Our Bodies, Ourselves (54 page)
Read Our Bodies, Ourselves Online
Authors: Boston Women's Health Book Collective
Sterilization has a long history of abuse. Women with disabilities, poor women, and women of color have been disproportionately targeted for sterilization. Although U.S. federal guidelines now require that special informed consent procedures be followed, the problem of sterilization abuse remains in some places. For more information on the history of sterilization, see “Sterilization Abuse” at the Our Bodies Ourselves website, ourbodiesourselves.org.
No-scalpel vasectomy is used increasingly throughout the world. It was developed in China, where it is now the standard technique. In no-scalpel vasectomy, a practitioner uses an instrument to puncture a tiny hole in the scrotum, lifts the vas deferens out through the hole, removes a piece of it, and then ties or burns the end. No-scalpel vasectomy is as effective as the scalpel method but has a lower complication rate.
17
Vasectomy does not affect a man's sexual function. It leaves the man's genital system basically unchanged. His sexual hormones are unaffected, and there is no noticeable difference in his ejaculate, because sperm make up only a small part of the semen. Even if they know these
facts, some men still worry that a vasectomy will affect their sexual performance. Talking with someone who has had a vasectomy can help relieve anxieties.
Vasectomy has become increasingly popular over the past years. Men often choose vasectomy after the failure of another birth control method; when they want to spare their partner from more-invasive surgery (female sterilization); or because they want to have complete control over their fertility.
18
Nearly 13 percent of U.S. married couples use vasectomy as their contraceptive,
19
and in some countries, such as New Zealand, almost half of men over forty have opted for it.
20
Recent advances allow some vasectomies to be reversed through an expensive microsurgical procedure. However, the longer a man has had his vasectomy, the lower the chance of success. In addition, reversals usually aren't covered by insurance. Pregnancy rates after a vasectomy reversal vary widely; even a skilled surgeon may have only a 30 percent success rate.
21
Vasectomy should be considered permanent.
Vasectomy is over 99 percent effective and is considered permanent.
⢠Permanent birth control.
⢠Does not interrupt sexual spontaneity.
⢠Requires no daily attention.
⢠Does not affect pleasure.
⢠Less complicated than female sterilization.
⢠Does not protect against STIs, including HIV.
⢠Not immediately effective.
⢠Requires minor surgery.
⢠Rarely, the vas deferens rejoins.
⢠Should be considered a permanent method; may not be reversible.
WITHDRAWAL (PULLING OUT)
Withdrawal (coitus interruptus) involves removing the penis from the vagina before ejaculation so that the sperm is deposited outside the vagina and away from the lips of the vagina. It is also called “pulling out” and is often used in combination with other methods such as condoms, fertility awareness, or periodic abstinence. Withdrawal offers no protection against sexually transmitted infections.
When used consistently and correctly, withdrawal is slightly less effective than male condoms at preventing pregnancy. Using the method successfully requires good communication and an experienced partner who knows his body. Your partner must:
⢠Know when he is going to ejaculate
⢠Demonstrate that he does not ejaculate very quickly, before he realizes it
⢠Have the experience and self-control to pull out in time
Withdrawal is between 73 and 96 percent effective at preventing pregnancy, depending on how perfectly it is done. With typical use, one of about every four women relying on withdrawal alone becomes pregnant during the first year. With perfect use, one of twenty-five women becomes pregnant during the first year.
⢠Withdrawal can be used to prevent pregnancy when no other method is available.
⢠Using withdrawal in combination with other methods may increase their effectiveness.
⢠No health risks or side effects.
EMERGING MALE CONTRACEPTIVES
Birth control has traditionally been the responsibility of women, and most methods of contraception work by altering a woman's fertility. Currently the only methods of male contraception are vasectomy and condoms. Vasectomy, while very effective, is permanent, and therefore is not appropriate for those who may wish to have children in the future. Condoms, because they must be used for each act of intercourse, are not widely used among committed couples. There is a critical need for safe, reliable, and reversible birth control methods for men. Despite this need, development of new contraceptives for men has been slow and poorly funded.
However, several new methods of male contraception are in development. China will likely have a hormonal contraceptive for men in the next decade. Although it's often referred to as the “male pill,” it will be administered by injection every eight weeks. The majority of men in clinical trials consider the method acceptable.
22
Also in the next decade, India may have a truly innovative birth control method known as RISUG. It is a compound that renders sperm unable to swim. A small amount is injected into the vas deferens in a ten-minute procedure. Clinical trials show it is highly effective, begins acting almost immediately, and has few side effects. Researchers found that RISUG in animals can be reversed with another injection that flushes it out of the vas deferens; they are now evaluating its reversibility in men.
23
Although these new contraceptives for men are in advanced stages of research, they will not be available in the United States anytime soon. It will take many years and more large-scale clinical trials for the Food and Drug Administration to thoroughly evaluate them.
For more information on experimental male contraception, see the website of the Male Contraceptive Coalition at male contraceptives.org.
⢠Promotes communication and responsibility between partners.
⢠Free.
⢠Does not protect against STIs, including HIV.
⢠Interrupts spontaneity.
⢠Requires a great deal of self-control, experience, and trust.
⢠Not for men who ejaculate prematurely or are sexually inexperienced.
The man withdraws his penis from the vagina before or when he feels he has reached the point when ejaculation can no longer be stopped or postponed. He ejaculates outside the vagina, being careful that semen does not spill onto his partner's vulva. Men who use withdrawal must be able to know when they are reaching ejaculatory inevitabilityâthe point in sexual excitement when ejaculation can no longer be stopped or postponed.
F
AM
FAM is a scientifically validated method of natural birth control that involves charting fertility signs to determine whether or not you are fertile on any given day. Fertility awareness can also be used to achieve pregnancy or for greater body
awareness in general
.
FAM as birth control involves some background research, record keeping, and a daily time commitment. It also involves being comfortable touching your own vagina and vaginal fluids. In order to use FAM effectively, you need more information than this book provides. You can learn more about FAM in the book
Taking Charge of Your Fertility
by Toni Weschler or by taking a class (see Recommended Resources).
H
OW
F
AM
W
ORKS
By charting your primary fertility signs (waking temperature, cervical fluid, and cervical position), you can determine which phase of the cycle you are currently in. Unlike the obsolete rhythm (or calendar) method, which relies on past cycles to predict future fertility, FAM effectively identifies your fertile phase, the time when ovulation is about to happen, and when it has occurred. You can then use your daily fertility observations to know whether or not you are safe for unprotected intercourse on any given day.
Couples can choose either to abstain or to use another method during the woman's fertile phase. It should be understood, though, that if you choose to have intercourse using another birth control method during your fertile phase, FAM cannot be any more effective than the method itself.
If FAM is used perfectly by a motivated couple who abstain during the fertile phase, the effectiveness rate is approximately 95â97 percent over the course of a year. It is difficult to know how effective it is with typical use. Various studies show that the effectiveness of natural family planning varies greatly; 75â90 percent per year is commonly reported in the medical literature. Natural methods of contraception are most appropriate for strongly motivated women and couples who can commit to learning the method thoroughly and following the rules consistently.
⢠No health risks or side effects.
⢠Can increase a woman's awareness and understanding of her gynecological health, hormonal balance, and fertility.
⢠Promotes communication and responsibility between partners.
⢠After the cost of initial instruction, costs nothing to practice.
⢠To learn it correctly requires taking a class or reading a book, and it usually takes about two cycles to assimilate FAM's basic principles.
⢠Does not protect against STIs, including HIV.
⢠Requires considerable commitment, cooperation, and self-control, by both you and your partner.
⢠Typical failure rate is higher than with other methods.
⢠Can be challenging to practice while breastfeeding, owing to the unpredictability of ovulation.
⢠Takes a few minutes a day to take your temperature and chart your fertility signs.
Technologies such as calculators, computer programs, saliva tests, and urine tests are increasingly
available to help determine fertility. However, these high-tech methods are more appropriate for women who are trying to achieve pregnancy rather than avoid it. This is because most of these methods do not give you enough warning of impending ovulation to account for the possibility of sperm surviving for up to five days in the uterus and fallopian tubes.
You should never assume that you are infertile simply because you are breastfeeding. But breastfeeding can prevent ovulation, and thus work as a natural form of child spacing,
if
certain criteria are met. The frequency with which a woman breastfeeds is the primary factor in determining when fertility returns. Breastfeeding every few hoursâeven if only for a minute or two each timeâis most effective at preventing ovulation.
Exclusive or full breastfeeding is not the same as frequent breastfeeding. The amount of time that a baby spends sucking or the amount of milk the infant receives are not factors in the effectiveness of breastfeeding as birth control.
Other factors can influence the return of postpartum fertility, including the use of pacifiers, whether or not food or liquid other than breast milk is given to your baby, or even whether you sleep with your baby. A woman who wishes to practice a form of natural contraception following birth has a couple of options.
You can use LAM during the first six months if you are exclusively breastfeeding.
This method must be very strictly followed to be effective. Even then, its success is contingent upon such frequent nursing that it is often difficult for women in Western societies to rely on completely. But the guidelines state that you are not likely to ovulate if you meet all of the following criteria:
⢠Your menstruation has not returned since childbirth.
⢠Bottle feeds or regular food supplements are not introduced.
⢠Your baby is under six months old.
The first criterion of LAM is that you have not resumed periods. If you are breastfeeding, any vaginal bleeding before the fifty-sixth day after birth is almost always anovulatory (meaning no ovulation has taken place) and therefore can be ignored. Any bleeding after the sixty-fifth day should be considered a sign of resumed ovulation.
The second criterion means that you are strictly breastfeeding and not giving your baby any other food or even offering a pacifier. The contraceptive effectiveness of LAM is maintained only if the intervals between night feedings do not exceed about every four hours. So the shorter the intervals between all feedings, and the closer you keep your baby to you, the more likely it is that LAM will be effective. To further increase the effectiveness of LAM, some instructors suggest that you nurse once or twice per hour during the day and several times at night during the baby's first few months.
This can be used throughout the return of your fertility, as well as afterward. The rules for practicing FAM while breastfeeding differ from those used in other circumstances and are not described in this book. FAM can be used most effectively if a woman can consult with a FAM instructor, whether in person, on the phone, or online. The website Taking Charge of Your Fertility (tcoyf.com) is a good site
to learn more
.
The basic principle is that the breastfeeding
woman observes her cervical fluid during the day. It typically shows a pattern of either nothing or dry cervical fluid day after day, or a combination of both. These days are considered safe. As soon as a woman's cervical fluid pattern begins to change to a wetter consistency, her body is indicating that she may be preparing to ovulate again. She must consider herself fertile on any days of wet vaginal sensation or wet cervical fluid, as well as three days beyond the last day of wetness.