Contraception IV: IUDs, Morning After, and Non-Penetration Lovemaking
Author: Michael Castleman, M.A.
INTRAUTERINE DEVICES (IUDs)
IUDs are small, flat plastic or plastic and copper objects inserted into the uterus. IUDs are theoretically 98% effective, with an actual effectiveness of 97%. To learn what contraceptive effectiveness statistics mean and to see how this method compares with the others, see the Overview discussion.
IUDs are inserted semi-permanently inside the uterus. A string attached to the device protrudes down through the cervix, which allows it to be removed. Unfortunately, micro-organisms may ascend the string and infect the uterus and fallopian tubes, which is why IUDs are associated with an increased risk of life-threatening infections of women's reproductive organs (pelvic inflammatory disease).
Doctors aren't exactly sure how IUDs prevent pregnancy, but they suspect the device causes some inflammation in the uterus which prevents embryo implantation.
During the 1970s, about 10 percent of women who used birth control chose IUDs, primarily a model called the Dalkon shield. Then the Dalkon shield turned out to cause high rates of pelvic inflammatory disease and infertility. It was withdrawn from the market. In 1988, its manufacturer agreed to pay $2.4 billion in damages to Dalkon shield users. The scandal turned the nation away from IUDs and today less than 1 percent of women use this method. Two IUDs are currently available, both considered safe -- a copper model called ParaGard and a progesterone-releasing IUD called Progestasert.
Many woman cannot wear IUDs. Don't get one:
* If you suspect you're pregnant. * If you've ever had pelvic inflammatory disease. * If you've recently had gonorrhea or chlamydia.
You probably should not opt for an IUD:
* If you have a history of ectopic pregnancy. * If you have multiple lovers. * If you have strong concerns about future fertility. * If you live far away from emergency medical care. * If you have anemia, heavy periods or painful periods. * If you have any uterine medical problems; for example, polyps or endometriosis. * If you had problems with previous IUDs. * If you're allergic to copper. * If you have diabetes or heart disease.
The IUD's main advantage is convenience. Once inserted, it remains in place until it's removed by a clinician, usually once a year for Progestasert and every three or four years for ParaGard. However, women must check their IUDs regularly by feeling for the string that emerges into the vagina through the cervix. If an IUD user cannot feel her string, she should contact her family planning provider immediately.
IUD disadvantages include heavier, more painful periods and increased risk of pelvic inflammatory disease.
IUDs must be fitted by a medical professional. Improper insertion can cause IUD expulsion, which leaves you unprotected and may push the device through the uterus into the woman's abdominal cavity, which is a medical emergency. IUD insertion requires a minimum of two office visits. The first visit includes a medical history, physical exam, blood test for anemia, Pap smear, pregnancy test and tests for gonorrhea and chlamydia. A clinician counsels the woman and she signs a consent form. If all tests are normal, on the subsequent visit the clinician determines the size and shape of the uterus and inserts the IUD. The woman should be instructed how to feel for the string. After insertion, the woman may experience some cramping.
Consult your clinician immediately:
* If you cannot feel your IUD string. * If you feel any part of the hard plastic IUD itself in the cervix or vagina. * If you develop any signs of pelvic inflammatory disease: fever, pelvic pain or severe cramping or an unusual vaginal discharge.
MORNING AFTER CONTRACEPTION
As long as condoms break, IUDs get expelled, diaphragms and cervical caps become dislodged, women forget to take birth control pills and sexual passions sweep people away, there will be a need for morning-after contraception.
Morning-after birth control, medically known as "postcoital contraception," is prudent after unprotected intercourse because a woman's risk of pregnancy is about 15 to 25 percent every time she has vaginal intercourse without contraception.
There are three basic options: birth control pills, high-dose estrogen or morning after IUD insertion.
* Birth control pills. The regimen is two pills within 72 hours (preferably within 24 hours), then two more 12 hours later. * High-dose estrogen. The drug of choice used to be diethylstilbestrol (DES), but today physicians prescribe other estrogens (Femogen, Premarin). * Morning-after IUD insertion. If inserted within a week of unprotected intercourse, an IUD prevents implantation of the fertilized egg in the uterine wall.
All postcoital contraceptives must be prescribed by a physician. Consult your doctor or a family planning clinic if you are concerned about pregnancy after unprotected intercourse. Of course, if you don't want to get pregnant, use a reliable birth control method conscientiously, so you don't have to opt for morning-after contraception.
NON-INTERCOURSE LOVEMAKING AS BIRTH CONTROL
Non-intercourse lovemaking means sex without vaginal intercourse. During oral or anal intercourse or mutual masturbation, no sperm are deposited in the woman's vagina, so pregnancy cannot occur.
Since the 1970s, sexuality surveys have shown that almost all American lovers engage in mutual masturbation and oral-genital caresses. Anal intercourse is a minority experience, practiced regularly by an estimated 5 to 10 percent of heterosexual lovers.
If you decide to use nonintercourse lovemaking as a form of birth control, refrain entirely from vaginal intercourse.
If you practice anal intercourse:
* Lubrication is crucial. Use vegetable oil or an over-the-counter sexual lubricant available at pharmacies such as KY Jelly, Surgilube or Astroglide. * Insert very slowly. Women usually feel most comfortable guiding the penis in with their own hand or backing on to it. * Do not penetrate deeply unless the woman says it's okay. * Nothing that has touched the anal area should come in contact with the vagina before washing with soap and water. Anal area bacteria introduced into the vagina may cause urinary tract infection.
Be aware that those who engage in anal intercourse with men infected with the AIDS virus are at considerable risk of becoming infected themselves. Anyone who is, or makes love with someone who is, non-monagamous and engages in anal intercourse should practice safe sex by using latex condoms.
PROGESTERONE IMPLANTS
This new, recently approved birth control method, called Norplant, involves the surgical implantation of six match-stick size hormone vials in a woman's upper arm. Norplant provides safe, reliable, reversible contraception for five years.
Norplant is 99% effective as long as the hormone vial remain in the woman's arm. To learn what contraceptive effectiveness statistics mean and to see how this method compares with the others, see the Overview discussion.
Progesterone implants have several advantages:
* They don't interrupt lovemaking or interfere with sexual spontaneity. * Side effects are minimal. Compared with the Pill or an IUD, the two other methods whose use is also unrelated to intercourse, implants cause fewer side effects. The most common ones are changes in menstrual cramping and menstrual flow.
But implants also have some disadvantages:
* The hormone capsules may be visible on the woman's inner arm. * There may be prolonged menstrual bleeding, spotting between periods and irregular or missed periods. * Norplant is initially expensive. Implants cost about $400 plus another $100 to $300 for their implantation. But over their five-year life, this method may actually wind up costing less than the Pill or condoms. * Finally, discontinuing the method requires minor surgery to remove the implants.
Women interested in progesterone implants should consult a family planning provider. The implantation procedure involves brief, minor surgery under local anesthesia. The physician inserts the six little implant tubes in a fan-shaped pattern on the inside of your upper arm. Once in place the implants release a low dose of levonorgestrel, a progesterone-type hormone, which lasts five years or until the capsules are removed. Once removed, fertility reliably returns.
SPERMICIDES
Spermicides are over-the-counter contraceptives available in creams, jellies, foams and suppositories. Some are used in conjunction with condoms, diaphragms and cervical caps. In this segment, we'll discuss the foams and suppositories that may be used by themselves.
By themselves, spermicides are theoretically 97% effective, with an actual effectiveness of 79%. To learn what contraceptive effectiveness statistics mean and to see how this method compares with the others, see the Overview discussion.
Spermicides kill sperm. The term "spermicide" sounds a lot like "insecticide" and "pesticide," but unlike the chemicals used to control insects and agricultural pests, spermicides are not poisonous. They interact chemically with the outer membranes of sperm cells and disable sperm cells. Spermicidal chemicals include nonoxynol-9 and ocoxynol. Spermicides have never been shown to damage vaginal tissue or to cause harm when small amounts are ingested during oral sex.
Spermicidal foam comes in aerosol containers with plunger applicators. To be effective, you must insert a new applicator-full no more than one hour before every ejaculation during vaginal intercourse.
Spermicidal suppositories must be inserted at least 10 minutes before intercourse to allow them time to melt. Twenty minutes is safer.
A woman should not douche or sit in a bathtub for at least six to eight hours after using a spermicide.
Spermicides have several advantages:
* They're available over-the-counter. No need to spend time and money on professional providers. * They help prevent sexually transmitted diseases including AIDS. * They provide backup protection if a condom breaks or if a man who intends to withdraw doesn't do so in time. * They provide additional lubrication during intercourse. * They cause no serious side effects. * You use them only when you make love.
But spermicides also have disadvantages:
* Some people consider them messy or difficult to insert. * As vaginal suppositories melt inside the vagina, some women complain of an unpleasant sensation. * Spermicides may irriate the vagina or penis. * Some people object to their taste during oral sex.
If you think a spermicide is causing a vaginal or penile irritation, stop using it. If it doesn't clear up within a few days, consult a physician.