Spill

Many people with CF experience urinary incontinence, or "leakage" of urine, particularly when they cough or laugh. Some people may experience this during exercise, and while performing lung function tests or chest physiotherapy. Incontinence may be more of a problem during periods of increased cough or when constipated.

Coughing causes incontinence because it increases the pressure on the pelvic floor muscles, which help to hold urine inside the bladder.

Urinary incontinence can be treated with pelvic floor exercises. CF physiotherapists can give advice about how to do these exercises. There are also specialist physiotherapists and nurses who can help with the management of urinary incontinence.

Many people develop genital candidiasis (thrush) when they take antibiotics. It is caused by a yeast (fungus), called Candida albicans that lives in the bowel. When conditions in the bowel are altered, for example, when starting or changing antibiotics, the balance between yeast and bacteria can be disrupted and lead to an overgrowth of Candida.

Thrush is very common in women. It occurs in some men, including men with CF, who often take antibiotics. It may occur with particular antibiotics, after a change of antibiotics, or during a tune up (i.e. when receiving intravenous antibiotics). It can cause itching, redness, pain, irritation and burning on urination.

There are many different treatments available for thrush. It is important to talk to your CF team if you are worried about thrush. It is best if it is treated early and it is important to make sure that the thrush treatments (including complementary medicines) don’t interact with your other medications.

In the past, the onset of puberty in young people with CF was delayed by up to two years. Now, most people with CF start puberty around the same time as those without CF (remembering that the timing of puberty varies in healthy people). Delayed puberty and a later growth spurt are more likely in people who have had trouble gaining weight or who have reduced lung function.

Part of CF care involves assessing growth and pubertal development. Puberty and the production of sex hormones (oestrogen and testosterone) are important for bone development and growth. Some CF centres may arrange for a review by an Endocrinologist (a doctor who specialises in hormones) to further assess pubertal development.

Some people with CF are concerned by their delayed growth and/or pubertal development. It is important to discuss concerns about puberty with your CF team as treatments may be available.

CF does not affect hormonal function. Men and women with CF have normal levels of sex hormones and can expect to have normal sex lives.

Many people with CF experience urinary incontinence, or "leakage" of urine, particularly when they cough or laugh. Some people may experience this during exercise, and while performing lung function tests or chest physiotherapy. Incontinence may be more of a problem during periods of increased cough or when constipated.

Coughing causes incontinence because it increases the pressure on the pelvic floor muscles, which help to hold urine inside the bladder. Wearing panty liners or pads can help protect you from unexpected leakage.

Urinary incontinence can be treated with pelvic floor exercises. CF physiotherapists can give advice about how to do these exercises. There are also specialist physiotherapists and nurses who can help with the management of urinary incontinence

Many people develop genital candidiasis, or vaginal thrush, when they take antibiotics. Thrush is caused by a yeast (fungus), called Candida albicans that lives in the bowel. When conditions in the bowel are altered, for example, when starting or changing antibiotics, the balance between yeast and bacteria can be disrupted and lead to an overgrowth of Candida in the vagina.

Thrush is quite common in all women after puberty, and is more common in girls and women with CF, who often take antibiotics. It may be worse with particular antibiotics, after a change of antibiotics, or during a tune up (i.e. when receiving intravenous antibiotics). Thrush causes vaginal itching, redness, irritation, white vaginal discharge and burning on urination.

There are many different treatments available for thrush. These include topical medications (creams) and oral medications as well as some complementary medicines (i.e. probiotics). It is important to talk to your CF team if you are worried about thrush. It is best if it is treated early and it is important to make sure that the thrush treatments (including complementary medicines) don't interact with your other medications.

In the past, the onset of puberty in young people with CF was delayed by up to two years. Now, most people with CF start puberty around the same time as those without CF (remembering that the timing of puberty varies in healthy people). Delayed puberty, a later growth spurt and onset of periods (menarche) are more likely in people who have had trouble gaining weight or who have reduced lung function.

Part of CF care involves assessing growth and pubertal development. Puberty and the production of sex hormones (oestrogen and testosterone) are important for bone development and growth. Some CF centres may arrange for a review by an Endocrinologist (a doctor who specialises in hormones), to further assess pubertal development.

Some people with CF are concerned by their delayed growth and/or pubertal development. It is important to discuss concerns about puberty with your CF team as treatments may be available.

CF does not affect hormonal function. Men and women with CF have normal levels of sex hormones and can expect to have normal sex lives.

As well as sperm, semen contains fluid made by glands called seminal vesicles. In men with CF, these glands don’t function normally and are sometimes absent. This means that men with CF may not experience nocturnal emissions ("wet dreams"). The ejaculate will contain fluid produced in other parts of the reproductive tract. Even though the volume of fluid may be reduced, sexual function is not affected. Sex will feel the same as it does for men who don’t have CF; it will also feel the same for their partners.

It is possible to find out if you are fertile or not through a test called semen analysis, which involves producing ejaculate by masturbation. This is then examined in a laboratory to look for sperm. You can ask your CF team or your GP if you are interested in having this test.

There is no right time to have semen analysis. Some people want to know if they are fertile in adolescence, and other people may choose to wait until they are thinking about having children.

Before you have been tested and know about your fertility, it is best to protect any female partners from pregnancy – just in case.

It is also important to remember that even if sex won't lead to pregnancy, it is still possible to contract a sexually transmitted infection (STI). It is important to use condoms to protect from STIs.

Men with CF produce sperm normally and their testes produce normal levels of testosterone (the male sex hormone). Testosterone is absorbed directly into the blood and is responsible for gains in muscle mass and sexual feelings. Men with CF have normal levels of testosterone and therefore normal sexual developmental and sexual function, including erections.

Approximately 98% of men with CF have problems with the development of the vas deferens, the duct that leads sperm from where it is produced in the testes to where it is stored prior to ejaculation. Therefore the ejaculate (semen) produced does not contain sperm. This means that most men with CF are infertile i.e. they cannot conceive a child through sexual intercourse. Men with CF are still able to have biological children using assisted reproductive technology.

There are a number of options available to men with CF who want to have children. For example, the sperm can be taken directly from the testis under local or general anaesthetic in a procedure known as microscopic epididymal sperm aspiration (MESA). The female egg is retrieved from the ovary using invitro fertilisation (IVF) techniques. The egg is then fertilised with the sperm, using intracytoplasmic sperm injection (ICSI), and the fertilised embryo is then placed into the woman’s uterus (womb). Artificial insemination with donor sperm is also possible and some men with CF choose to adopt children.

There are a number of things to think about when you are considering starting a family. These include the impact that parenting may have on your health and on your ability to look after yourself. It is also important to consider who is going to look after your children if you are unwell.

Genetic counselling is also important. Your biological children will inherit one copy of the CF gene from you, but they will not have CF unless they also inherit a copy of the CF gene from their mother. The potential mother can have genetic testing to find out if she is a carrier of the CF gene. This will tell you what the chance is that your child will have CF, which may affect your choices about how you start a family. It is also possible to have the foetus tested for CF during early pregnancy, using procedures known as chorionic villus sampling or amniocentesis.

Women with CF have anatomically normal reproductive tracts and normal hormonal function. The ovaries (where eggs are stored), the fallopian tubes (that join the uterus [womb] to the ovaries) and the uterus (where the fertilised egg implants itself and the baby develops) are all expected to be normal. There are reports that the mucous in and around the cervix is thicker than in women without CF.

Women with CF usually have normal menstrual cycles (periods) and are able to become pregnant. Increasing numbers of adult women with CF are becoming pregnant and giving birth to healthy babies.

Increasingly, women with CF are becoming pregnant and giving birth to healthy babies, with minimal impact on their health. If you are healthy, with stable lung function, pregnancy is safe. However, pregnancy puts additional strain on your body, and can be a risk, particularly if you are unwell or have poor lung function.

Outcomes are better if pregnancy is planned. It is recommended that you discuss your plans with your CF team, and that you are as healthy as possible before conceiving.

There are some circumstances where pregnancy is not recommended because of the risk to the mother’s health. Women can become pregnant even if they are unwell, or have very low lung function, so it is important to use reliable contraception if you are sexually active and do not wish to become pregnant.

There are a number of things to think about when you are considering starting a family. These include the impact that parenting may have on your health and on your ability to look after yourself. It is also important to consider who is going to look after your children if you are unwell.

Genetic counselling is also important. Your biological children will inherit one copy of the CF gene from you, but they will not have CF unless they also inherit a copy of the CF gene from their father. The potential father can have genetic testing to find out if he is a carrier of a CF gene. This will tell you what the chance is that your child will have CF, which may affect your choices about how you start a family. It is also possible to have the foetus tested for CF during early pregnancy, using procedures known as chorionic villus sampling or amniocentesis.

If you do become pregnant, your CF team, your obstetric team (doctors and midwives who look after a woman during pregnancy), and possibly a neonatal team (doctors who look after a baby after it is born), will need to be involved in your care.

The most common STI in young people is chlamydia. Other STIs include herpes simplex virus (HSV), genital warts (human papilloma virus, HPV), gonorrhoea, syphilis, HIV and hepatitis B. Genital warts are now becoming less common because of the HPV vaccination (Gardasil), which most people have in their first year of high school. This vaccine is recommended for people with CF. Many STIs can be treated with specific antibiotics however others may require longer term treatment (e.g. HIV).

If you are worried that you have may have an STI, or are concerned that you have missed any immunisations, you can talk to your GP, CF doctor or nurse, or sexual health clinic. Chlamydia can be detected by a simple test that can be performed on a urine sample.

Condoms or other forms of barrier protection, such as female condoms or dental dams, are important to prevent transmission of STIs during any form of sex. If you are having sex with a female, use condoms to prevent STIs, even if she is using another form of contraception (such as the pill) to prevent her from becoming pregnant. The risks of contracting STIs are increased in men who have sex with men, so it is imperative to use condoms.

Symptoms of STIs include genital pain, itching and burning, and pain on urination but many STIs have no symptoms at all. It is not possible to know whether your partner has an STI just by looking. If you are having any type of sex you should be tested for chlamydia every year, particularly if you have had unprotected sex or had a condom break during intercourse. The doctor who orders the chlamydia test might ask you a few questions about the sex you have had, and then might suggest other tests. This is the same for people with and without CF.

Some STIs may cause particular problems in people who are immunosuppressed (or who might be immunosuppressed in the future). It is very common to need immunosuppressive medications if you have an organ transplant (e.g. lung or liver), so prevention is important for people with CF.

ReachOut

Family Planning

The Hormone Factory

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Safer sex means preventing against both STIs and pregnancy. Barrier protection, such as condoms, helps with this, and is recommended for all types of sex. Condoms that fit over a penis can be bought cheaply from pharmacies and supermarkets. There are instructions on how to use them in the packet. You can also get detailed information from family planning, sexual health clinics and online from various sexual health websites. There is a list of resources at the end of the website.

If you are having vaginal sex with a male it is best to use an additional method of contraception to prevent unwanted pregnancy. There are a number of forms of contraception available that protect women from unwanted pregnancies, but not STIs. These include the oral contraceptive pill ("the pill") and long acting reversible contraception, such as Implanon and the Mirena intrauterine device (IUD). These are medications that need to be prescribed, and sometimes inserted. Your GP or a sexual health clinic is a good place to start to discuss these options. It is also important to talk to your CF team as some of these medications may be more appropriate for you than others.

The oral contraceptive pill ("the pill") is commonly used by women with and without CF. It contains oestrogen and progesterone, and is a tablet that needs to be taken every day at the same time.

There are some situations in which the pill is best avoided. If you have active liver disease, poorly controlled malabsorption, or have permanent intravenous access (e.g. Port-a-cath), you should discuss contraceptive choices with your doctor.

Most antibiotics do not interact with the oral contraceptive pill, and you generally do not need to worry when you change antibiotics. Rifampicin and related antibiotics are an exception to this, and you need to use additional barrier protection during, and for one month after, taking rifampicin.

Drugs are metabolised (broken down and absorbed) differently in people with CF. If you have "breakthrough bleeding" or "spotting" when you are on the pill, the dose might not be right for you – make sure that you tell your doctor.

There are other, newer, contraceptive agents that are available, which may be more appropriate for young women with and without CF. These are called long-acting reversible contraceptives (LARC) and are progesterone-only medications. They include Implanon, which is a rod inserted under the skin of the arm, and the Mirena IUD which is inserted into the uterus. Implanon works for approximately three years, and the Mirena for approximately five years. They don't contain oestrogen, so there is less concern regarding liver disease or thromboembolism (blood clots), and because they are not tablets, there is no problem with absorption or antibiotic interaction. You can talk to your CF team, your GP, a sexual health clinic or a gynaecologist about these options and many GPs can insert Implanon in their clinics using local anaesthetic.

ReachOut

Family Planning

The Hormone Factory

Law Stuff

Sexually Transmitted Infections (STIs) are infections that are passed from one person to another during sexual activity. Men with CF have the same risk of contracting STIs as men without CF, regardless of their fertility status. Condoms are important to prevent STIs during all kinds of sex.

If you are having sex with a female, use condoms to prevent STIs, even if she is using another form of contraception (e.g. the pill) to prevent her from becoming pregnant.

Safer sex means choosing good barrier contraception. For men, using a condom is the best way to prevent STIs. Condoms also help prevent pregnancy if having sex with a female. Preventing a pregnancy is not just the responsibility of women.

You can buy condoms cheaply from pharmacies and supermarkets. There are instructions on how to use them in the packet. You can also get detailed information from family planning, sexual health clinics and online from various sexual health websites. There is a list of resources at the end of the website.

Even if you know you can't get someone else pregnant, condoms are important to lower the risk of getting or transmitting STIs.

Sexually Transmitted Infections (STIs) are infections that are passed from one person to another during sexual activity. People with CF have the same risk of contracting STIs as people without CF. Barrier protection (e.g. condoms, female condoms or dental dams) is important to protect both you and your partner from STIs when having all kinds of sex.

If having vaginal sex with a male, using both a barrier method to prevent STIs and a form of contraception (e.g. the pill or Implanon) to prevent pregnancy is the safest approach. If a condom breaks (and this can happen), then if you are using additional contraception, you are still protected from pregnancy.

The most common STI in young people is chlamydia. Other STIs include herpes simplex virus (HSV), genital warts (human papilloma virus, HPV), gonorrhoea, syphilis, HIV and hepatitis B. Genital warts are now becoming less common because of the HPV vaccination (Gardasil) that most people have in their first year of high school. This vaccine is recommended for people with CF. Many STIs can be treated with specific antibiotics. Some STIs can have complications such as pelvic inflammatory disease which can lead to infertility, or require longer term treatment (e.g. HIV).

If you are worried that you have may have an STI, or are concerned that you have missed any immunisations, you can talk to your GP, CF doctor or nurse, or sexual health clinic. Chlamydia can be detected by a simple test that can be performed on a urine sample.

Condoms or other forms of barrier protection, such as female condoms or dental dams, are important to prevent transmission of STIs. If you are having sex with a male, use condoms to prevent STIs, even if you are using another form of contraception (such as the pill) to prevent pregnancy.

Symptoms of STIs include genital pain, burning, itching, pain during urination and vaginal discharge but many STIs have no symptoms at all. It is not possible to know whether your partner has an STI just by looking. If you are having any kind of sex then you should be checked for chlamydia every year, particularly if you have had unprotected sex or had a condom break. The doctor who orders the chlamydia test might ask you a few questions about the sex you have had, and then might suggest other tests. This is the same for people with and without CF.

Some STIs may cause particular problems in people who are immunosuppressed (or who might be immunosuppressed in the future). It is very common to need immunosuppressive medications if you have an organ transplant (e.g. lung or liver) so prevention of STIs is important for people with CF.

Having "safer sex" means that you are protecting yourself from STIs, and from unwanted pregnancy if having sex with a male. If you want further advice or are concerned that you have contracted an STI, you can make an appointment with your GP or a sexual health clinic.

Sexual activity is aerobic exercise. Some people with CF may cough or feel short of breath during sex. Some people find that doing their airway clearance before sex is helpful.

Men with CF need to have the same sexual health check-ups as men without CF. It is recommended that all sexually active people under 30 years of age have a chlamydia test every year. This can be taken on a urine test. The doctor who orders the chlamydia test might ask you a few questions about the sex you have had and then might suggest other tests. If you have sex with men, are Aboriginal or have partners from overseas, testing for other STIs, such as gonorrhoea, HIV, syphilis and hepatitis B is also recommended. This is the same for men with and without CF.

People with CF have normal sex hormone levels, sexual function and sex lives. Being infertile does not affect sexual function. Men with CF experience erections and ejaculation in the same way as men without CF. The volume of ejaculate (fluid produced during orgasm) may be less, but this fluid volume varies from person to person and your partner will not be aware of it. It will not affect either person’s experience.

Women with CF need to have the same sexual health check-ups as women without CF. It is recommended that all sexually active people under 30 years of age have a chlamydia test every year. This can be taken on a urine test or a self-collected vaginal sample. The doctor who orders the chlamydia test might ask you a few questions about the sex you have had and then might suggest other tests. If you are Aboriginal or have partners from overseas, testing for other STIs, such as gonorrhoea, HIV, syphilis and hepatitis B is also recommended. This is the same for women with and without CF.

Pap tests are performed to screen for cervical cancer. Pap tests are performed on women once they have been sexually active for at least 2 years and are over 18 years of age, and more frequently in immunosuppressed women (for example, women who have had organ transplants). The Australian Cervical Screening guidelines are changing in the next few years, because of the HPV vaccine (Gardasil) and new HPV testing technology. Women with CF need to have the same testing as women without CF. This can be arranged through your GP.

Sexual activity is aerobic exercise. Some people with CF may cough or feel short of breath during sex. Some people find that doing their airway clearance before sex is helpful.

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