outercourse also implies that outercourse can't be sexually satisfying in and of itself. It certainly can. Penetration isn't the be all end all of sexual activity. People can have fulfilling sex lives without penetration, sometimes without even taking their clothes off!

Emergency Contraception Emergency contraception consists of methods that can be used by women after sexual intercourse to prevent pregnancy. Emergency contraception methods have varying ranges of effectiveness depending on the method and timing of administration. Types of Emergency Contraception Intrauterine Device Cu-IUD ECPs UPA in a single dose (30 mg) Levonorgestrel in a single dose (1.5 mg) or as a split dose (1 dose of 0.75 mg of levonorgestrel followed by a second dose of 0.75 mg of levonorgestrel 12 hours later) Combined estrogen and progestin in 2 doses (Yuzpe regimen: 1 dose of 100 µg of ethinyl estradiol plus 0.50 mg of levonorgestrel followed by a second dose of 100 µg of ethinyl estradiol plus 0.50 mg of levonorgestrel 12 hours later) Initiation of Emergency Contraception Timing Cu-IUD The Cu-IUD can be inserted within 5 days of the first act of unprotected sexual intercourse as an emergency contraceptive. In addition, when the day of ovulation can be estimated, the Cu-IUD can be inserted beyond 5 days after sexual intercourse, as long as insertion does not occur >5 days after ovulation. ECPs ECPs should be taken as soon as possible within 5 days of unprotected sexual intercourse. Comments and Evidence Summary. Cu-IUDs are highly effective as emergency contraception (283) and can be continued as regular contraception. UPA and levonorgestrel ECPs have similar effectiveness when taken within 3 days after unprotected sexual intercourse; however, UPA has been shown to be more effective than the levonorgestrel formulation 3–5 days after unprotected sexual intercourse. The combined estrogen and progestin regimen is less effective than UPA or levonorgestrel and also is associated with more frequent occurrence of side effects (nausea and vomiting). The levonorgestrel formulation might be less effective than UPA among obese women. Two studies of UPA use found consistent decreases in pregnancy rates when administered within 120 hours of unprotected sexual intercourse. Five studies found that the levonorgestrel and combined regimens decreased risk for pregnancy through the fifth day after unprotected sexual intercourse; however, rates of pregnancy were slightly higher when ECPs were taken after 3 days. A meta-analysis of levonorgestrel ECPs found that pregnancy rates were low when administered within 4 days after unprotected sexual intercourse but increased at 4–5 days (Level of evidence: I to II-2, good to poor, direct). Advance Provision of ECPs An advance supply of ECPs may be provided so that ECPs will be available when needed and can be taken as soon as possible after unprotected sexual intercourse. Comments and Evidence Summary. A systematic review identified 17 studies that reported on safety or effectiveness of advance ECPs in adult or adolescent women. Any use of ECPs was two to seven times greater among women who received an advance supply of ECPs. However, a summary estimate (relative risk = 0.97; 95% confidence interval = 0.77–1.22) of five randomized controlled trials did not indicate a significant reduction in unintended pregnancies at 12 months with advance provision of ECPs. In the majority of studies among adults or adolescents, patterns of regular contraceptive use, pregnancy rates, and incidence of STDs did not vary between those who received advance ECPs and those who did not. Although available evidence supports the safety of advance provision of ECPs, effectiveness of advance provision of ECPs in reducing pregnancy rates at the population level has not been demonstrated (Level of evidence: I to II-3, good to poor, direct). Initiation of Regular Contraception After ECPs UPA Advise the woman to start or resume hormonal contraception no sooner than 5 days after use of UPA, and provide or prescribe the regular contraceptive method as needed. For methods requiring a visit to a health care provider, such as DMPA, implants, and IUDs, starting the method at the time of UPA use may be considered; the risk that the regular contraceptive method might decrease the effectiveness of UPA must be weighed against the risk of not starting a regular hormonal contraceptive method. The woman needs to abstain from sexual intercourse or use barrier contraception for the next 7 days after starting or resuming regular contraception or until her next menses, whichever comes first. Any non hormonal contraceptive method can be started immediately after the use of UPA. Advise the woman to have a pregnancy test if she does not have a withdrawal bleed within 3 weeks. Levonorgestrel and Combined Estrogen and Progestin ECPs Any regular contraceptive method can be started immediately after the use of levonorgestrel or combined estrogen and progestin ECPs. The woman needs to abstain from sexual intercourse or use barrier contraception for 7 days. Advise the woman to have a pregnancy test if she does not have a withdrawal bleed within 3 weeks. Comments and Evidence Summary.The resumption or initiation of regular hormonal contraception after ECP use involves consideration of the risk for pregnancy if ECPs fail and the risks for unintended pregnancy if contraception initiation is delayed until the subsequent menstrual cycle. A health care provider may provide or prescribe pills, the patch, or the ring for a woman to start no sooner than 5 days after use of UPA. For methods requiring a visit to a health care provider, such as DMPA, implants, and IUDs, starting the method at the time of UPA use may be considered; the risk that the regular contraceptive method might decrease the effectiveness of UPA must be weighed against the risk of not starting a regular hormonal contraceptive method. Data on when a woman can start regular contraception after ECPs are limited to pharmacodynamic data and expert opinion. In one pharmacodynamic study of women who were randomly assigned to either UPA or placebo groups mid-cycle followed by a 21-day course of combined hormonal contraception found no difference between UPA and placebo groups in the time for women’s ovaries to reach quiescence by ultrasound and serum estradiol; this finding suggests that UPA did not have an effect on the combined hormonal contraception. In another pharmacodynamic study with a crossover design, women were randomly assigned to one of three groups: 1) UPA followed by desogestrel for 20 days started 1 day later; 2) UPA plus placebo; or 3) placebo plus desogestrel for 20 days. Among women taking UPA followed by desogestrel, a higher incidence of ovulation in the first 5 days was found compared with UPA alone (45% versus 3%, respectively), suggesting desogestrel might decrease the effectiveness of UPA. No concern exists that administering combined estrogen and progestin or levonorgestrel formulations of ECPs concurrently with systemic hormonal contraception decreases the effectiveness of either emergency or regular contraceptive methods because these formulations do not have antiprogestin properties like UPA. If a woman is planning to initiate contraception after the next menstrual bleeding after ECP use, the cycle in which ECPs are used might be shortened, prolonged, or involve unscheduled bleeding. Prevention and Management of Nausea and Vomiting with ECP Use Nausea and Vomiting Levonorgestrel and UPA ECPs cause less nausea and vomiting than combined estrogen and progestin ECPs. Routine use of antiemetics before taking ECPs is not recommended. Pretreatment with antiemetics may be considered depending on availability and clinical judgment. Vomiting Within 3 Hours of Taking ECPs Another dose of ECP should be taken as soon as possible. Use of an antiemetic should be considered. Comments and Evidence Summary. Many women do not experience nausea or vomiting when taking ECPs, and predicting which women will experience nausea or vomiting is difficult. Although routine use of antiemetics before taking ECPs is not recommended, antiemetics are effective in some women and can be offered when appropriate. Health-care providers who are deciding whether to offer antiemetics to women taking ECPs should consider the following: 1) women taking combined estrogen and progestin ECPs are more likely to experience nausea and vomiting than those who take levonorgestrel or UPA ECPs; 2) evidence indicates that antiemetics reduce the occurrence of nausea and vomiting in women taking combined estrogen and progestin ECPs; and 3) women who take antiemetics might experience other side effects from the antiemetics. A systematic review examined incidence of nausea and vomiting with different ECP regimens and effectiveness of anti nausea drugs in reducing nausea and vomiting with ECP use. The levonorgestrel regimen was associated with significantly less nausea than a nonstandard dose of UPA (50 mg) and the standard combined estrogen and progestin regimen. Use of the split-dose levonorgestrel showed no differences in nausea and vomiting compared with the single-dose levonorgestrel (Level of evidence: I, good-fair, indirect). Two trials of anti nausea drugs, meclizine and metoclopramide, taken before combined estrogen and progestin ECPs, reduced the severity of nausea. Significantly less vomiting occurred with meclizine but not metoclopramide (Level of evidence: I, good-fair, direct). No direct evidence was found regarding the effects of vomiting after taking ECPs.

4389cbc0-adea-42ad-b09b-88e5714a23ec < Back Ending A Pregnancy There are two ways of ending a pregnancy: in-clinic abortion and the abortion pill. Both are safe and very common. If you’re pregnant and thinking about abortion, you may have lots of questions. We’re here to help. Is abortion the right option for me? Abortion is very common, and people have abortions for many different reasons. Only you know what’s best for you, but good information and support can really help you make the decision that is best for your own health and well-being. Why do people decide to have an abortion? If you’re thinking about having an abortion, you’re so not alone. Millions of people face unplanned pregnancies every year, and about 4 out of 10 of them decide to get an abortion. Some people with planned pregnancies also get abortions because of health or safety reasons. Overall, 1 in 4 women in the U.S. will have an abortion by the time they’re 45 years old. Sometimes, the decision is simple. Other times, it’s complicated. But either way, the decision to have an abortion is personal, and you’re the only one who can make it. Everyone has their own unique and valid reasons for having an abortion. Some of the many different reasons people decide to end a pregnancy include: They want to be the best parent possible to the kids they already have. They’re not ready to be a parent yet. It’s not a good time in their life to have a baby. They want to finish school, focus on work, or achieve other goals before having a baby. They’re not in a relationship with someone they want to have a baby with. They’re in an abusive relationship or were sexually assaulted. The pregnancy is dangerous or bad for their health. The fetus won’t survive the pregnancy or will suffer after birth. They just don’t want to be a parent. Deciding to have an abortion doesn’t mean you don’t want or love children. In fact, 6 out of 10 people who get abortions already have kids — and many of them decide to end their pregnancies so they can focus on the children they already have. And people who aren’t already parents when they get an abortion often go on to have a baby later, when they feel they are in a better position to be a good parent. The bottom line is, deciding if and when to have a baby is very personal, and only you know what’s best for you and your family. What can I think about to help me decide? Family, relationships, school, work, life goals, health, safety, and personal beliefs — people think carefully about these things before having an abortion. But you’re the only person walking in your shoes, and the only person who can decide whether to have an abortion. The decision is 100% yours. Here are some things to consider if you are thinking about an abortion: Am I ready to be a parent? Would I consider adoption? What would it mean for my future if I had a child now? What would it mean for my family if I had a child now? How would being a parent affect my career goals? Do I have strong personal or religious beliefs about abortion? Is anyone pressuring me to have or not have an abortion? Would having a baby change my life in a way I do or don’t want? Would having an abortion change my life in a way I do or don’t want? What kind of support would I need and get if I decided to get an abortion? What kind of support would I need and get if I decided to have a baby? Decisions about your pregnancy are deeply personal. You hold the power to make decisions that are best for you in order to stay on your own path to a healthy and meaningful life. There are lots of things to consider, and it’s totally normal to have many different feelings and thoughts when making this decision. That’s why it’s important to get factual, non-judgmental information about abortion. Support from family, friends, partners, and other people you trust can also be helpful. But at the end of the day, only you know what’s right for you. Who can I talk with about getting an abortion? Lots of people lean on others to help them with their decision. It’s good to choose people who you know are understanding and supportive of you. Your local health center has caring professionals that can answer any questions you may have. They'll give you expert care, accurate information about all your options, and non-judgmental support along the way — no matter what you decide about your pregnancy. Other family planning centers and private doctors may also talk with you about your decision. But be careful when looking for a reliable health center, because there are fake clinics out there that claim to offer information about pregnancy options and abortion. They’re called Crisis Pregnancy Centers, and they’re run by people who don’t believe in giving you honest facts about abortion, pregnancy, and birth control. Crisis pregnancy centers are often located very close to Planned Parenthood health centers or other real medical centers, and have similar names — they do this to confuse people and trick them into visiting them instead. No one should pressure you into making any decision about your pregnancy, no matter what. So it’s important to get the info and support you need from people who give you the real facts and won’t judge you. If you’re having a hard time finding someone in your life to talk with, check out All-Options. All-Options has a free hotline that gives you a confidential space to talk about making decisions about a pregnancy. They’ll give you judgment-free support at any point in your pregnancy experience, no matter what you decide to do or how you feel about it. When do I have to make a decision? It’s important to take the time you need to make the best decision for you. It’s also a good idea to talk to a nurse or doctor as soon as you can so you can get the best medical care possible. The staff at your local Planned Parenthood health center is always here to provide expert medical care and support, no matter what decision you make. Previous Next

e60af237-32f8-4921-be14-d5d3b7aed5bf < Back Planned Parenthood There are two ways of ending a pregnancy: in-clinic abortion and the abortion pill. Both are safe and very common. If you’re pregnant and thinking about abortion, you may have lots of questions. We’re here to help. Previous Next

What Is Sexual Orientation? It’s not completely known what causes someone to be lesbian, gay, straight, or bisexual, but your sexual orientation probably started at a very young age. This doesn’t mean that you had sexual feelings, just that you had feelings about who you were attracted to. As you get older these feelings get stronger and shape your sexual identity. Sometimes sexual orientation changes over time. And sometimes it stays the same throughout your life. But sexual orientation isn’t a choice, and can’t be changed by therapy, treatment, or pressure from family or friends. You also can’t “turn” a person gay. For example, a girl who plays with toys traditionally made for boys isn’t going to become a lesbian because of that. Sexual orientation can feel incredibly simple — you’re a girl who’s always liked both guys and girls and you identify as bisexual — or it can feel way more complex. It may take several years to understand your sexual orientation or come out. Some people call themselves questioning, which means they aren’t sure about their sexual orientation or gender identity. This is common — especially for teens.

Human Papillomavirus (HPV) Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Some health effects caused by HPV can be prevented by the HPV vaccines. What is HPV? Should I get the HPV vaccine? HPV is the most common sexually transmitted infection (STI). HPV is a different virus than HIV and HSV (herpes). 79 million Americans, most in their late teens and early 20s, are infected with HPV. There are many different types of HPV. Some types can cause health problems including genital warts and cancers. But there are vaccines that can stop these health problems from happening. How is HPV spread? You can get HPV by having vaginal, anal, or oral sex with someone who has the virus. It is most commonly spread during vaginal or anal sex. HPV can be passed even when an infected person has no signs or symptoms. Anyone who is sexually active can get HPV, even if you have had sex with only one person. You also can develop symptoms years after you have sex with someone who is infected. This makes it hard to know when you first became infected. Does HPV cause health problems? In most cases, HPV goes away on its own and does not cause any health problems. But when HPV does not go away, it can cause health problems like genital warts and cancer. Genital warts usually appear as a small bump or group of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. A healthcare provider can usually diagnose warts by looking at the genital area. Does HPV cause cancer? HPV can cause cervical and other cancers including cancer of the vulva, vagina, penis, or anus. It can also cause cancer in the back of the throat, including the base of the tongue and tonsils (called oropharyngeal cancer). Cancer often takes years, even decades, to develop after a person gets HPV. The types of HPV that can cause genital warts are not the same as the types of HPV that can cause cancers. There is no way to know which people who have HPV will develop cancer or other health problems. People with weak immune systems (including those with HIV/AIDS) may be less able to fight off HPV. They may also be more likely to develop health problems from HPV. How can I avoid HPV and the health problems it can cause? You can do several things to lower your chances of getting HPV. Get vaccinated. The HPV vaccine is safe and effective. It can protect against diseases (including cancers) caused by HPV when given in the recommended age groups. (See “Who should get vaccinated?” below) CDC recommends HPV vaccination at age 11 or 12 years (or can start at age 9 years) and for everyone through age 26 years, if not vaccinated already. For more information on the recommendations, please see: https://www.cdc.gov/vaccines/vpd/hpv/public/index.html Get screened for cervical cancer. Routine screening for women aged 21 to 65 years old can prevent cervical cancer. If you are sexually active: Use latex condoms the right way every time you have sex. This can lower your chances of getting HPV. But HPV can infect areas not covered by a condom – so condoms may not fully protect against getting HPV; Be in a mutually monogamous relationship – or have sex only with someone who only has sex with you. Who should get vaccinated? HPV vaccination is recommended at age 11 or 12 years (or can start at age 9 years) and for everyone through age 26 years, if not vaccinated already. Vaccination is not recommended for everyone older than age 26 years. However, some adults age 27 through 45 years who are not already vaccinated may decide to get the HPV vaccine after speaking with their healthcare provider about their risk for new HPV infections and the possible benefits of vaccination. HPV vaccination in this age range provides less benefit. Most sexually active adults have already been exposed to HPV, although not necessarily all of the HPV types targeted by vaccination. At any age, having a new sex partner is a risk factor for getting a new HPV infection. People who are already in a long-term, mutually monogamous relationship are not likely to get a new HPV infection. How do I know if I have HPV? There is no test to find out a person’s “HPV status.” Also, there is no approved HPV test to find HPV in the mouth or throat. There are HPV tests that can be used to screen for cervical cancer. These tests are only recommended for screening in women aged 30 years and older. HPV tests are not recommended to screen men, adolescents, or women under the age of 30 years. Most people with HPV do not know they are infected and never develop symptoms or health problems from it. Some people find out they have HPV when they get genital warts. Women may find out they have HPV when they get an abnormal Pap test result (during cervical cancer screening). Others may only find out once they’ve developed more serious problems from HPV, such as cancers. How common is HPV and the health problems caused by HPV? HPV (the virus): About 79 million Americans are currently infected with HPV. About 14 million people become newly infected each year. HPV is so common that almost every person who is sexually-active will get HPV at some time in their life if they don’t get the HPV vaccine. Health problems related to HPV include genital warts and cervical cancer. Genital warts: Before HPV vaccines were introduced, roughly 340,000 to 360,000 women and men were affected by genital warts caused by HPV every year.* Also, about one in 100 sexually active adults in the U.S. has genital warts at any given time. Cervical cancer: Every year, nearly 12,000 women living in the U.S. will be diagnosed with cervical cancer, and more than 4,000 women die from cervical cancer—even with screening and treatment. There are other conditions and cancers caused by HPV that occur in people living in the United States. Every year, approximately 19,400 women and 12,100 men are affected by cancers caused by HPV. *These figures only look at the number of people who sought care for genital warts. This could be an underestimate of the actual number of people who get genital warts. I’m pregnant. Will having HPV affect my pregnancy? If you are pregnant and have HPV, you can get genital warts or develop abnormal cell changes on your cervix. Abnormal cell changes can be found with routine cervical cancer screening. You should get routine cervical cancer screening even when you are pregnant. Can I be treated for HPV or health problems caused by HPV? There is no treatment for the virus itself. However, there are treatments for the health problems that HPV can cause: Genital warts can be treated by your healthcare provider or with prescription medication. If left untreated, genital warts may go away, stay the same, or grow in size or number. Cervical precancer can be treated. Women who get routine Pap tests and follow up as needed can identify problems before cancer develops. Prevention is always better than treatment. < Previous Next >

31cbe5db-89f4-4152-9d76-287f9c86c8a7 < Back Emergency Contraception Emergency contraception consists of methods that can be used by women after sexual intercourse to prevent pregnancy. Emergency contraception methods have varying ranges of effectiveness depending on the method and timing of administration. Types of Emergency Contraception Intrauterine Device Cu-IUD ECPs UPA in a single dose (30 mg) Levonorgestrel in a single dose (1.5 mg) or as a split dose (1 dose of 0.75 mg of levonorgestrel followed by a second dose of 0.75 mg of levonorgestrel 12 hours later) Combined estrogen and progestin in 2 doses (Yuzpe regimen: 1 dose of 100 µg of ethinyl estradiol plus 0.50 mg of levonorgestrel followed by a second dose of 100 µg of ethinyl estradiol plus 0.50 mg of levonorgestrel 12 hours later) Initiation of Emergency Contraception Timing Cu-IUD The Cu-IUD can be inserted within 5 days of the first act of unprotected sexual intercourse as an emergency contraceptive. In addition, when the day of ovulation can be estimated, the Cu-IUD can be inserted beyond 5 days after sexual intercourse, as long as insertion does not occur >5 days after ovulation. ECPs ECPs should be taken as soon as possible within 5 days of unprotected sexual intercourse. Comments and Evidence Summary. Cu-IUDs are highly effective as emergency contraception (283) and can be continued as regular contraception. UPA and levonorgestrel ECPs have similar effectiveness when taken within 3 days after unprotected sexual intercourse; however, UPA has been shown to be more effective than the levonorgestrel formulation 3–5 days after unprotected sexual intercourse. The combined estrogen and progestin regimen is less effective than UPA or levonorgestrel and also is associated with more frequent occurrence of side effects (nausea and vomiting). The levonorgestrel formulation might be less effective than UPA among obese women. Two studies of UPA use found consistent decreases in pregnancy rates when administered within 120 hours of unprotected sexual intercourse. Five studies found that the levonorgestrel and combined regimens decreased risk for pregnancy through the fifth day after unprotected sexual intercourse; however, rates of pregnancy were slightly higher when ECPs were taken after 3 days. A meta-analysis of levonorgestrel ECPs found that pregnancy rates were low when administered within 4 days after unprotected sexual intercourse but increased at 4–5 days (Level of evidence: I to II-2, good to poor, direct). Advance Provision of ECPs An advance supply of ECPs may be provided so that ECPs will be available when needed and can be taken as soon as possible after unprotected sexual intercourse. Comments and Evidence Summary. A systematic review identified 17 studies that reported on safety or effectiveness of advance ECPs in adult or adolescent women. Any use of ECPs was two to seven times greater among women who received an advance supply of ECPs. However, a summary estimate (relative risk = 0.97; 95% confidence interval = 0.77–1.22) of five randomized controlled trials did not indicate a significant reduction in unintended pregnancies at 12 months with advance provision of ECPs. In the majority of studies among adults or adolescents, patterns of regular contraceptive use, pregnancy rates, and incidence of STDs did not vary between those who received advance ECPs and those who did not. Although available evidence supports the safety of advance provision of ECPs, effectiveness of advance provision of ECPs in reducing pregnancy rates at the population level has not been demonstrated (Level of evidence: I to II-3, good to poor, direct). Initiation of Regular Contraception After ECPs UPA Advise the woman to start or resume hormonal contraception no sooner than 5 days after use of UPA, and provide or prescribe the regular contraceptive method as needed. For methods requiring a visit to a health care provider, such as DMPA, implants, and IUDs, starting the method at the time of UPA use may be considered; the risk that the regular contraceptive method might decrease the effectiveness of UPA must be weighed against the risk of not starting a regular hormonal contraceptive method. The woman needs to abstain from sexual intercourse or use barrier contraception for the next 7 days after starting or resuming regular contraception or until her next menses, whichever comes first. Any non hormonal contraceptive method can be started immediately after the use of UPA. Advise the woman to have a pregnancy test if she does not have a withdrawal bleed within 3 weeks. Levonorgestrel and Combined Estrogen and Progestin ECPs Any regular contraceptive method can be started immediately after the use of levonorgestrel or combined estrogen and progestin ECPs. The woman needs to abstain from sexual intercourse or use barrier contraception for 7 days. Advise the woman to have a pregnancy test if she does not have a withdrawal bleed within 3 weeks. Comments and Evidence Summary.The resumption or initiation of regular hormonal contraception after ECP use involves consideration of the risk for pregnancy if ECPs fail and the risks for unintended pregnancy if contraception initiation is delayed until the subsequent menstrual cycle. A health care provider may provide or prescribe pills, the patch, or the ring for a woman to start no sooner than 5 days after use of UPA. For methods requiring a visit to a health care provider, such as DMPA, implants, and IUDs, starting the method at the time of UPA use may be considered; the risk that the regular contraceptive method might decrease the effectiveness of UPA must be weighed against the risk of not starting a regular hormonal contraceptive method. Data on when a woman can start regular contraception after ECPs are limited to pharmacodynamic data and expert opinion. In one pharmacodynamic study of women who were randomly assigned to either UPA or placebo groups mid-cycle followed by a 21-day course of combined hormonal contraception found no difference between UPA and placebo groups in the time for women’s ovaries to reach quiescence by ultrasound and serum estradiol; this finding suggests that UPA did not have an effect on the combined hormonal contraception. In another pharmacodynamic study with a crossover design, women were randomly assigned to one of three groups: 1) UPA followed by desogestrel for 20 days started 1 day later; 2) UPA plus placebo; or 3) placebo plus desogestrel for 20 days. Among women taking UPA followed by desogestrel, a higher incidence of ovulation in the first 5 days was found compared with UPA alone (45% versus 3%, respectively), suggesting desogestrel might decrease the effectiveness of UPA. No concern exists that administering combined estrogen and progestin or levonorgestrel formulations of ECPs concurrently with systemic hormonal contraception decreases the effectiveness of either emergency or regular contraceptive methods because these formulations do not have antiprogestin properties like UPA. If a woman is planning to initiate contraception after the next menstrual bleeding after ECP use, the cycle in which ECPs are used might be shortened, prolonged, or involve unscheduled bleeding. Prevention and Management of Nausea and Vomiting with ECP Use Nausea and Vomiting Levonorgestrel and UPA ECPs cause less nausea and vomiting than combined estrogen and progestin ECPs. Routine use of antiemetics before taking ECPs is not recommended. Pretreatment with antiemetics may be considered depending on availability and clinical judgment. Vomiting Within 3 Hours of Taking ECPs Another dose of ECP should be taken as soon as possible. Use of an antiemetic should be considered. Comments and Evidence Summary. Many women do not experience nausea or vomiting when taking ECPs, and predicting which women will experience nausea or vomiting is difficult. Although routine use of antiemetics before taking ECPs is not recommended, antiemetics are effective in some women and can be offered when appropriate. Health-care providers who are deciding whether to offer antiemetics to women taking ECPs should consider the following: 1) women taking combined estrogen and progestin ECPs are more likely to experience nausea and vomiting than those who take levonorgestrel or UPA ECPs; 2) evidence indicates that antiemetics reduce the occurrence of nausea and vomiting in women taking combined estrogen and progestin ECPs; and 3) women who take antiemetics might experience other side effects from the antiemetics. A systematic review examined incidence of nausea and vomiting with different ECP regimens and effectiveness of anti nausea drugs in reducing nausea and vomiting with ECP use. The levonorgestrel regimen was associated with significantly less nausea than a nonstandard dose of UPA (50 mg) and the standard combined estrogen and progestin regimen. Use of the split-dose levonorgestrel showed no differences in nausea and vomiting compared with the single-dose levonorgestrel (Level of evidence: I, good-fair, indirect). Two trials of anti nausea drugs, meclizine and metoclopramide, taken before combined estrogen and progestin ECPs, reduced the severity of nausea. Significantly less vomiting occurred with meclizine but not metoclopramide (Level of evidence: I, good-fair, direct). No direct evidence was found regarding the effects of vomiting after taking ECPs. Previous Next