—Cris M.*, Georgia Gwinnett College

I get a lot of questions about the pullout method, also known as coitus interruptus or the withdrawal method. It’s the third most commonly used form of birth control among college students, according to the National College Health Assessment survey (fall 2015, involving 90,000 students).

The short answer: Yes, pulling out can prevent pregnancies on its own, when used correctly. But it isn’t the most effective form of birth control. If you’re using this method, it’s best to use it in conjunction with another form of contraception to decrease the likelihood of unintended pregnancy.

Here’s what you need to know:

The effectiveness of the pullout is dependent on using the method correctly

When not used correctly, 27 women out of 100 who rely on pulling out will become pregnant each year, according to Planned Parenthood. However, when withdrawal is done perfectly, those unplanned pregnancies are reduced to about 4 out of 100 women each year. In other words, if you are not using another method of birth control, it’s extremely important to use withdrawal correctly.

How to ‘pull out’ the right way

Many errors can occur while using the pullout method. The most important thing to keep in mind is to avoid having ejaculate fluid come into contact with the vulva (the outside of the vagina) or the vagina. This includes pre-ejaculate fluid, also known as pre-cum, as pre-cum can contain viable sperm that could cause pregnancy.

Being able to pull out prior to ejaculation is something that a man needs to know how to do. As a sex educator, I’m not in the business of telling people what to do unless it’s to prevent harm to themselves or others. That said, for this method to be used correctly, a man must understand his body and pull out prior to ejaculation.

To master this technique, a man can masturbate alone. This helps him understand his body and what it feels like for him right before ejaculation. It’s important to practice this several times before trying it out with a partner. If a man isn’t comfortable with masturbation, using another form of contraception instead of the pullout method might make more sense. Understanding how the body feels prior to ejaculation is crucial to withdrawing correctly.

Communication is also key for the pullout method to work. Being able to talk about where a person is going to “pull out” to ejaculate is important, as well as when to stop stimulation so that the person has time to withdraw before ejaculating outside the body.

The downsides of pulling out

There are many opportunities for pulling out to fail. This can be a difficult contraception method to implement. It requires knowledge of the body and the ability to pull out despite distractions. While masturbation can help a male to understand his body, it isn’t guaranteed. Plus, pulling out provides no protection from sexually transmitted infections (STIs).

How else can you prevent pregnancy?

Many forms of contraception are more effective than the pullout method. In fact, it’s even better to use the pullout method in addition to another form of birth control, to further decrease the risk of unintended pregnancy. For example, if a man puts on a condom before pre-ejaculatory fluid (pre-cum) is released, and then pulls out, ejaculating outside of the body in the condom, no sperm will come into contact with the vulva or vagina.

Compare birth control methods: Bedsider

 (*Name changed)

—Carson G., University of North Dakota
(*Name changed)

Yes!

First, it’s important to define sex. Sex can be with yourself (masturbation) or with others. It’s a consensual act between partners engaging in any agreed-upon activity. Here are some of the physical benefits:

Moderate workout

Sex is a form of exercise—though it may not be as rigorous as some other aerobic activities. Sex can get the heart rate up and it requires the use of various muscles. While I’m not suggesting that we use sex as an alternative to workouts, it can supplement them.

Reduced risk of certain diseases

Fun fact: Males who ejaculate frequently (at least 21 times a month) are less likely to develop prostate cancer, studies suggest. While the research isn’t complete, there is no known harm associated with ejaculating this often. Unless masturbation takes a person away from work, academics, commitments, relationships, or friendships, it’s healthy.

Increased bladder control

This has been shown for women. Sex can be a good workout for the pelvic floor muscles, because contractions of those muscles before and during orgasm can help strengthen them. That strengthening protects against incontinence, or the loss of bladder control, which affects about three in ten women during their lives.

Pain relief

Orgasms can help reduce pain from migraines or cluster headaches, according to a 2013 study in the journal Cephalalgia.

Relaxation and sleep

Various studies have shown that sex (including masturbation) can help reduce stress and assist with sleep. There’s some research to suggest that sex can help lower blood pressure (one study specifically states that this benefit comes from sex with a partner).

Protection from overwork

People who have less sex tend to accept more assignments at work, compensating for their frustration, according to a study by German researchers.

—Catherine N., University of Wyoming

If you’ve been on a regular workout routine and aren’t seeing the results that you want, or aren’t feeling great despite your efforts, that can be very frustrating. Working out inefficiently or working out too much (overtraining) can have the opposite effect on your body of what you intend.

Signs of working out too much:

Feeling tired all the time

You might not be getting enough quality sleep at night. Our body repairs itself from exercise while we sleep. Too much exercise can throw off the nervous system and endocrine system, which can lead to disrupted sleep, resulting in a feeling of unusual tiredness.

Increased resting heart rate

A normal heart rate is 60–100 beats per minute. Take your pulse before you get out of bed in the morning. If it’s unusually high or low, you could be overtraining.

Overuse injuries

Muscle soreness for a day or two after exercise is normal, but if you find you’re always sore or are developing common overuse injuries (such as tendonitis or stress fractures), you could be training too much.

Signs of working out inefficiently:

Not seeing any progress

If you’ve been working out for over a month and have not seen any gains in strength or endurance (depending on what your goals are), it could be because your workouts aren’t efficient. Increase the intensity of your workouts by going faster or longer, or lifting heavier weights. You might need to up your efforts to start seeing results.

Spending over an hour at the gym

It doesn’t take a long time to get a good workout in. Again, depending on your goals, you might only need 30–45 minutes in the gym. Decrease your breaks between sets and really focus on what you’re there to do: work out. Your heart rate should be up and you should be moving. Sitting around too much, checking your phone, or chatting while not moving may be making your workouts less effective.

—Gordon N.*, Northern Illinois University
(*Name changed)

Kudos to you for acknowledging that there’s an issue here: your avoidance of seeing health care providers and perhaps getting tested for a health condition. It’s not uncommon for people to be uncomfortable about this. Asking somebody to help interpret your own body is a sensitive, even intimate, thing to do. Moreover, there’s an obvious power imbalance. The provider has knowledge and training that you (probably) lack. They may tell you something that will affect your sense of self.

So let’s take a step back. What do you really have to worry about?

Are you worried the provider might be a paternalistic, patronizing jerk? Check out your student health center.

No one should be made to feel ashamed by a doctor. If that’s the case, ask people you trust for a recommendation for a health care provider who is likely to be a good fit for you. You’re entitled to choose your provider not just on the basis of convenience, but because that person makes you comfortable and because you have reason to trust their sensitivity and expertise.

Student health center providers are usually excellent at making students feel comfortable. They’re very practiced in speaking with and helping students who don’t have much experience being on their own in a health care setting. They are good at discussing anxieties that patients may bring. They may also have systems in place to help mitigate some of these anxieties, such as same-day results for certain testing.

Are you afraid of what you might find out? Talk this through and take control of the timing.

I’ve had a number of patients over the years convinced they have contracted HIV and terrified to get tested. We sometimes spend two or three visits talking it through before actually doing the test. The point I emphasize is that testing doesn’t affect the diagnosis. If you have the condition already, you won’t have it any less by not getting tested. On the other hand, a positive test will start you on the path to treating the condition and potentially helping prevent the transmission of HIV to others. It’s also possible that you don’t have the condition at all and that you’re wasting enormous psychic resources worrying about having a disease you don’t have.

For non-emergency situations, most testing can wait. You may feel more comfortable if you can control the timing of testing while engaging with your health care provider. I suggest you talk with your provider about your discomfort.

Are you still stuck? Consider talking this through with a counselor.

If you remain absolutely unable to act, perhaps because of worries that you might have a particular diagnosis, consider talking this through with a counselor first. The counselors at your campus counseling center will likely have encountered this anxiety before, and can help you figure out ways forward. Good luck.

—Jaidan O.*, Portland State University, Oregon

(*Name changed)

Reading is one of those college activities that some students love to hate. And in this technology-driven world, which provides all kinds of engaging ways to learn, reading seems so… well, “last century.”

Here’s the difference: While your latest smartphone may be outdated next week, good old-fashioned reading strategies never go out of style. One of the most popular—and most effective—is Frances Pleasant Robinson’s SQ3R method:

urvey | Before you dig into any reading assignment, do a quick inspection of the material. What’s the title? Who’s the author? How long is the assignment? What are the first and last paragraphs? Surveying your reading helps you prepare for how much time you may need to spend and what you may expect. You can do this very quickly.

uestion | Once you have read the title, maybe even the headings in the chapter and the summary at the end and other parts of the reading material, ask yourself a few questions to prime your brain to read actively. “What do I already know about this subject?” and “What did my professor tell me I need to pay attention to?” are two questions that can start you thinking about your reading assignment before the assignment even begins. You can do this part quickly as well.

ead | This is where you dig into the assignment. It’s usually best to read with a pen or pencil in your hand so you can make notes about what you’re reading, write questions about the material, and mark any unusual words, statements, or ideas. In some cases, you may need to reread difficult passages. You will need to take your time on this part; there’s no shortcut to reading an assignment thoroughly.

ecite | Reciting can be done by talking through what you just read or by writing a brief summary of the material. This step is important because it helps you check your comprehension. It can keep you from passively reading and not retaining anything you read. Depending on the length of the assignment, you will need to stop occasionally to recite before moving on. You can do this part quickly once you develop strong summary and comprehension skills.

eview | The chances are slim that you can read something once and recall all the important details. Therefore, you will need to take some time and review what you’ve read. This is where your reading notes come in handy. Instead of rereading the entire assignment, you can review the notes you took, the vocabulary you marked, and the summaries you wrote. Depending on how you will use the reading (e.g., you may be tested on the material), you may also need to translate the information into other study aids (such as flashcards or practice tests). You may spend the most time on this step, but it will pay off. You will remember and understand what you have read.

Cold-causing viruses circulate readily in college communities, and they disrupt students’ academics and other activities, so it’s absolutely worth minimizing our exposure to them. We have easy ways to do that. Bear in mind, though, that sometimes, you’re just going to get sick. I often tell students: “If you don’t have time to catch a cold every now and then, you’re probably overcommitted.” Here’s what you need to know to make catching a cold a less frequent event:

How to avoid catching or sharing a cold

• Wash your hands frequently: No other strategy is as effective, says the CDC.
• Train yourself not to touch your nose or eyes unless you’ve just washed your hands; this also helps reduce your risk.
• Stay home the first few days of being sick: Cold viruses are shed most heavily in the first few days of illness.
• When coughing or sneezing, cover your mouth and nose with a strong tissue, or use this handy gadget called a Coughcatcher (see the next slide).
• Do not take antibiotics; they do not prevent or treat colds. With no possible benefit here, the effects of taking antibiotics “for a cold” will be solely negative.

How colds are spread

• Via our own hands: Cold viruses are sneezed, coughed, or breathed into the air and land on surfaces like desks and tables. Viruses can survive for hours on everyday surfaces. When we touch those surfaces, we get the virus on our hands. Those viruses can survive on our skin for two hours. When we touch our eyes or nose, we allow the virus to infect vulnerable cells. This is why frequent, thorough hand washing is so important.
• Via droplets in the air that we inhale: Cold viruses can also be spread directly from person to person through respiratory droplets (microscopic germs that are sneezed, coughed, or breathed into the air).
• Via children, directly or indirectly (sorry, kids): Children are thought to be the reservoirs of colds in communities. The viruses spread from young children to older siblings or adults, and then through school or work communities.

How to treat a cold

• Colds get better without treatment after 5–10 days. Rest up, drink water and other healthy fluids, and try not to spread your virus to others.
• Again, do not use antibiotics. Colds are caused by viruses. Viruses are different from bacteria. Antibiotics are not effective against viral infection, and they have downsides—both for you personally and for the community.
• There is no compelling evidence to suggest that probiotics, zinc, vitamins, face masks, herbal products, or gargling are effective treatments for colds.

What a cold is and how a cold works

• When health care providers and educators talk about the “common cold,” we’re referring to a specific type of illness. It is not the same as influenza (flu), pharyngitis (sore throat), sinusitis etc., though some of the symptoms can overlap.
• A cold is a viral infection. More than 200 different viruses can cause colds, though about half of colds are caused by the rhinovirus.
• When a cold-causing virus enters a cell, it hijacks the cell’s machinery and begins replicating itself, producing millions of copies. This infection triggers an inflammatory response in the body, which generates the characteristic symptoms of colds, like runny nose, nasal congestion, scratchy or sore throat, cough, and sometimes fever (this is more likely in younger people).
• Not everyone develops symptoms every time they are exposed to a cold-causing virus. Children catch more colds than adults, suggesting that the body may develop some immunity to colds over time, though we never become fully immune.

What is a Coughcatcher and where do I get it?

—Stephanie G., Mount Royal University, Alberta

This age-old question has been around since, well, since we’ve had relationships! It’s relatively easy to take one another for granted and stop appreciating each other. People can get stuck in routines and have difficulty remembering to have fun together.

There are many great ideas to get the “spark” back. Here are a few:

• Discuss “your story;” how you started your relationship
• Do something together you haven’t done before (if it’s sexual, you obviously need consent from everyone involved)
• Discuss what you appreciate and admire about each other
• Be intentional about spending quality time together; be sure to make time for connecting with one another
• If you’re comfortable, discuss your fantasies together; see if you’re interested in exploring any of them
• Slow down and take time to look into each other’s eyes and see the person you had a spark for
• Do something simple for your partner, such as leaving a loving or sexy note
• Notice the little things that you each do for the other—and tell one another that you appreciate it
• Discuss what you like about each other; this can be as simple as a smile

Keep in mind that relationships have their ups and downs, which means our feelings can change over time. Just because a spark may not be currently present doesn’t mean that it won’t be rekindled at a later date.

—Addison P.*, New Jersey Institute of Technology

(*Name changed)

It’s generally recommended that people 18–25 years old get in touch with a healthcare professional once every year or two. A physical is also known as a preventive health visit, because the goal is to help you stay healthy. This includes spotting small problems early, before they become bigger problems.

Insurance covers one preventive visit a year Under the Affordable Care Act (“Obamacare”), one preventive care visit a year is covered by all insurance plans that are sold via state or federal government websites. Ideally, your healthcare provider should be someone that you’ve gotten to know and trust over time—someone you find it relatively easy to talk to—although this may not be possible if you’ve recently relocated for school.

It’s a valuable opportunity to talk with your doctor Studies suggest that for most people at a preventive care visit, the conversation with the healthcare provider is more valuable than the physical exam. If you’re completely healthy, checking in once every year or two is a good opportunity to ask questions that may have come up since your last physical. For example, you may want advice about returning to a vigorous sport after time away, guidance about a new diet plan you’re considering, or advice about a possible symptom.

Additionally, a wellness visit is a good opportunity for the provider to ask you some age-appropriate questions. There are questions designed to screen for health risks specific to your demographic, which cover topics such as sleep habits, diet, physical activity, sexual health, drugs and alcohol, mood, and risk-taking behaviors.

If you see a provider regularly, you may or may not need an annual visit If you have regular or occasional contact with a provider, especially if you have a chronic condition, this sort of check-up visit may be less important, especially if you cover these topics during your ongoing visits. Often, though, visits for illnesses or problems don’t allow the time and space for the broader “State of the Union” conversation I describe above. It may be worth taking additional time for a comprehensive health assessment. It’s not always easy to open up about personal issues, and having a visit that allows time for a broad conversation may help you raise a topic you’ve hesitated to mention.

—Blake M.*, Santa Clara University, California

*Name changed

Gaining enough confidence to start going to the gym could be one of the best things you do for yourself all year. If you have the desire to be physically active, don’t let a lack of confidence keep you from reaching your goals.

Typically, a lack of confidence comes from focusing too much on the unrealistic expectations or standards that you think others may have. Going to the gym should be something you do for yourself, to make yourself feel good and to contribute positively to your overall health. Here are two ways to help you combat lack of confidence and get to the gym:

1. Set your own realistic expectations This starts before you even go near the gym. Don’t worry about what others are doing. Different people are going to have different goals. Some people might be trying to build muscle while others are trying to lose weight or gain flexibility. Some might be recovering from an injury or an illness and are trying to gain back endurance and strength. You don’t know everyone’s story and they don’t know yours. Decide what you want to improve on and go into the gym with a plan to achieve that goal.

2. Learn proper form Another contributor to a lack of confidence is not trusting your abilities. The workout world can be intimidating, from all of the different types of cardiovascular and weight machines, to free weights, to a variety of classes in yoga, spinning, kickboxing, etc. It can be difficult to figure out what will work best for you and how to perform that specific activity. To help you get started in the gym with a specific plan, seek out the help of a personal trainer, a coach, or a friend who knows what they’re doing. Many fitness centers have someone on staff who provides complimentary sessions for first-time gym goers to help them learn what’s available and how to properly perform various moves.

—Alyssa O., California State University, San Bernardino

Here’s what I generally recommend to students:

• Go to school with ibuprofen (instead of aspirin)
• Keep a supply of acetaminophen too (Paracetamol and Tylenol are common brands)

To see why, read on.

Aspirin and ibuprofen do have quite a lot in common—I think of them as close cousins.

Aspirin is salicylic acid, a naturally occurring substance that Native Americans used to extract from willow bark. It’s an analgesic (meaning it blocks pain) and anti-inflammatory. It also inhibits platelets in the blood from clumping together. This can be a benefit, as when it decreases the risk of a blood clot after a heart attack or surgery. Aspirin can also be a risk, as it can lead to gastrointestinal (GI) bleeding (more commonly in the elderly).

Ibuprofen is a synthetic molecule based on the chemical structure of aspirin. It was originally a prescription medication, but proved safe enough that it went over-the-counter in the early 1980s. Ibuprofen is widely available in both name-brand and generic forms, as well as in combination with antihistamines or decongestants designed to treat colds or the flu. Ibuprofen shares many of the same risks as aspirin: Overuse can lead to GI bleeding or kidney damage. Occasional use, though, is generally safe. The over-the-counter doses are 200 mg a pill, which allows some flexibility in dosing.

Aspirin and ibuprofen are both useful medications for treating common pains (headaches, sore throats) and inflammation (ankle sprains). They also work nicely for the woozy headache one can get after sun overexposure.

I generally recommend ibuprofen instead of aspirin because aspirin carries the potential risk of a rare but serious condition called Reye’s syndrome. This can occur when a person under 18 takes aspirin while infected with the influenza virus (flu). Because the risks and benefits of aspirin and ibuprofen are similar, I keep it simple and recommend ibuprofen.

Acetaminophen isn’t an anti-inflammatory like ibuprofen or aspirin, so it’s not as good for musculoskeletal injuries. On the upside, it doesn’t have the risk of GI bleeding or kidney injury. It can cause liver injury if overused. The mechanism of action is different enough from aspirin and ibuprofen that it’s useful to have acetaminophen on hand too. Some pain responds better to one than the other.

“Is it possible to get too much sleep?”

—Ana H., Towson University, Maryland

Not exactly. But are there circumstances in which the amount of sleep someone is requiring would be concerning? Yes.

It’s common to meet with students who are tired all the time and seem unable to get sufficient sleep. Most of the time, people who sleep a lot need to. Young adults generally need 8–9 hours a night, ideally on a fairly regular schedule (same bedtime and wake time). Straying from this can lead to “sleep debt.” Just like student loan debt, sleep debt has to be paid off eventually. The more you accrue, the more intensely your body will want to pay it down—by getting more sleep.

This starts with REM (dreaming) sleep. Do you know that sensation of falling asleep suddenly and immediately starting to dream? It can be quite disorienting, especially when it happens in class. (Not that I’d know about that. OK, maybe a little.) That’s a sleep-deprived brain desperately trying to do some catch-up.

If you don’t need the sleep, it’s usually pretty hard to sleep. I think most people are familiar with the experience of leaving school for a vacation and sleeping nonstop for the first several days. I certainly remember times that I woke up at 11 a.m., had a little something, went back to bed until 2 or 3 p.m., did a little something, took a 5 p.m. nap… you get the idea. After a few days, though, staying awake wasn’t so excruciating. After another few days, I was back to sleeping 9–10 hours a night. This was my body paying off sleep debt then resetting to a baseline rhythm. Once I’d done that, I didn’t have the intense appetite or need for sleep any more.

When people just can’t seem to get enough sleep, regardless of hours sleeping, including naps, we start to worry that there’s an underlying cause, such as mono or another illness. Psychological causes can also be at play, especially depression.

So can you get too much sleep? Usually when we feel the need to sleep more than the standard pattern, there’s a good reason. Generally, it’s a good idea to listen to your body.

If after 4–5 days of intense sleeping, especially if you don’t know why you need so much sleep and/or don’t feel that you’re getting any benefit from all the extra sleep, it might be time to talk with a medical provider and maybe get some testing done.

“How can I improve my endurance?”

—Amber L., Concordia College, New York

Endurance, or the body’s ability to withstand physical stress over a long period of time, is a key component of overall health and wellness. If you find yourself getting tired after regular daily activities (e.g., walking to class or going up and down stairs), focusing on your endurance may be a good idea.

The key to building endurance? Consistency. To help prevent injury, increase the duration and intensity of your exercise gradually over time. The goal is to remain injury-free so you can be consistent with your physical activity.

These three approaches can help you improve your endurance:

1. Build muscle

A common misconception is that building endurance requires only aerobic activity. Stronger muscles will pump a larger amount of blood back to the heart with each contraction. This increases the amount of blood that’s available to be pumped back out to the body by the beating heart. Blood carries oxygen to working muscles, so the more blood being pumped through the body, the better.

2. Cross train

Sustained periods of aerobic activity are essential to building endurance. There are a lot of ways to get the heart pumping and achieve the positive effects of aerobic activity, so don’t focus on just one. Running, swimming, walking, and using an elliptical machine or a stationary or regular bike are all good forms of exercise. If you find that the intensity level becomes unsustainable (you’re breathing too hard), slow it down a little so you can continue the activity for a longer period of time.

3. Combine strength and cardiovascular workouts

An efficient way to build endurance is to combine strength training and aerobic activity (circuit training) with little rest in between. For example, perform a strength exercise (say, a squat). Then, without rest, go right into an activity, like biking hard for a minute. You can also add a set of core work into the circuit, like holding a plank for 30 seconds. Circuits like this not only make your muscles stronger but also keep your heart rate up and keep you breathing hard, increasing your overall endurance.