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Fertility Control
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Now, at the end of the 20th century, comes another step forward. The concept is simple. Women no longer have to reproduce to prove that they are feminine. It is acceptable to put off pregnancy for years, or not to want children at all. For on the bottom line:

  • It is safer never to be pregnant than to give birth.
  • It is safer to use contraceptives than to risk pregnancy.

Opposing these two factors, however, keep in mind that never pregnant women have a slightly higher risk of breast cancer, and cancer of the reproductive organs.

Women who use birth control devices, no matter what type, are preventing more than pregnancy.

  • The Pill reduces the chance of reproductive cancers.

  • Barrier methods protect against sexual disease.

  • All methods are less likely to result in ectopic pregnancy.

  • All methods prevent the risk of complications at pregnancy and birthing.

  • Women age 35 and over more usually choose abortion.

  • Only 10 percent of women use no protection at all.

  • Those using no protection account for only just over a half of the 3.5 million unintended pregnancies.

  • Ten percent of planned abortions end in spontaneous abortion first.

A spontaneous abortion is one which occurs without medical intervention. It is known to occur in 15 percent of cases. Yet it is estimated that 50 percent of early fetal tissue spontaneously aborts before week 11 of gestation, often before a woman is aware that she is pregnant. Though tragic for would-be parents, spontaneous abortions can be a blessing in disguise. The fetus is almost always severely compromised. The fate of any 1,000 fertilized eggs has been estimated as follows:

  Number Percent
Lost before implantation 250 25
Lost before pregnancy diagnosed 150 15
Spontaneous abortion 100 10
Normal infants born 400 40
Stillborn infants 10 1
Special care infants 90 9
You Can't Be Too Rich or Too Thin

Nor can you be just a little bit pregnant.

Fertility control is about stopping the egg and sperm getting together, or stopping the fertilized egg from implanting in the uterus. In girls, an egg is not produced until some 18 months after menarche. In older women, egg production stops at some time during menopause. These dates cannot be more specific. It is essential for those wishing to avoid pregnancy to stick to the rule of thumb:

  • A woman is fertile from her first to her last period.
  • Sperm production continues from puberty until very old age.

Motivation is the key factor for effective fertility control. Ambivalence will do many a couple in. Health professionals know that it takes not one, but two, unintended pregnancies before ambivalence dies and motivation grows keen. For couples who do control their fertility, the decision when to start a family can be difficult. For them, the olden days when a pregnancy "just happened" have gone. In either situation, fertility control is at the very core of female existence. It involves the most profound choices which a woman makes in her life.

There are further choices to be made concerning the different methods of contraception. None are perfect. Each has benefits and drawbacks in terms of health, effectiveness, reproductive stage, lifestyle, aesthetic appeal, and so on. No one method is carved in stone. Some couples forget this, and stay with a contraceptive they really dislike, or one which is outdated for their needs. Be prepared to change, according to particular needs.

Points of Prevention

  • Egg in the ovaries: hormones by Pill, injection, implant.

  • Egg in the tubes: sterilization, or hormones.

  • Egg in the uterus: hormones or IUD.

  • Sperm leaving testicles: sterilization by vasectomy.

  • Sperm leaving penis: condom, withdrawal, periodic abstinence.

  • Sperm in vagina: condom, diaphragm, cap, sponge, spermicide.

The terms birth control, contraception, planned parenthood, fertility control, all mean the same thing. Each woman can learn her fertile times, her times of high risk.

High Risk Times

Mucus from the cervix is the key to fertile times. By changing in texture and amount, it can block sperm or assist them safely through the cervix. After a period, cervical mucus is scant. The vagina is dryish. At about day 6, mucus production is rising. At ovulation, it is profuse, clear and watery. Now is the fertile time of the month. The os (door of the cervix) opens to welcome in the sperm. Cervical mucus practically pours out, coating the vagina with fluid. (This is not the same thing as the sweating phenomenon, which coats the vagina at sexual arousal.)

After ovulation, when progesterone is made, the os closes. Mucus production almost stops. What is left forms a mesh; thick, sticky, and opaque. It appears on underwear as creamy, crumbly lumps. Sperm cannot get through. (With fertility problems, the "cervical factor" means that the cervix is producing only thick scant mucus and the sperm are blocked.)

Learn high risk times by checking the cervical mucus. Keep in mind that it will be watery enough to flow to the outside. So check it at the vulva only, or on underwear, toilet paper, or a sudden sensation of being wet. If held between the fingers, cervical mucus feels slippery; it stretches rather than breaks. (Take care also not to confuse it with the wetness from semen, spermicides, or the discharge of an infection).

Home ovulation predictor tests are a far more accurate way to find ovulation time. They measure the surge of LH hormones which appear in urine. They respond to the LH surge by changing colour. The actual time of ovulation can be predicted daily, twice daily, even more, by repeated testing and charting the results. Keep in mind that there is a time lag before LH appears in urine. The kits can be bought at a local pharmacy. The instructions differ, so read them carefully.

It is considered fairly safe for unprotected intercourse in the early "dry" 5 or 6 days after a period. There is a slight risk of pregnancy if sperm survive into the "wet" days which follow. Avoid unprotected intercourse from the start of a rise in mucus output until at least 3 days after mucus levels peak. Unprotected intercourse is considered fairly safe again after ovulation.

It can be seen there is much caution in this advice. Though both egg and sperm have a short shelf-life, they have been known to get together after amazing lengths of time. The upper limit for sperm survival is about 48 hours. Sperm which are moving have been found in cervical mucus up to 6 to 8 days after intercourse; they may have lost the power to fertilize by then. The life span of the egg is even shorter, between 10 and 24 hours.

Never rely on douching as a method of birth control. Though some sperm will be washed out, the rest are actually pushed up and through the cervix by the flood of water entering the vagina.

Mucus production lessens as a woman nears menopause. Checking the amount and consistency is also a useful way to gain some idea if menopause is approaching.

Withdrawal

This is another centuries old and even more popular method of birth control. It is used worldwide and by lovers of all ages. The success rate depends upon the man. He must have acquired full ejaculatory control, which is not an easy skill. The man has to learn and practice this over many years. Even then, he can lose ejaculatory control at any time, for any of a number of ordinary reasons: over-excitement, tiredness, and so on.

Most young men lack ejaculatory control. Their orgasms feel imperative, and overwhelm attempts at control. Withdrawal is not a method of contraception which works in youth. Ironically, due to its apparent simplicity, it is the number one choice when young couples start making love. Inform a son or daughter that those who use withdrawal are often called "parents" in nine months time.

Another disadvantage is that the man must always be on guard. He cannot relax his vigilance as he nears the orgasmic threshold. In youth, this can cause immense stress. It is thought to be one of the main reasons why control problems (premature or retarded ejaculation) develop later on.

In couples of all ages, withdrawal can fail due to the drops of fluid which appear on the penis at erection. Their function is to lubricate the glans and ease penetration. However, the fluid comes from Cowper's glands, part of the male reproductive system. It contains millions of sperm, which will be deposited inside the vagina. If using withdrawal, make sure that the tip of the penis is wiped dry first.

Nevertheless, withdrawal remains the most popular method of birth control worldwide. It has no side effects for older couples, is free, simple to use, and instantly reversible.

Periodic Abstinence

The movement away from conventional medicine and back to self-care has also affected choice of contraception. The "natural" method involves abstaining from intercourse at high risk times, and is now called "periodic abstinence." It is a boon for women who cannot take the Pill for health reasons, and/or fear the side effects of its long-term use. It appeals to couples who dislike barrier methods, and/or those whose religion denies them access to birth control by any artificial device.

The calendar method involves guessing the ovulation date based on the woman's previous history and timing of her periods. The basal body temperature (BBT) method involves taking the vagina temperature and noting the rise which signifies ovulation. The mucus method was previously discussed. The symptomothermal method combines the BBT and mucus method, also noting other signs of ovulation: swelling or tender breasts, and mittelschmerz. All these methods are less reliable than the home ovulation predictor kit.

Periodic abstinence can be very effective. It requires total commitment by both partners, with no vulva-penis contact at high risk times. Motivation is critical in recording and keeping exact information on period and temperature charts, mucus changes, and physical signs. There are no side effects in older couples, and it is immediately reversible.

Spermicides

Spermicides are foams, creams, gels, tissues, or suppositories which dissolve in the vagina. They contain chemicals which kill sperm. They are designed to be used with a diaphragm or cap; they have a high failure rate when used on their own. Protection lasts between 6 and 8 hours, but only if used with the above devices to keep the spermicide in place. Otherwise, the dissolved fluid will flow out of the vagina. If using spermicide alone, insert it very soon before intercourse for better protection. Make sure that it is high up in the vagina, as near the cervix as possible.

Spermicides can be used for extra protection with a condom. In a few cases, the vagina or penis is allergic to their chemicals. This can be felt as a slight burning sensation. It is now thought that spermicides might encourage female urinary tract infections. One study found that the level of bacteria in the vagina was much higher in women who used them regularly than in women who did not. It is thought that the chemicals might be killing off benign bacteria, which upsets the vagina's natural ecology. This allows infectious strains to flourish, and enter the urinary tract from the vagina.

However, spermicides do provide a slight protection against sexual disease. Some couples dislike the extra wetness from the chemicals as they dissolve. Otherwise, there are no side effects, they are not difficult to use, and are instantly reversible.

The Condom

The condom is another centuries old, tried and true method of birth control. Also known as sheaths, rubbers, or French letters, they are made of latex rubber; five percent are from the guts of lambs. Lambskin condoms are an option for men who seek increased sensitivity, and for those who are allergic to rubber. However, "skin" condoms are natural membranes: they have larger pores than latex ones. This makes them less effective at protecting against the transmission of sexual disease.

Condoms are straight or shaped, smooth or ribbed, lubricated or dry, coloured or transparent, with or without a reservoir tip at the end. The tip is fairly important. Semen, pumped out of the penis under high pressure, can more easily burst a condom without a reservoir tip. Condoms are "one size fits all," but they are packaged in different amounts, 3, 6, and so on.

Condoms must be donned before any vulva-penis contact. Some couples use this as part of their love making. A condom must stay in place until ejaculation is completed. Then the covered penis is removed, taking care not to let any of the contents spill out, some women dislike the sensation of condoms; others are pleased not to "leak" afterwards.

Health professionals promote the use of condoms as "safer sex." Yet a condom can be defective, and a condom can break. It may not be worn before vulva contact; it may not be worn until all contact ends. It is as well to know what health professionals know: "Condoms do not provide 100 percent protection against unintended pregnancy, sexual disease, AIDS, or anything else."

A few people are allergic to latex rubber. There has been only one case of a life-threatening reaction to the condom; the others were from latex gloves, anesthesia equipment, a rubber dental device, even a racquetball handle.

Nevertheless, condoms are extremely popular. They are not costly; couples with limited means can obtain them at reduced price from health clinics. They have no side effects, are easy to use, and are instantly reversible.

Diaphragm

The diaphragm is a dome-shaped rubber cup which covers the cervix. It has a flexible rim which fits snugly in place. It is used with spermicide put inside the dome before the diaphragm is inserted. It can be inserted prior to a date, but keep in mind that spermicide effectiveness is lost after six to eight hours. When love making is completed, leave the diaphragm in place for six to eight hours. It' removed before this, any sperm still alive can swim through to the uterus.

Diaphragms come in several sizes. They require a prescription, and are fitted by a health professional. The springy rim should slip easily into the fornices at the top of the vagina, and be a snug fit. When correctly in place, the woman is unaware of its presence, she does not feel it. If she does, then it is the wrong size, or the rim has not slipped into place. Check to make sure that there is no sensation before leaving the physician's office. If the diaphragm is only felt when inserted at home, remove it, and start again.

Diaphragms have been implicated in endometriosis, toxic shock syndrome, and urinary tract infection, though there is no proof. Nevertheless, avoid leaving a diaphragm in place for longer than eight hours. The cervical cap is smaller and cone-shaped. It blocks sperm in the same way as the diaphragm, though it only covers the cervix, being held in place by suction. It has no rim to rest in the fornices, and so avoids the problem of UTI.

Diaphragms or caps can be checked for wear and tear by filling them with water, or holding them up to the light. They last about two years. They must be changed after birthing or surgery which results in change of cervix size. They afford some protection against the transmission of sexual disease. They are easy to use, not costly, and instantly reversible.

Sponges

Blocking the cervix by putting a sponge high up in the vagina is another centuries old custom. Nowadays, commercial sponges are made of polyurethane, and filled with enough spermicide to last for 24 hours, no matter how often intercourse occurs. However, sponges have been linked to problems by blocking the menstrual flow. Therefore, it is advisable to remove sponges six to eight hours after making love. They afford some slight protection against the transmission of sexual disease. They are easy to use, have no side effects, and are instantly reversible.

Return of the IUD?

An intra uterine device, which is placed in the uterus, stops the process of implantation. It is not known exactly how this works. Perhaps the IUD sets up irritation of the uterus lining and the fertilized egg simply cannot implant.

In many countries, the IUD never went away. It is the world's most popular contraceptive device which is reversible. It is also one of the most effective.

An IUD is inserted by a health professional. Once in place, the woman (or partner) makes sure that it has not been expelled by regularly checking the string which hangs down in the vagina. There is a 40 in 100,000 risk of perforation of the uterus wall, but only at the time of insertion. This is not considered a large risk. IUDs last five to six years. The main problems include: pain, bleeding, partial or total expulsion of the IUD, retraction of the string so it can no longer be felt, irritation of the penis by the string.

An IUD offers no protection against sexual disease. It is more appropriate for mutually monogamous couples. Users should have no previous history of pelvic infections and at least one baby; childbirth reduces the risk that the device might be expelled. Some American physicians are hoping that the IUD will be used here again. It offers 96 percent protection against pregnancy. Once in place, there is no further fuss. Apart from checking the string, the IUD can be forgotten until it needs to be changed.

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