Great Sex, Naturally (47 page)

In the case of progesterone, in addition to the transdermal oil or cream, and the oral pills known as
oral micronized progesterone
(such as Prometrium), there’s a third form—a sublingual pill, sometimes referred to as a
troche
, which is absorbed under your tongue. The sublingual pill is generally preferable to the oral one, but transdermal applications are still your best bet. Every woman is unique, however, and it’s sometimes wisest to stick with whatever method works for you.

An extra advantage of transdermal application is that this method allows you to have your hormones blended by a compounding pharmacy into a “cocktail” to suit your specific needs. Or they can be prepared individually, making it convenient to take them separately and adjust your dose of a given hormone at any time.

Where on your body should you apply your hormones? In the form of transdermal oils or creams, they can be applied to any thin-skinned area of your body, such as your inner arm or thigh—but even on those areas, the hormones have to pass through relatively thick dermis before being absorbed into your bloodstream. For much better absorption, you can apply them directly to the mucous membranes of your vulva or vagina; place the recommended amount on your fingertip, and gently massage it into your vulvar or vaginal tissues.

Choosing the best “base” for your transdermal hormone application is also important. Natural bioidentical hormones that you apply transdermally can be put into a variety of oil or cream bases by compounding pharmacies; when your physician orders your prescriptions, you can request certain bases. Knowing what to choose can have consequences for your health, especially if you apply hormones frequently to your delicate vulvar and vaginal tissues. Let’s look at some commonly used bases, beginning with your best options:

—
Oil bases.
Two of the safest and most popular bases for transdermal hormone applications are olive oil and jojoba oil. You can conveniently apply a few drops of the mixture to your vulva or vagina each day. These bases usually contain minimal unwanted chemicals or other ingredients, and are well tolerated by most women. Other options for oil bases include grape-seed oil and emu oil (derived from the fat of the Australian emu bird).

—
NataCream.
Another good choice, this cream base—all the components of which are of vegetable origin—is free of ingredients that may be found in other products, such as solvents, chemical impurities, dioxine, and ethylene oxide. NataCream is available from Key Compounding Pharmacy in Kent, Washington.

—
PLO gel.
This cream base is frequently used for transdermal hormone applications, is readily absorbed, has a low risk of tissue irritation, and works well for many women. It contains soya lecithin, isopropyl palmitate, sorbic acid, and poloxamer 407. The first two of these ingredients are fairly benign, but the Environmental Working Group (EWG) lists the last two as moderate hazards (although they’re not found in high amounts in PLO gel).

When choosing the bases for your transdermal hormone applications, you should avoid certain types commonly used by compounding pharmacies, as they contain compounds that could compromise your health. Since healthy oil and cream bases are readily available, it’s easy to steer clear of those with questionable ingredients. The following bases are
not
recommended for your hormone applications:

—
Velvachol.
You should avoid Velvachol because of its high content of parabens—chemical preservatives and known environmental toxins that mimic estrogen (which means they could potentially increase your cancer risk) and can accumulate in the fatty layer of your skin. A study reported in 2004 in the
Journal of Applied Toxicology
found increased concentration of parabens in breast tumors, and subsequent research confirms that parabens are not only estrogen-mimickers but can also interfere with your hormone levels. You should also steer clear of Velvachol because it contains petrolatum, a petroleum-based ingredient; it’s best to avoid using petroleum products on your body.

—
MBK fatty acid.
MBK fatty acid isn’t recommended, because it contains PEG-8 distearate and hydrogenated vegetable oil. The EWG rates PEG-8 distearate as a moderate hazard with possible links to toxicity, and hydrogenated oils are chemically synthesized trans-fatty acids that shouldn’t be ingested or used on your body.

—
Vanpen.
Vanpen should be avoided because it contains the chemical butylated hydroxytoluene, also known as
BHT
. According to the EWG, BHT is a moderate hazard linked with toxicity and endocrine-system disruption; other sources indicate that it’s toxic to the immune system and human skin, may have nerve toxic effects, and may contribute to the development of cancer cells. Animal studies have found that it can increase the risk of cancerous tumors.

APPENDIX G

Safe Sex, Naturally

The number of sexually transmitted infections (STIs) is greater than many people realize. In addition to HIV and herpes, they include human papilloma virus, chlamydia, hepatitis B, hepatitis C, trichomoniasis, gonorrhea, and syphilis. Some can be treated with natural techniques, others require pharmaceutical drugs, and some have no cure. Most can cause serious health consequences with wide-ranging symptoms.

STIs appear to be on the rise with the increased use of drugs like Viagra. Since Viagra became available in 1998, studies show sharply increased STI rates among the post-midlife population (the drug’s most frequent users). A 2008 British study reported that the rate had more than doubled between 1996 and 2003 among people 45 or older—a significantly higher increase than in those under 45. Another study conducted in 2000 in Washington State found that the rate of gonorrhea had risen more than 18 percent among those middle-aged and older, again a higher increase than among younger people. Although these studies weren’t focused specifically on Viagra, and researchers attribute the findings in part to other factors, much speculation remains about the extent to which the problem is compounded by the popularity of Viagra and similar drugs.

The safest way to avoid STIs is to be in a committed monogamous relationship—defined as one in which neither you nor your partner has any sexual activity outside the relationship. This means your exchange of bodily fluids is “private”; in a sense, you share an intimate mucous-membrane barrier that protects both of your immune systems by excluding certain aspects of the environment outside of your relationship. As long as this barrier remains in place, it’s extremely unlikely that any STI will get through.

If you’re in a new relationship, communication and trust are essential. You need to know as much as possible about your new partner’s sexual history before having sex. But since unknowns are inherent in new relationships—even with the best efforts to communicate, you may not have ultimate certainty about your partner’s sexual history—the following steps are recommended for safe sex:

—
Educate yourself.
Be aware of how HIV, herpes, and other STIs are transmitted. For example, learn what herpes outbreaks look like; you or your partner may have herpes without knowing it. Get tested for HIV, and request that your partner be tested, too.

—
Examine your bodies.
Carefully inspect yourself and your partner for cuts, blisters, sores, or other breaks in the skin anywhere on your bodies—especially in or around your mouths, hands, and genitals—which can present opportunities for STI transmission. If either of you has openings in your skin on these areas, refrain from sex until they’re healed.

—
Use condoms.
Avoid lubricating the penis before putting on a condom, which can cause it to slip off during sex. Make sure condoms stay in place during sex by feeling the “ridge” at the base of the penis with your hand. Withdraw your partner’s penis from your vagina soon after sex—a time that condoms are apt to come off—with one of you holding the condom’s base in place.

—
Use lubrication and avoid chafing.
Lubrication prevents vaginal or penile abrasions that can lead to infections. Use water-based lubrication with latex condoms; oil-based lubrication can dissolve latex. Whether you use condoms or not, avoid anything that might cause chafing, such as excessive thrusting when your vagina feels dry.

APPENDIX H

Natural vs. Synthetic Birth Control

Some people might wonder what natural sex has to do with birth control. Wouldn’t it be natural to simply let nature run its course? The answer is both yes and no. Pregnancy is a natural consequence of sex without birth control, but it’s also a natural impulse, exercised by people throughout the ages, to control whether pregnancy happens. Depending on your personal philosophy, you may feel preventing birth is as natural as promoting it.

If you use birth control, the method you choose can be important for your overall health. As with everything else, you want your birth-control method to compromise your well-being as little as possible. Although birth-control pills have become commonly used, they interfere with your natural hormonal balance by using synthetic hormones to prevent you from ovulating. As explored in
Chapter 4
, your hormonal balance is crucial to your health and sexuality. Birth-control pills also put you at risk for side effects that include irregular menstrual bleeding, depression, headaches, dizziness, breast tenderness, weight gain, and other symptoms.

There are various methods of using synthetic hormones to prevent pregnancy, but don’t be fooled by the fact that they may not be referred to as “the Pill.” All rely on more or less the same approach of meddling with your natural hormone levels, and can have similar symptoms. They include hormone patches like Ortho Evra, estrogen and progestin injections like Lunelle, and progestin injections like Depo-Provera.

Natural birth-control methods may seem less convenient than synthetic hormones in the short run, but they’re likely to be much better for your health in the long run. And a combination of two or three natural methods can be highly effective in preventing pregnancy. Let’s look at some pros and cons of common natural methods, including some that may be considered seminatural because they involve spermicide (also included are some nonnatural methods that provide alternatives to synthetic hormones):

—
Periodic abstinence.
With periodic abstinence, you simply refrain from having sex when you’re most likely to conceive. You can use a basal thermometer or other methods to gauge your monthly time of peak fertility. (For more information, see
Taking Charge of Your Fertility
, by Toni Weschler.) Periodic abstinence allows for unrestricted sex any time of the month except around your ovulation, but if used by itself, it’s not one of the more dependable ways of preventing pregnancy.

—
Condoms.
The pros of condoms include their ability to help protect you against STIs. The cons include decreased sensation for you and your partner and possible allergic reactions to latex. Female condoms are available, although they’re less effective for birth control than male condoms.

—
Cervical cap.
You can insert a cervical cap up to two hours before sex; to be effective, it has to be used with spermicide.

—
Diaphragm.
As with a cervical cap, a diaphragm can be inserted up to two hours before sex, and works effectively when combined with spermicide. If not fitted properly, diaphragms may increase your likelihood of urinary tract infections.

—
Intrauterine device (IUD).
Inserted by a physician and sometimes left in place for several years, an IUD can have the advantage of convenience. But for some women it may increase menstrual cramps, bleeding, and the risk of pelvic inflammatory disease. In some situations, IUDs may also result in perforation of the uterus.

—
Tubal ligation and vasectomy.
These methods allow for spontaneous sex without concern for birth control. If in the future you want to become pregnant, however, either method requires additional surgery, which may not be effective.