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Risk of Fetal Malformation after Isotretinoin use ; Paranoia about pregnancy and fetal malformation

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This is a continuation of my last consult, reference: 45042
To: Dr Aarti Vazirani

Dear Dr,
i hope you remember given our past conversations a year ago my situation, paranoia and stress regarding certain issues.I wanted to ask several questions. Im a 22 year old female living in Cairo, a very close minded society where i cannot see an OBGYN and share my sexual life with anyone.
My period works like clock work, its always on time but sometimes is a day or 2 late, maximum 3 days (which happened once) . My average cycle is around 28days. I am a virgin, intact hymen and not sexually active. However, my paranoia and stress which is in my character makes me doubt anything and over think things which involve intimacy.
My last period was from May 13th till May 16th. My current period should have started on june 10th, it is now 5 DAYS late which is the maximum delay ive had and of course thinking abt it is stressing me more and prob delaying it. Im also taking this medicine called NETLOOK 20mg (ISOTRETINOIN) from the10th of MARCH till now to get rid of acne and its crucial while I take this pill, I do not get pregnant or else would have an abnormal baby, thats what my dermatologists warned me of as its a major sideaffect.it says on the medication box "pregnancy forbidden! risk of malformation" OFc since im not sexually active (a virgin) and dnt plan on having sex I’m continuing to take the medicine. The dermatologists said if my period is not irregular i shouldn't have a delay.
The latest sexual encounter I had after my last period(May 13) was with my boyfriend on May 22nd which is 3 weeks ago. The maximum that happened is his hand massaged the outside of my vagina, he never came but I have no idea if he had pre cum on his penis and if he touched his penis with his hand before he massaged my vagina Or if I had any pre cum on my hand after touching his penis. The only reason I would doubt that he had was because he was hard and I touched it and am extremely worried. Overall all i know for a fact he didnt cum before us getting initmate and not during or after intimacy, so there was no cum at all and I dnt recall him playing with himself or anything like that before massaging the outside of my vagina but he may have.
Also in mid February (a few months back) there was a sexual encounter with my bf such as hand massages but more intense with grinding over clothes. But after it I got 3 periods on schedule unlike whats happening to me now. Is there such a thing as getting my periods on time if I were pregnant from this February encounter? I said this because I have no idea if theres such a thing tht can risk me being pregnant and because this February encounter was the most severe sexual intimacy i had.
My body right now and in the past months has been very normal, no changes, just that I lost a bit of weight and now my breasts are definitely bigger and swollen since Im supposed to be having my period which is very late (4 days is the maximum for my norm). So im wondering why my breasts are bigger and period hasnt arrived. Im also always stressed and a nervous person i knwo that can delay a period. I just want to know if im in the safe and NOT PREGNANT i dont care abt the rest as long as i know that im NOT pregnant. I cant talk abt it to my family who are very close minded except my boyfriend who thinks i have absolutely nothing to worry about and am being paranoid. But I need to put my mind at rest by asking you since the idea is super scary.
1.Am I pregnant ?..MOST IMP QS.
2.Do you think it will come anytime soon?
3.Why might this be happening? Given my circumstance?
4.Is there a chance I might skip my period?
5. Even if he had precum on his hand and massaged the outside of my vagina would that lead to pregnancy?
6. Is there such a thing as the February encounter I had where I might be pregnant and get 3 of my periods on time?
7. What can i do to induce my period?
Don’t worry I wont be having sex till marriage probably from how paranoid I am about things unless I take contraception.
Thank you SO MUCH for your time and help, I really appreciate it.

Category: OBGYN

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Dr. Aarti Vazirani
Category: Infertility Specialist
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Expert:  Dr. Aarti Vazirani
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Thanks for choosing doctorspring.com

Thanks for writing in again and trusting me with your health concern.
Hope you have been well, and it is always nice to hear from you.
Regarding your concerns -
1. Chances of a pregnancy are EXTREMELY REMOTE, almost impossible. If he just rubbed the outside of your vulva, never inside the vagina, then even if there was precum, there cannot be a pregnancy. Very slight risk of pregnancy exists only if he had pre cum on his hand and then entered your vagina with the precum , which has not happened. I would say you are NOT pregnant.

2, Also, I think you would soon have your period. Your obvious anxiety and stress can delay your cycle. Other factors could be - change in diet, sleeping habits, travelling, weight gain or loss, exercise , ingestion of medications etc.

3. In your case, I think it could be stress.

4. I see no reason for you to skip your period, unless any of the above factors are present to an overwhelming degree.

5. No, just massaging the outside of the vagina will not lead to a pregnancy.

6. No, you would not have regular cycles if you had conceived in February, and with that encounter again, pregnancy is impossible.

7. Do not do anything to induce your period. Just try and relax. Wait for a week more, and if you do not menstruate by then, take a home pregnancy test ( to reassure yourself ) .
Once it is negative, consult a gynaecologist to have an examination , hormonal levels and pelvic ultrasound scan.
This would rule out hypothyroidism, polycystic ovaries etc which also can cause irregular periods.
All the best
Do get back to us for additional queries.

Regards


Patient replied :

I am FREAKING OUT and really need your help in answering these questions. I’m about to explode with tears and I can’t talk to anyone but my bf and u because of the closed minded society I live in. I have attached 2 images for POINT NUMBER: 3

  1. Worst case if my period is skipped this time is that ok, like can this happen disregarding pregnancy? or does it indicate pregnancy? And if it is skipped this time the next due date should be the normal expected date? It is now one week late, you told me to wait another week so 2 weeks in total. KEEP in mind my cycle is always on schedule, with a maximum delay of 2to3 days.
  2. Also I have lost weight, not a lot but I have been eating much less than my norm and lost a few kilos my weight ranges from 50-55 Kgs and my height is around:165cm. My parents say I seem weak and a bit unhealthy, I don’t starve myself I have healthy food but smaller portions and little carbs (nothing extreme) Now ofc I am more stressed than usual given my period is 1 week late. I had a traumatic affect of my dogs death but I still got my period after the death a month ago (beg of May), so I’m stressfully wondering what could be the reason since ive had more stressful encounters in the past. Is it my weight loss and small portion eating? or my life cycle and sleeping patterns, which vary since I sleep at 5am at times till 2pm? I don’t travel much so its not the travelling.
  3. Also I have been feeling the normal symptom of hungry cravings before my period and my breasts are DEFINITELY bigger than the norm, which is what happens before my period (now I see them a bit bigger than the normal period bloatedness but Im not sure if that’s paranoia ). Is it possible for me to have the bigger breasts and hungry cravings like I am now which is a period sign but can be due to pregnancy instead of a period sign? Or is it possible to have the normal symptoms of the period like big breasts and STILL skip my period this time or does it indicate its going to come cause of the symptoms? Also , heres a very PARANOID question: is it possible for me to have milk in my breasts now ? (for the baby or is that farfeteched) My breasts are bigger and I don’t know what it means overall cause I keep relating it to pregnancy now. I attached the image if you ll be able to tell anything from it.
  4. Regarding the scenario of sexual pleasure, my bf for sure never inserted his fingers in my vagina not even I myself have done that and even if I did it I could have torn my hymen or caused sme bleeding right? So inserting or sticking the finger inside the vagina fully hasn’t happened before. Also he didn’t play with himself before this incident nor did he play with himself after but maybe I might have had something on my hands after touching his penis and might have gotton it in me if I touched myself even though I never inserted my finger in my vagina before. (All I know is I peed after he pleasured my vagina from the outside so I don’t know if wiping after peeing might have done something) He might have also had something since he did touch his penis but not to play with it just to remove it out of his pants. I don’t know but he tells me he doesn’t recall any precum.
So when you said in your previous message “his hand entered your vagina”, you mean fingering right, like it going inside fully not the outer area of the vagina? Also according to my cycle May 22nd ( was the day of the sexual incident) and was a day of fertility for me. This is just an additional fact. 5.Also when you said if I don’t get my period after another week (so 2 weeks in total) to take a home pregnancy test. Is this to overcome my fear and paranoia or is it because I still have a chance of getting pregnant? Because honestly my biggest fear is to like the past take the test again esp since I didn’t get my period so far this time. So I just PREFER NOT TAKING THE TEST at all and trusting your words since im a virgin and never had sex. I contradict myself, in saying this is ridiculous but I like to assure myself the WORST case is out of the question. My boyfirned who loves me is telling me to really calm down because It’s a crazy “impossible scenario” to have gotton pregnant. I just want to know and hear that I don’t need to take the pregnancy test because I am not pregnant and to count on your word and the logic and professional knowledge you have that I am NOT PREGNANT. And to comfort myself I tell myself that my past situation where I emailed you a year ago where his penis and my vagina touched was more intense than this scenario. 6.What do you expect to happen given all the facts and my history regarding my cycle? THE WHOLE point is this has NEVER happened to me before and I am freaking out and my parents being very closed minded leaves me with very little comfort with someone to talk to. I am super super paranoid and a big worrier as you can see. THE BREASTS THING is freaking me out a lot as well. 7.Last but not least, this medication I started taking on March 10th, a vitamin A medication for ACNE called Netlook 20 MG(ISOTRETINOIN) says on the cover: “pregnancy forbidden! risk of malformation" , my dermatologists told me to make sure I do not get pregnant or else the baby can have malformation. Given that I haven’t had sex or don’t plan to, I have been taking that medication. They also asked about my period cycle I said its regular so they said it shouldn’t affect your period. This medication is very bad for the liver so I have to take blood tests to make sure my liver is fine, I told my dermatologist about my delayed period she wasn’t sure if this could be the reason but said sometimes it made girls bleed and maybe in my case it did the opposite where it dried the uterus creating lack of blood. My other dermatologist said its not a hormone medicine and doesn’t affect menstrual cycle. The whole point is the medication dries all of ur skin, growing new skin, drying my lips etc it is a lighter version of roaccutane. (another acne medicine) This is the only medication im taking. And I am avoiding google or any research because last time I had mini panick attacks reading things that only confused me more. Thank you for dealing with my panicky state!


Expert:  Dr. Aarti Vazirani
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Thanks for choosing DoctorSpring.com



Hello again.



First one word - RELAX.



You are too young to worry in this manner.



THis will make life impossible for you - you have so many situations ahead that would be much more stressful and demanding, stop freaking out like this, it will make you a nervous wreck !



YEs, you can talk to me as much as you want, it is a pleasure and honour, and I understand your predicament about not being able to confide in anybody, but , for your own sake and peace of mind, please relax dear.



Now let me deal with your questions -



1. As your hymen is intact, the vagina has never been entered, you CANNOT BE PREGNANT. The pregnancy test is to reassure you. All my knowledge and experience will fail to reassure you since you are so paranoid.



Go ahead and take the 2 minute test tomorrow morning itself , it is quite reliable , do not wait for a week more to take the test.



It is your mind that needs the test, after reading your detailed description, I am 100 % sure you are not pregnant.



2. A skipped period can be due to stress, weight loss, erratic sleep, so dont worry. If you skip this period there is no way to predict your next period, as it indicates irregular cycles, which needs evaluation as suggested by me.



3. You cannot secrete milk this early, even if you are pregnant, and you are NOT PREGNANT.



4. The breast changes can be due to an approaching period, or hormonal changes induced by extreme stress. The breasts look normal and non pregnant to me in the pictures.



5. THe acne medication does not affect periods.



6. If you have to trust me , dont take any test and wait for your periods. Once you stop worrying, I think they will come. If you wish to be more at peace, take the test, but it is for you, not to substantiate my opinion which I have stated clearly.



I think you should try and see some counsellor, this amount of stress, anxiety and paranoia is not normal.



Please relax and try to meditate or indulge in some hobby, your period will follow.



Take care.



Write in as much as you want 



Regards


Dr. Aarti Vazirani
Category: Infertility Specialist
Experience: 
Residency: Obstetrics & Gynecolog, BJMC,Civil hospital, Ahmedabad, 2008
Post Graduate: MS (Obstetrics & Gynecology), B.J. Medical College, Ahmedabad, 2008
Medical School: MBBS, B.J. Medical College, Ahmedabad, 2004
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