Dr Valerie Tagwira, an expert on sexual health, recently answered iVillagers' questions during a web chat on the Periods & Sexual Health messageboard
Dr Tagwira works for the sexual health charity Marie Stopes International. Her work includes discussing and providing contraception, and counselling for young women concerned about sexually transmitted infections and unplanned pregnancy.
Is spotting normal?
Why do I bleed after sex?
The question of conception
Do I have PCOS?
My husband and I are going to try for a baby in December. I am 22 and am not taking the contraceptive pill.
I have experienced pre-menstrual spotting, which starts about five days before my period arrives. There is no pain and my periods are light/medium. My period lasts about three days of full flow and then three days of spotting again.
My doctor says she thinks this is normal and it is just my body preparing for a period as my hormone levels drop. I don't have any sexually transmitted infections and have had scans to check for cysts, examinations on my cervix and a smear. They were all normal.
Is this spotting normal? Will it affect my fertility? I am very worried.
tinkerbellbaby
Dr Valerie: From the history that you give, I would like to reassure you that there is no indication of anything that may affect your fertility.
Because all the tests have been normal, your doctor is absolutely right about the spotting being normal. Under the influence of hormones, the lining of your womb thickens in preparation to receive a fertilised egg. In the absence of fertilisation, the lining breaks down and you experience a period.
Shedding of the lining of the womb may initially be patchy in some women, resulting in small amounts of brown or faint red loss at the beginning. Again, as the period tails off at the end, it is not unusual to have similar brown loss in small amounts.
From the information that you have provided, there is nothing which suggests the likelihood of you having endometriosis. Although some women with endometriosis have no symptoms, it is typically associated with painful periods, chronic pelvic pain and pain during sex. There is no association with spotting before or after periods.
Leading up to your pregnancy, please maintain a healthy diet and normal weight. If you are a smoker, it would be a great idea to quit smoking as well as to cut down on any alcohol intake so as to have a healthy pregnancy. You should also consider taking folic acid before conception.
I have recently begun to bleed after having sex. This started about three months ago and occurs at anytime during my cycle. I tend to have quite regular periods of about 27/28 days that last for about five days in duration and cause me no pain.
My current partner has quite a large penis so I'm wondering if this could be a factor. I recently had a smear, and the nurse commented that my sample was pink in colour but that my cervix looked okay. Is this something I should worry about?
lou_uk
Dr Valerie: There are various reasons why a woman may have bleeding between periods and after sex. Erosions on the cervix, as well as infections and polyps (small benign growths) on the cervix and vagina are all possible causes. However, you do say that your cervix was noted to be healthy, so that is reassuring.
Rarely, cancerous changes on the cervix can cause bleeding after sex. This is highly unlikely in a young woman who has regular cervical smears and no history of previous abnormal smear results.
It would be useful to know if you have recently noticed a change in the amount, colour or smell of your vaginal discharge, as these would suggest a possible infection. Infection of the lining of the womb can also, at times, cause unexpected, light bleeding, although this does not necessarily occur after sex. However, polyps in the womb could potentially cause bleeding after sex.
Sometimes, bleeding is related to the type of contraceptive that one is using. You did not say if you are on any contraceptive. The ones that contain progestogens only (like the Mini pill, Mirena and Depo Provera) may cause irregular bleeding in some women. Again, this would not be particularly related to sex, and is not harmful unless the bleeding becomes heavy.
You do point out that your partner has a large penis. As long as intercourse is not traumatic, and you ensure that you are well-lubricated and relaxed beforehand, this should not be a cause of bleeding and discomfort. In case this is a problem, you may want to consider using lubricants.
If your problem is persistent, I would suggest you visit your doctor. He or she will take a detailed history, examine you, perform tests if necessary and offer you treatment if required.
I am 27 and have been trying to conceive for six months. I stopped taking the pill last July and have had quite irregular cycles since then.
Since December I have been using ovulation predictor tests and I have noticed that my period is arriving quite soon after ovulation. In December my LP was 10/11 days, January 8/9 days and February was 3/4 days.
My doctor said that my LP was not a problem and the only reason I am getting my period early is because I am not pregnant. Does this sound like I do actually have a problem? My doctor is making me feel like I am wasting his time, but I really feel like something isn't right.
wishing-on-a-star
Dr Valerie: From the information that you have given, everything sounds reassuring. There is nothing to suggest that you might have a fertility problem.
The irregular bleeding may suggest that not all your cycles are ovulatory at present; home kits do not necessarily confirm ovulation. Most urine kits detect a Luteinising Hormone which peaks before ovulation, but they are not 100 per cent reliable at predicting ovulation.
Luteinising Hormone can rise without any egg having been released by your ovary. The tests are therefore a useful guide for timing intercourse to coincide with when you are most likely to be fertile. Generally, a progesterone level of 30nmol/litre or above does confirm ovulation.
Because you are young and otherwise healthy, regular ovulation should be occurring soon, and your chances of conceiving naturally are high. You are very keen to become pregnant, and I totally understand how you must be feeling.
However, your doctor's response is quite appropriate. From a medical point of view, you are not defined as having a possible sub-fertility problem until after one year of regular, unprotected sex.
Within those 12 months, 85 per cent of couples are expected to have conceived. Ninety five per cent of all couples conceive by the end of two years of trying.
If not, more invasive tests may be carried out in a fertility clinic setting. In the meantime, avoid stress, maintain a healthy weight and avoid alcohol intake and smoking. All these are general measures that not only enhance chances of conceiving naturally, but they also ensure that you have a healthy pregnancy. Do talk to your doctor or pharmacist about taking pre-pregnancy folic acid.
Do I have PCOS (Polycystic ovarian syndrome)?
I have had erratic cycles since my periods started, but have been on the pill for many years so it was not really a problem. However, I had a copper coil fitted about two years ago, so my normal cycle is back again; sometimes two cycles one after the other, sometimes nothing for five or six weeks.
I have also had a spotty chin and some dark facial hairs since coming off the pill, and I wondered if all of these symptoms could be due to PCOS. I have not had any weight gain, however. Does this matter?
nicolaturner
Dr Valerie: It is not unusual to have irregular bleeding if you have a Mirena coil, because of the way it works. Sometimes abnormal bleeding with a coil in place may suggest the possibility of infection, especially if you also have vaginal discharge and pain in your lower abdomen.
A recent change in bleeding pattern in association with lost coil threads may mean that the coil has been displaced or expelled, in which case you may be at risk of unplanned pregnancy. Therefore, it would be in your best interests to use condoms until you have been seen by a gynaecologist.
Do mention your concerns about PCOS to the gynaecologist so that he or she can assess you accordingly. Excess hair and acne may suggest a possibility of PCOS, but your hormone levels, blood sugar and cholesterol levels, and the appearance of your ovaries on a scan are also important.
Approximately half of women with PCOS have a normal weight. If you end up not having a coil fitted, you may want to talk to the gynaecologist about a contraceptive pill called Dianette.
It is useful for both spotty skin and excess hair growth, although it may take several months before you notice any change. There are, of course, other treatments that you could discuss.