sex ed for adults

I had a pretty long confusing and frustrating day in clinic, filled with strange complaints and even stranger non-compliance. and now, as some cathartic moment, i feel the urge to rant. later in life, when i'm older, i will write a book. a book about women's relationship to their own bodies. until then, this will have to suffice. warning: this will likely be somewhat, umm...un-kosher. Over the last several years, i have encountered many patients with significant confusion about their reproductive capacity. consider this a public service announcement on birds and bees. it takes a man and a woman, and a few behavioral steps, to conceive what, after some cooking time, will become a child. all women of reproductive age are at risk for getting pregnant. of reproductive age, means that as long as you are getting a period (that pesky vaginal bleeding we frequently complain of) on some regular basis, like at least a little bit, maybe sometimes, you can still get pregnant. when i say 'at risk', i just mean it's possible. not scary, just possible. now, to truly actually be at risk for pregnancy, you need a few things, such as 1) a man with a functioning penis, 2) vaginal intercourse, 3) and oh yeah, unprotected vaginal intercourse. it sounds like a lot of things, but if any of the mentioned components are missing, it may not happen. and because there are so many components it sounds really difficult, but it's really not. like at all. which is why it's very surprising when women end up in emergency room, complaining of diarrhea or a swollen 4th toe and end up with a positive pregnancy test because their emergency room doctors remember that all reproductive age women (read above) are at risk of getting pregnant and obtain a pregnancy test on all....well you get it. this usually leads to a strange conversation: "so you're sexually active" "yes" "and not using protection" "no" "and you're shocked that you're pregnant". the truth is, most women i know most of the time are trying not to get pregnant. unless you're living in a rural community in a third world country, are part of the mormon community, or are a duggar, you're unlikely to want many children all the time. (this excludes couples with infertility because that sucks and i'm really sorry). that requires a few steps. you can always join a nunnery and dedicate your life to jesus, or to some other deity requiring celibacy, otherwise, there will need to be some steps taken by you to prevent pregnancy. contraception is a good option. there are many choices out there, but you have to be an active participant. like, when asking for contraception, you can't just say no to it all because you dont want to swallow pills, bother to remember to come in for shots, dont want hormones/device/things in or on your body, or adamantly decline surgery. sigh. at some point, sadly, the options do run out. similarly, permanent sterilization, also known as tubal ligation, getting your tubes tied, or tubalization, is a great option, but as the name implies, permanent, meaning it's forever, like for always, and not until you change your mind, or break up with your boyfriend. so you should probably be really sure you want it. in truth, many women, in this country and around the world, do have contraceptive needs that are far from met. politically, socially, or economically, many women do not have access to contraception, of their choice or at all. as much as i complain about women who are asking for contraception without needing it because, you know, they're not having sex, i applaud them for being proactive, for worrying, and asking. because the truth is, many others cannot do that.