Happy belated Mother's Day! Did you spend it celebrating your own mom, and wistfully thinking about a time that you'll make her a grandma? Or does the idea of having a(nother) baby in the next few years make you break out in a cold sweat? If it's the latter, you'll want to make sure that your contraception is as effective as possible.

The intrauterine device, also known as the IUD, is one of the oldest forms of birth control. Women have been inserting things into their vagina and uterus to avoid pregnancy--think ivory, wood, and even glass--since we figured out where babies come from. We've come a long way since elephant dung, thank goodness. There are now two IUDs on the market in the U.S. Both are over 99 percent effective at preventing pregnancy, making them the most reliable forms of reversible contraception (and in some studies, they're even better than tying your tubes).

Dear Dr. Kate,

When I was 15, I had an abortion. I am now 23 and I am considering having a baby. I am worried, however--I have heard that when you have an abortion it risks future pregnancies. I have always wanted a baby, and I couldn't imagine life without having my own children...but when I was so young I was in no way ready at that point to have one. My questions are: Is there a chance that I won't be able to get pregnant in the future because of my abortion? And how can I tell if I will be able to have a child? I mean, is there a way for me to assure myself that I will be able to reproduce?

The Worrier

Today is the seventh annual National Day to Prevent Teen Pregnancy. It's organized by a non-profit, non-partisan group and directs teens to a website that offers a quiz to encourage them to think about what they would do in certain sexual situations. I'm all for creative ways (and websites) that drive home the very real possibilities of pregnancy and infection when you're sexually active. But I fear that the message of the day, "Sex has consequences," will be heard by teens as another "Just say no" command that has no bearing on their everyday lives. Truth is, the average age of first intercourse in the U.S. is about 17--and that's been essentially unchanged for the past decades (and quite possibly the past century). And about 25 percent of teens don't use any form of contraception the first time they have sex. So how do we balance acknowledging teens' sexuality with breaking through their feelings of invincibility? As a gyno who has many teen patients, I want them to know that I know they're having sex, and that I think it's okay (if they care what I think)...but they still need to protect themselves.

Did you use birth control or a condom the first time you had sex?

Last week I talked about my patients who think that they're "too small" to have comfortable intercourse. I post about this topic so much because I hear it from my patients every day in the office. To complete the none-too-happy painful-sex-post trilogy, here is the quick guide to self-diagnosis of soreness, and what you can do to feel better.

IF YOU FEEL:
Discomfort at the start of intercourse
IT MAY BE:
Insufficient lubrication or not enough arousal
YOU CAN TRY THIS AT HOME:
Foreplay--tell him it's doctor's orders--and a great-feeling lubricant

IF YOU FEEL:
Burning sensation with intercourse (even with lube)
IT MAY BE:
Vulvodynia--persistent pain in the vulva that can happen even when not having sex
YOU CAN TRY THIS AT HOME:
Topical anesthetic (by prescription) and sometimes oral medication

IF YOU FEEL:
Pain or pressure with certain positions
IT MAY BE:
A retroverted uterus--your cervix can get cranky when it's bumped into
YOU CAN TRY THIS AT HOME:
Positions where you control how deep he goes--you on top may be best

IF YOU FEEL:
Pain with deep penetration or thrusting
IT MAY BE:
Endometriosis or pelvic inflammatory disease
YOU CAN TRY THIS AT HOME:
Make an appointment with your gyno to go over possible treatments

Has sex ever been physically uncomfortable for you? What made it better?

Even the cleverest of my patients sometimes don't understand their own bodies. When I asked 25-year-old L. if she had any problems with sex, she shrugged. "Sex hurts most of the time," she told me. "And my boyfriend says that I'm really small down there. Do you think I'm too small for sex?"

She's not the first patient I've seen who has posed this question to me. Some women are born anatomically different--in rare cases, you can have "two vaginas," a really short one, or no vagina at all. But if you've had a pelvic exam, and your gyno hasn't said anything, it means you're normal.

And "normal" means you're just fine for sex. Your vagina was designed to deliver a seven-pound squirming bundle of life into the world...she can certainly accomodate your boyfriend (or toy), no matter how well-endowed he (it) is. But it doesn't mean you don't need to get in the mood first.

Dr. Kate,

I'm a 48-year-old woman and I have a new boyfriend. Recently we started having sex, and I haven't been with a man in quite a while. It really hurt, and he couldn't fully penetrate me. I even bled a little. What can I do to help my situation? I don't want this to happen all the time.

Back in the Saddle

Dear Back,

Becoming sexually active again after a long sex break is similar to actual first-time sex. Pain during sex can be chronic--vulvodynia is a big problem for many women--or situational. It certainly is not made up, and not something you have to live with. So some things that might help:

• Make sure you get enough foreplay so you're really aroused before intercourse (you want to have plenty of blood flowing to your vagina to make penetration easier).

• He can insert a finger in your vagina first, so you can judge how you're doing arousal-wise before actually having intercourse.

Dear Dr. Kate,

I have a question that I plan to bring up to my OB-GYN at my next appointment, but I'm freaking out now and can't wait until May. About six months ago, I started spotting between periods. It was only once and it only lasted for a couple days--my sister-in-law walked me through it and I didn't think anything of it. This month, my period had been over for about a week and boom, here it comes again. This time it took on the shape of a normal flow for me, except in reverse. It started out light and then it progressed over three days to a heavy flow, clots and all! I don't have a history of anything being irregular with me down there, and I don't have pain or anything odd during sex. I'm currently not on any birth control pills, but I'm planning to talk to my doc about that when I see her in May. Is there any possible explanation you can give me, or shed some general light on spotting, so that I don't continue this flipping out?

A. in Illinois

I'm glad that we've been celebrating orgasms this month, but I'm afraid that some readers may be feeling left out. Many of my patients tell me that they're worried about their sex drive, that they're not as interested in sex as they once were. A lack of desire is pretty common, and almost half of women report experiencing it at some point. A decreased drive may be due to a medical reason, in which case your gyno can help...but your drive may be totally normal.

The old-school thinking about our sex drive is that we get aroused, seek out sex, and then get satisfaction, 1,2,3--just like men. Now, this may be how we respond sometimes, but not all the time (and not for all women). So many things can affect our ability to get aroused: concerns about pregnancy, safety, privacy, timing (it's too hurried, not sexy, or just too late at night). The new thinking? Our sexual response experience is more like a circle, and not a straight line. Great research by Rosemary Basson has shown that we're more likely to experience spontaneous desire in a new relationship, after a long separation, or if it's been awhile since we've had sex. And many women think less frequently of sex when they're in long-term relationships, or feeling stress at work, or for many other reasons.

T. called me last week, still reeling from the news that her pap test was positive for HPV. "I keep thinking, when did I get it, how long have I had it, and worst, what do I tell the next guy I sleep with?!"

The question of whether or not (and how) to disclose to your partner that you have HPV is fraught. I find myself torn, and feeling a dialogue between my two halves--Trusting Female Friend and Cautious Doctor--coming on...

Trusting Female Friend: My new guy is so great...I think it's time to have The Talk, and let him know that I have HPV.

Cautious Doctor: Why would you do that?

TFF: But you always advocate full disclosure--why wouldn't I tell him?

CD: Because he can't do anything with the information.

TFF: He'll be more likely to want to use condoms, I bet.

CD: Condoms are great, but they don't completely prevent HPV transmission--it doesn't prevent all skin-to-skin contact during sex. So yes, wear the condoms, but for yourself as well as him.

TFF: But I don't want to give him an STD--that's so skanky.

CD: Honestly, he's likely already been exposed--or infected--by HPV himself.

Sometimes you find that orgasm expertise is hard to, well, come by. Good gynos ask you about your sex life--current partners, one or more, male or female, contraception (or lack thereof)...and about the sex itself. I'll ask my patients if they are having any problems with sex, like pain, and I'll leave the question open for them to answer as they wish. I know how to address some problems--about discomfort during sex, or lack of natural lubrication. But if I hear problems about orgasms, I don't always know what to say.

My hesitation in giving advice is ironic, since there was a time when gynecologists were responsible for actually giving their patients orgasms. In the 1800s, women were often diagnosed with hysteria; while the diagnosis came from many symptoms, it was thought to be a consequence of deficiency of sexual gratif