Contraception Continued

ORAL CONTRACEPTIVE PILLS

These are hormone products initially developed for the treatment of menstrual difficulties and for infertility. Their use specifically for contraceptive purposes had been thoroughly studied and they are now widely accepted in the United States and the United kingdom. Their effect is to prevent the monthly release of an ovum or egg by the ovary of the female. Counting the first day of flow or spotting as Day 1, they must be started on Day 5 of the monthly period even if the flow has not quite ceased, and a tablet must be taken every day at the same time of day for twenty days. On the 24th day of the cycle the last of that month’s twenty tablets is taken and, approximately three days later, menstruation will occur. The pill is started again on day 5 of that period.

This method is considered to be as close to 100 per cent  as any method we know short of absolute abstinence.

A few patients experience some temporary side effects which, under the guidance of a doctor, are usually controlled easily. And what of health scares? The most careful scientific studies for the last five years on a large group of women taking the tablets has shown no evidence of any permanent harmful effects. Fertility is not affected at all, many women becoming pregnant in the very month they stop taking the tablets. However, more research is needed to perhaps avoid the need to take them daily.

DIAPHRAGM, CAP AND JELLY OR CREAM.

The diaphragm and cap are devices made of soft rubber with a flexible metal spring around the circumference. They are made in a variety of sizes and shapes, and their purpose is to cover the cervix, which is the entrance to the uterus. To obtain one, each individual woman must be examined by a physician. Only then can it be properly fitted because the required size and shape vary from individual to individual.

Along with these devices, a contraceptive jelly or cream must always be used, the choice between jelly or cream depending on the aesthetic preference of the user. One of the great advantages of the diaphragm is that it may be inserted as much as six hours before intercourse and may be worn for as long as 16 hours at a time. After intercourse it must be left in place for at least six hours afterwards. One type, the cervical cap, if made in plastic may be inserted on the last day of the menstrual period and left in place until the beginning of the next.

With the diaphragm or cap douching is not at all necessary; in fact, most doctors advise against it. However, if the woman wishes, she may douche with plain warm water containing two tablespoons of vinegar to each quart after removing the device not less than six hours following intercourse. The physician who fits the device will give detailed instructions for its proper use.

THE CONDOM. The diaphragm or cap previously described is used by the wife. Just as effective is the condom, or rubber, which can be used by the husband to cover the penis. It is put on just before the sex act and captures the seminal fluid, which thus does not reach the female generative organs. The condom is harmless. There is, however, always the possibility that it may break before or during intercourse, or slip off after the climax, enabling semen to spill into the vagina. For more complete protection, therefore, the wife may wish to insert one of the contraceptive products mentioned below into the vagina just before intercourse.

JELLIES, CREAMS AND AEROSOL FOAMS ALONE. Some brands of jellies and creams are manufactured specifically for use alone. In the U.S. an aerosol foam has proved especially effective and acceptable. A special applicator comes with each container and is required to introduce the cream, jelly or foam product into the vagina. They are very effective as contraceptives, but not quite as effective as the previous methods. If intercourse is repeated, another dose of jelly, cream or foam must be inserted each time. No douche is necessary, but if one is desired, it should not be taken until at least six hours after the last intercourse. This gives the product time to have its effect on the sperm.

PESSARIES. These are small cones or capsules containing sperm-destroying chemicals in a base of cocoa butter or gelatin that melts at body temperature. One is inserted into the vagina five minutes before each intercourse, to melt slowly. Pessaries are not considered as effective or satisfactory as the previously described methods.

WITHDRAWAL OR COITUS INTERRUPTUS.

This refers to withdrawal of the penis from the woman’s vagina prior to the husband’s ejaculation, so that the semen is deposited completely outside of the genital tract. The woman’s orgasm should preferably take place before the withdrawal.

From a medical point of view this method is not considered to be completely reliable or desirable. It may fail to prevent conception because of poor control or carelessness on the part of the husband, or because sperm can sometimes slip out before ejaculation.

Moreover, constant anxiety that the withdrawal will not take place in time may interfere with the couple’s spontaneous enjoyment of the sex act. Continuous and long-time use of this method has in some cases been found to lead to emotional or physical problems in one or both partners. However, it is unquestionably very useful in emergencies or when no other method is available, and some couples do find it acceptable for continued use.

DEVICES TO GO INSIDE THE UTERUS

Mechanical devices have been developed which can be inserted into the womb by a doctor and left in place for several months, or even years. These are called intra-uterine methods, and were formerly made of silver. They were thought to cause harmful effects, but such complications as were reported as a result of their use have been shown to be due to the silver itself.

Therefore, although they are not at present recommended, new studies being conducted with similar devices now made of stainless steel or plastic apparently promise to show that this method may well turn out to be one of the safest and most acceptable and effective available.

The safe period or rhythm method is based on the biological fact that a woman can become pregnant only at ovulation time, that period of her menstrual month when the egg is released from the ovary.

It is now generally believed that normally a woman produces only one egg cell during each menstrual cycle. The cell is released from the ovary about two weeks before the beginning of the next menstrual period, and its life span—that is, the time during which it is capable of being fertilized by a sperm cell—lasts for some 24 to 48 hours.

The sperm cells, in turn, when they are in the womb or in the tubes, retain their ability to fertilize the egg also for only an estimated 48 hours. Conception can therefore presumably be prevented by avoiding intercourse during the fertile days of the cycle.

But the problem is to determine the exact day of ovulation for the individual woman. At present there is no completely accurate way of doing it. It has to be based chiefly on a study of the record of the woman’s past 8-12 menstrual cycles, although the ending of each month’s fertile period can also he determined by a record of her daily temperature. If taken daily, immediately on awakening, the temperature will show a slight rise about the time when ovulation takes place and will remain higher for the rest of the cycle. If menstrual and

temperature records are kept carefully for at least eight and preferably twelve months, and if the menstrual cycles are not too irregular, it is possible to estimate the safe and unsafe days with a fair degree of accuracy.

Because ovulation occurs about two weeks prior to the beginning of the following menstrual period, a woman with a regular 28-day cycle would ovulate around the 14th day after the first day of her period. Allowing two to three days before and after ovulation, to include the time when both the egg and sperm remain alive, for a woman with a regular cycle of 28 days the fertile or “unsafe” days would last from the 11th to the 18th day of such a cycle. From the 18th day on there would be no egg present to be fertilized and conception could not normally take place. The days before the 11th day are also believed to be safe, but this is much less certain, because the length of time the sperm cells can remain alive within the woman is still not definitely known.

But with women whose cycles are of other lengths than 28, different calculations must be made.

And if the woman’s periods are irregular, the safe and unsafe days will also be irregular. Illness, shock, or other physical or emotional changes can disturb the menstrual cycle and upset the calculation of the time of ovulation. Because of these problems, the rhythm method is not considered to be entirely reliable nor is it suitable for many women. If it is to be used, it is advisable to consult a doctor who is trained in figuring out the “safe period”. Of course, even if the period can be determined correctly, this method still prevents intercourse during many days of the month. Some women combine the “safe period” method with mechanical or chemical methods: they rely on the “safe period” during the infertile days and use contraceptives during the estimated fertile period.