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Sex And Contraception After Giving Birth

The addition of a baby to a couple's life affects all aspects of their relationship and therefore affects how and when they relate to each other sexually.

Possible Deterrents To Sexual Relations And Dealing With The Problems

1. EXHAUSTION IRRITABILITY. It might be necessary to forego lovemaking until more sleep has been obtained and there are more positive than negative feelings as a result.

2. FEAR THAT THE BABY MAY AWAKEN AND WITNESS YOUR INTERCOURSE. Plan to make love in another room, or put the sleeping baby in another room.

3. FEAR OF PAIN AT THE EPISIOTOMY SITE. Episiotomy soreness or pain may linger as long as approximately four to six weeks. Use a surgical jelly (such as KY) on the perineum and at the vaginal opening to help the area be more supple. Remember to continue doing your Kegel (pelvic floor) exercises daily, to encourage healing. The woman-above position may be more comfortable and gives more control of movement, thus minimizing discomfort. If the woman-below position is desired, try placing a pillow beneath your hips; this raises the pelvic area to an angle which may alleviate discomfort.

4. LITTLE OR NO VAGINAL SECRETIONS, CAUSING PAINFUL ATTEMPTS AT INTERCOURSE. Use surgical jelly (such as KY) or other lubrication at the vaginal opening and on the penis - not just at the time of insertion, but during foreplay. Use gentle, tender touches, loving words. Have a drink before making love; it can relax both of you. Do not force relations if they continue to be painful after all remedies are tried. Agree between you to forget about it for a while and then try again. Meanwhile, be sure to continue your Kegel exercises daily to encourage healing of the episiotomy site and hemorrhoids. These will also help you be aware of tension in your vaginal area when attempting intercourse, and you will be better able to achieve muscle relaxation for easier entry.

5. EMBARRASSMENT AND INABILITY TO FANTASIZE DUE TO BODY IMAGE (TUMMY STILL FLABBY, NO WAISTLINE, LEAKING BREASTS). Use soft lights; perhaps a special pink or blue bulb in your bed table lamp can add atmosphere, intimacy, and allure. Instead of being nude, wear a shortie nightgowns (with or without your bra and gauze nipple pads). The nightgown will hide the flabbiness while giving the feeling of femininity and attractiveness. It may also be a turn-on to your partner.

6. DISCOMFORT DUE TO FULL, HEAVY, TENDER, AND SORE BREASTS. If you feel more comfortable, wear your uplifting bra with gauze nipple pads. You might also try expressing some milk manually while taking a hot shower to relieve some of the fullness.

7. BLOODY VAGINAL DISCHARGE. If you have and can conquer negative feelings about intercourse during vaginal discharge, simply take a shower (washing thoroughly) and place some rubber sheeting on the bed with several towels on top. If you cannot accept intercourse while still bleeding or discharging, put it off. Perhaps other forms of love play, cuddling, and release of sexual tensions can be used (e.g., massage, mutual masturbation, oral techniques).

8. DISHARMONY IN THE HOUSEHOLD. Work toward keeping the home environment as calm and peaceful as possible. Recall together your loving relationship and work to keep the bond you both had. Plan time together - alone. Plan a romantic dinner, some drinks, and dancing in your own home right before making love to set the mood.

9. FEELINGS OF NEGLECT, BEING OVERBURDENED, NOT BEING UNDERSTOOD, DEPRESSION. Share your feelings with each other. Give mutual understanding, comfort, help, and respect. Show your concern, interest, and love for each other. Stress the positives; delete the negatives.

10. CONFLICTING FEELINGS REGARDING BREASTFEEDING GIVING BIRTH, AND SEXUAL INTIMACY. Know that it is normal for breastfeeding to stir sexual feelings in a woman. Give yourself time to adjust to and accept your body's multi-roles: birth-giving, milk-giving, and sexual gratification.

11. CONCERN OVER NEW MOTHER'S NOT ACHIEVING ORGASM FOR A WHILE. Know that for several months after birth - sometimes as long as a year - orgasm may not be achieved. This is normal and although the cause is unknown, it probably has some relationship to hormonal changes.

CONTRACEPTION

When sexual relations are to be resumed, it is vital to have freedom from fear of an unwanted pregnancy. There are several factors to be considered in deciding upon the best contraceptive method for you:

SAFETY: The benefits of any contraceptive technique should be weighed against the possible health risks.

EFFECTIVENESS: You should be aware of the varying degrees of effectiveness among contraceptives and who is making the claims. Information may be biased, depending upon its source (e.g., drug manufacturers). Also, and very important, the degree of effectiveness depends upon the regular and proper use of a particular method. When a contraceptive is hailed as “effective,” such evaluation is based on perfect conditions wherein each method is used correctly and consistently. The most effective contraceptive is useless if used improperly. The “best” contraceptive for you may be the one rated lowest in effectiveness; your success with it will result from your adherence to its proper use.

COMFORT, CONVENIENCE, AND PERSONAL PREFERENCE: A contraceptive should be physically comfortable as well as easily adaptable to your particular lifestyle and habits.

EFFECT ON SEXUAL RELATIONSHIP: If the use of a particular contraceptive technique disturbs or diminishes the joy of the sex act for either partner, another method - or alternating methods to please both partners - should be considered.

COST: Contraceptives are much less expensive than the medical cost of a pregnancy. However, some contraceptives are less expensive than others and you might think it necessary to consider cost when making your decision.

The following are descriptions of available contraceptives and their respective advantages and disadvantages:

Oral Contraceptives

Birth control pills are made of artificially manufactured hormones which prevent conception by creating conditions within a woman's body similar to those present during actual pregnancy. Since ovulation does not occur during pregnancy, it does not occur if a woman takes her prescribed dosage of pills. Furthermore, oral contraceptives change the nature of cervical mucus and the lining of the uterus, thus preventing pregnancy. There are different types of birth control pills:

Combination pills contain both estrogen and progestin in each pill. Sequential pills contain estrogen only in each pill taken during most of the pill-taking cycle and a combination of estrogen and progesterone in each pill taken the last few days. Two or three days after taking the last pill - combination or sequential - you begin to menstruate.

Sequential pills are considered more of a health risk because the estrogen content is high and not balanced with progesterone in most of the pills taken during the cycle. The higher the estrogen content, the more risk of blood clotting. Sequentials are also less effective in preventing pregnancy than combination pills. If you miss a sequential pill or vary the time of day you take it, you risk becoming pregnant. Considering the higher risks and lower effectiveness of sequentials, these pills have been taken off the market in the United States, although some are still available in other countries.

It is important to know that different brands of either type have varying strengths and qualities of hormones.

If your doctor prescribes high-dose estrogen pills, ask if you have a particular medical condition requiring it. The natural estrogen and progesterone balances in your body which your doctor may not want to upset or exaggerate may have some bearing on the type of pill prescribed for you. You have the right to question why he or she chose a particular type and to know all the issues involved plus all the risks. If using one brand results in undesirable side effects, your doctor can prescribe a different brand more suitable to your body chemistry.

If you have any of the following symptoms, you should call your doctor immediately and stop taking the pill: severe headaches or vomiting, dizziness or fainting, severe leg or chest pains, weakness or numbness of an arm or leg, difficulty breathing, vision or speech disturbances, coughing up blood. (If you stop taking the pill under these circumstances, be sure to use other means of contraception.)

Before prescribing the pill, your doctor should examine your internal pelvic organs and breasts, take your blood pressure, test your urine and blood, and do a Pap smear. He should also ask about you and your family’s medical history to discover possible tendencies toward breast cancer, blood clots, poor blood circulation migraines, diabetes, etc., which would contraindicate pill usage. Tell your doctor about high blood pressure, liver disease, diabetes, irregular periods, previous pregnancies, abortions, miscarriage, or complications of pregnancy such as varicose veins and toxemia. Your doctor should also know about your menstrual cycles, how long they last, how heavy the flow, and if you experience fluid retention, swelling and tenderness of the breasts, cramps, and mood changes during your menstrual cycles. While taking the pill, you should be checked by a doctor every six months to a year, to insure that no condition has developed which would indicate that you should discontinue use of the pills.

If you are over thirty-five there is a higher risk of serious side effects if you take the pill. If you are over thirty and smoke cigarettes in addition to taking the pill, you‘re at even higher risk. If you have been using the pill for five years or more, you are also at high risk. When you want to conceive again, many doctors will advise you to use other means of contraception for two or three months after stopping the pill to allow your natural menstrual cycle to re-establish itself.

Advantages:

1. If used according to instructions, the pill is considered the most effective means of contraception (other than sterilization or abstinence).

2. There is no interruption of love play to apply contraceptive materials.

3. Your menstrual periods will be predictable every twenty-eight days.

4. You will probably have a shorter and lighter menstrual flow (if using the combination, low-dose pills).

5. You will probably have fewer or no menstrual cramps and premenstrual tension.

6. Certain ovarian cysts and breast changes occur less frequently in women using oral contraceptives.

Disadvantages:

1. You are risking major health hazards as well as other possible side effects: blood clotting (sometimes resulting in the loss of a limb or of sight, paralysis, or death), heart attack, stroke (caused by loss of blood circulation to the brain by clots or hemorrhaging in the brain, which can result in possible paralysis of all or part of the body, or death), rise in blood pressure, aggravation of an existing cancerous condition, growth of polyps (non-malignant tumors) in the lining of the uterus, headaches(migraine or other), increased susceptibility to venereal disease and vaginitis (an infection), changes in skin pigmentation, gum inflammation, fluid retention, weight gain, nausea, fatigue, breast tenderness, acne, breakthrough bleeding, missing a menstrual period or two, increased growth of body hair, decreased vaginal secretions, lower sexual desire.

2. You should not take the pill if you are breastfeeding.

3. You must maintain periodic gynecological check-ups to provide early detection of possible serious complications.

4. You must remember to take a pill every day, whether or not intercourse has taken place. If you stay away from home overnight or longer, you must prepare a supply of pills to take with you.

5. If you forget to take the pill when you should, you risk becoming pregnant that month. It is then advised that you use another means of contraception in addition to the pill as an extra precaution until your next period.

6. After you stop taking the pills altogether, it may take several months before your natural menstrual cycle returns.

7. If you conceive while on the pill, there is a chance that the fetus will develop congenital heart disease or other abnormalities. It is therefore advisable that you use a different method of contraception during the first three months after stopping the pill, before attempting to conceive.

8. The pill is ineffective when taken with certain other medications and in patients who have had lower bowel surgery.

9. If you need surgery, you must not take the pills for four weeks prior and four weeks afterward - because of the pill's tendency to affect blood circulation and blood pressure.

10. There are many conditions and family tendencies which contraindicate the use of the pill.

THE MINI PILL: This contains a low dose of progesterone only and is taken once a day every day of the year. Progesterone causes thickening of mucus in the cervix with the intention of blocking sperm from entering the uterus. Progesterone also affects the uterine lining, thereby inhibiting the implantation of a fertilized egg. The mini pill must be taken without fail every day and at the same time each day or you may become pregnant.

Because no estrogen is used, the risks of the serious illnesses associated with estrogen are reduced. However, there are other undesirable side effects known to develop, including: depression, decreased sexual desire, fatigue, increased appetite, irregular menstrual periods (or none), breakthrough bleeding.

MORNING-AFTER PILL: This is so named because it is used after unprotected intercourse has taken place. Because of its extremely potent nature, it should only be used as an emergency measure (such as after rape) and should not be substituted for a regular contraceptive method.

The pills contain diethylstilbestrol (known as DES), an artificial estrogen which acts quickly and effectively on the lining of the uterus to prevent implantation. DES causes extreme nausea and vomiting. If you must take this, your doctor may prescribe a companion drug to control the vomiting so you will not expel the pill.

In the 1940s and 1950s many doctors prescribed DES to women who had tendencies toward miscarriages, in the belief that the drug would prevent future occurrences. After over ten years of being prescribed, it was discovered that DES did nothing at all to prevent miscarriages. It did however have an effect on many of the daughters born to women who had taken DES during their pregnancies: it caused vaginal adenosis and, in some cases, cancer.

Women who were born in the 1940s and 1950s should check with their mothers and/or their mothers' doctors to determine whether DES was taken during their pregnancies. If so, DES daughters should be sure to notify their own doctors and have special vaginal examinations every six months in order to detect early pre-cancerous conditions.

You should be aware that if you take DES as a morning-after pill, and it does not work to prevent pregnancy, there is the possibility that a daughter born of that pregnancy may eventually develop vaginal cancer. There is also a possibility that a DES son might develop some form of genital disorder, although this has not yet been proven.

SYMPTOMS OF SERIOUS PROBLEMS: POSSIBLE CAUSE:
severe leg pain in calf or thigh severe chest pain or shortness of breath blood clot
severe headaches eye problems (blurred vision, flashing lights, blindness) stroke or high blood pressure
severe abdominal pain gall bladder disease

If any of these symptoms exist, do not wait! Stop taking the pill and contact a doctor immediately. Tell him or her what pills you've been taking and describe the symptoms.

IUD (Intrauterine Device)

The IUD is a device which, after insertion into the uterus through your vagina and cervical canal by a specially trained person, prevents implantation of a fertilized egg into the lining of the uterus. Nobody is quite sure just why this happens, although there are several theories.

This method is considered less effective than the pill to prevent pregnancy. However, there have been cases of IUDs being expelled without the woman's knowledge - and cases of pregnancies occurring with the IUD in place.

There are several types of IUDs available; your doctor should know which type is best suited for your particular needs. Some of these are:

THE LIPPES LOOP AND SAF-T-COIL. These are made of plastic and seem to be effective and safe when used by a woman who has had at least one child. (A uterus that has not been stretched by pregnancy tends to reject these.) Both come in different sizes; the larger the size possible to use in a woman's uterus, the Jess chance there is for pregnancy to occur. Small ones may be used in women who have never been pregnant.

COPPER T AND COPPER 7. these are considered effective with little likelihood of expulsion and are recommended for women who have never had children, although others may use them. They are made of plastic wound with fine copper wire. Copper has traditionally been credited with preventing conception, although no one knows exactly how. Tests have shown that the copper is eliminated from the body in normal uterine secretions, although some of it is undoubtedly dissolved into the blood stream.

PROGESTASERT. Based on the principle that progesterone inhibits implantation of a fertilized egg, this device emits the hormone in small quantities over a period of time until it is depleted - older models after one year; current models after two years.

(Note: The Dalkon Shield and the Majzlin Spring have been taken off the market because they were suspected of causing serious health risks.)

Important Points:

Most doctors will not insert an IUD until your six-week check-up because it may be rejected by your uterus before then.

Before getting an IUD, you should have a complete internal examination. A breast examination, VD test, and Pap smear should also be done. If you have a vaginal infection, an IUD can make it difficult or even impossible to cure and will probably make it worse. Furthermore, during insertion of the IUD, any existing vaginal infection can be carried into the uterus. The doctor must also be certain that you are not pregnant, because insertion of the IUD will almost always cause a miscarriage. In cases where miscarriage does not occur, the IUD can cause severe infection and complications.

You cannot use an IUD if you have an unusually small uterus, extremely heavy menstrual flows and/or cramps, VD, a vaginal or uterine infection, or pelvic inflammation.

Your IUD should be inserted by a specially trained person (usually a physician) and preferably one who has had experience with such devices.

You should know what kind of IUD you have and when it was inserted. Copper T and Copper 7 devices must be replaced every three years, and Progestasert once a year. Other IUDs need not be removed unless you want to become pregnant. If future findings result in the banning of a particular type of IUD from the market, you would need to know if yours must be removed.

After an IUD has been inserted, do not leave the examining room until you learn how to feel for the plastic strings from the IUD which protrude through your cervix. This way, you'll know how to check periodically to be sure the device has not been expelled without your knowledge. It is wise to check every week, after each menstrual period, and every time you have abdominal cramps. If you cannot locate the strings, try again the next day (your uterus may simply have tipped backward temporarily) and if you still can't find the strings in a few days or if you can feel the IUD itself, contact your doctor immediately.

It is often recommended that you use an additional means of birth control in the mid-cycle for the first three to six months after an IUD was inserted until your system becomes used to its presence and it is less likely to be expelled or fail to prevent pregnancy.

Call your doctor immediately if you develop severe cramps, fever, pelvic pain or tenderness, foul-smelling vaginal discharge, or unusual vaginal bleeding. (It is common to have a heavier-than-usual menstrual flow while the IUD is in place.) These symptoms may be signs of serious infection which can lead - if untreated - to a hysterectomy (removal of the uterus) or even death.

Never try to remove an IUD by yourself or have anyone other than a specialist remove it. You risk permanently damaging your cervix or perforating your uterus, possibly resulting in an emergency hysterectomy or even death.

If you become pregnant while the IUD is in place, your doctor may advise having the device removed, which may result in a miscarriage. However, if the IUD is left in place, there is a stronger chance that miscarriage will occur anyway. If the pregnancy should continue with the IUD in place, complications may occur - including infection and premature labor - although there is a good chance that the baby will be born at full term and unharmed.

Advantages:

1. The IUD is high on the list of effective contraceptives.

2. Spontaneous sexual relations can be enjoyed without having to interrupt foreplay by applying contraceptives – unless you are using additional means of contraception for more thorough protection.

3. The IUD is cost-free after the initial cost of the device and its insertion (and until eventually you pay the fee to have it removed when desired).

4. The IUD can remain in your uterus for years until you want it removed to allow pregnancy to occur or, if yours is a Copper or Progesterone device, until it needs replacement.

Disadvantages:

1. Insertion may be painful and may cause lightheadedness or even fainting spells during and soon after insertion. (A woman whose uterus has not been stretched by pregnancy usually experiences the most discomfort.) Sometimes a local anesthetic is needed for insertion and painkillers or tranquilizers are required for relief of cramps afterward.

2. Side effects include a heavier and prolonged menstrual flow; menstrual cramps; spotting or bleeding between periods during the first few months.

3. Possibility of serious pelvic infection.

4. Possibility of expelling the device with or without your knowledge. (This is more likely to occur in women who have not borne children.)

5. Possibility of perforating the uterus.

6. Possible backache.

7. You may need iron supplements due to loss of blood. (Copper IUDs seem to cause less blood loss than other types.)

8. If you are anemic, the heavy menstrual bleeding resulting from an IUD can be serious.

9. You must be sure to have a red blood cell count every year.

10. You must have the IUD removed by a physician if you want to become pregnant.

11. If you have never had a baby, the IUD can be painful because it is large for your previously unstretched uterus and may cause cramping, backache, or even expulsion of the device.

12. You should check the strings every week and after each period and abdominal crampiness to be sure it has not fallen out.

13. An IUD is not usually inserted until at least six weeks postpartum - sometimes three months.

Barrier Methods

THE DIAPHRAGM WITH SPERMICIDAL JELLY OR CREAM. The diaphragm is made of soft rubber in the shape of a miniature bowl with a flexible metal spring rim. When fitted and inserted properly, it should fit snugly over the opening of the cervix, held in place by the pubic bone in front and the vaginal wall behind. The diaphragm may be approximately two to four inches in diameter. Before insertion, spermicidal jelly or cream must be placed inside the diaphragm “bowl” and a little applied around the inside of the rim to kill any sperm attempting to get beyond the diaphragm. (Too much cream or jelly on the rim may cause slipping of the diaphragm.)

The diaphragm works in two ways: it blocks the entrance to the uterus and it presses the spermicidal cream or jelly within its cup against the cervical opening, thus killing any sperm which may have gotten past the blockade.

In order to be most effective, the diaphragm must be properly fitted, it must be used with contraceptive jelly or cream, it must be kept in place for at least six hours after intercourse, additional jelly or cream should be applied to the outside of the still-in-place diaphragm prior to each new act of intercourse that follows, and no douching should be done for at least six hours afterward.

To obtain a diaphragm, you must be examined by a physician who will measure you for the correct size. Usually, after having a baby - whether it was a Cesarean or a vaginal delivery - your diaphragm size changes, so do not use one that you used before your pregnancy. You 'til probably not be fitted until your six-week postpartum check-up and in some cases perhaps not until three months after having your baby, because there may still be swelling in the pelvic area.

After being measured and fitted, time should be arranged for you to be alone in the doctor's examining room to permit you to practice inserting and removing the diaphragm. The doctor should be called in to check if it has been placed properly. Before you remove it, feel what it feels like when it is placed properly. You doctor will either sell you one or give you a prescription for the size diaphragm you need. If it is well cared for, a diaphragm can last several years. After the initial cost of the diaphragm and the medical examination, the expense is only for spermicidal jelly or cream.

Advantages:

1. When used properly, this is a considerably effective means of birth control.

2. There is no known or suspected health hazard connected with the use of the diaphragm and spermicidal jelly or cream, although there are rare mild allergic reactions.

Disadvantages:

1. A diaphragm will usually not be fitted until at least six weeks postpartum and sometimes as long as three months.

2. You must be sure to insert the diaphragm with jelly or cream before having intercourse.

3. You must have it with you whenever you need it. You must be sure to have an adequate supply of spermicidal jelly or cream.

4. You must be sure to use additional jelly or cream (added to the outside of the diaphragm without removing it!) if intercourse is to be repeated - even if it is less than an hour after the last application of jelly or cream.

5. You must leave the diaphragm in place for at least six hours after intercourse has taken place.

6. The leaking of cream or jelly from the vagina after intercourse can be annoying. You may need to use a tampon or sanitary napkin.

7. You may need a different size diaphragm if you gain or lose ten pounds or more, as well as after each pregnancy.

8. Some women are allergic to rubber and must use a plastic diaphragm. There may be an irritation reaction to the spermicidal jelly or cream by the woman or her partner.

9. Even when the diaphragm is properly used, pregnancy can occur - although rarely. Because the vagina expands during intercourse, the diaphragm may be somewhat dislodged. Also, there is some suspicion that slipping of the diaphragm can occur from long sessions of intercourse with frequent insertions of the penis, woman-above positions, and if too much spermicidal cream or jelly is placed on the rim of the diaphragm.

VAGINAL SPERMICIDES These are available in aerosol foam, cream, or jelly form and are specifically designed to be used without a diaphragm or other contraceptive device. When placed high up in the vagina, by a special applicator, spermicides work in two ways: they form a barrier over the cervix, blocking sperm from entering the uterus, and they kill sperm on contact.

Aerosol foam is a white aerated substance much like shaving cream in color and texture. It is available in a can or bottle-type dispenser with a plunger-type plastic applicator. It is not as effective as a condom or a diaphragm used with cream or jelly. However, foam is more effective than cream or jelly used alone, because of its ability to spread more evenly throughout the vagina. (Note: The creams and jellies made to be used with a diaphragm are not to be used alone because their potency is less.) If you use foam without any other protection, be sure to insert two applicators-full, as close to the time of intercourse as possible. Many women use foam as an additional means of protection during the first month of using birth control pills, when using an IUD, or when their partners use condoms.

Advantages:

1. Spermicides are easily available without a prescription and can be applied easily.

2. They are not expensive.

3. They may be helpful against VD.

4. Some spermicidal agents are mildly lubricating.

Disadvantages:

1. Foam is not effective enough to be totally depended upon.

2. Application of foam, jelly, or cream interrupts lovemaking (unless the couple includes it in foreplay).

3. Creams and jellies are less effective than foam and they tend to leak from the vagina more than foam after intercourse.

4. You must - no matter how soon after the last application - apply more foam, jelly, or cream every time you have intercourse.

5. You cannot douche for at least six hours after intercourse.

6. The additional lubrication from these preparations may be a disadvantage in lovemaking for some couples.

7. You must always have an extra supply available for when you need it. (Some bottles and cans do not show when nearly empty.)

8. You must have your applicator and supply with you in case you need it while away from home.

9. Spermicidal agents may irritate either partner. The stronger and more effective the spermicidal agent, the more irritating it may be. During the early postpartum period, you may find you will be more prone to vaginal irritation.

10. Most spermicidal agents, which contain mercury and/or boric acid, can be harmful if swallowed. (There are one or two preparations which do not contain these ingredients.)

11. Spermicidal agents can make oral sex unpleasant because their taste is usually not palatable. (However, the latest preparation on the market is a jelly which its manufacturer claims is not only edible but pleasant-tasting as well and comes in a variety of flavors. FDA approved, it has the same active ingredient as other preparations.)

THE CONDOM The condom is a very thin sheath which is pulled over an erect penis just before intercourse. (A lubricant - never petroleum jelly - can be used on the condom after it is in place, to prevent tearing.) The tip of the condom catches the seminal fluid and prevents sperm from entering the vagina. If used with care and in combination with spermicidal foam in the vagina, this can be an effective means of birth control. Condoms cannot be kept in a wallet, pocket, or warm place for very long or they will deteriorate. If there is accidental spillage of seminal fluid into or near the vagina, use spermicidal loam, cream, or jelly immediately to kill as many sperm cells as possible. (Keep a supply readily available for such emergencies.)

Advantages:

1. Easily available without prescription, inexpensive, and easy to apply.

2. No known or suspected health hazard.

3. It protects against VD and other infections.

4. For men who tend to ejaculate quickly, a condom can help decrease stimulation and prolong intercourse.

Disadvantages:

1. Putting it on interrupts spontaneity (unless done as part of foreplay).

2. The woman is dependent upon her partner to provide protection.

3. A condom might be defective. It may have deteriorated from non-use or extreme temperature conditions.

4. It must be put on before any contact is made between the penis and vaginal area - because even the first few drops of discharge from the penis can contain enough sperm for pregnancy to occur.

5. It must be removed very carefully.

6. The condom minimizes sensation for the man. It minimizes lubrication for intercourse, usually requiring additional lubrication to prevent vaginal irritation. (Never use petroleum jelly; there are pre-lubricated condoms available, but they tend to slip off easily.)

Rhythm Method

This involves predicting fertile and non-fertile days in each menstrual cycle according to the time of ovulation and the life span of the egg and sperm cells. There seem to be approximately seventy-two hours each month when pregnancy can occur. A woman using the rhythm method refrains from having intercourse during those days - and several other days before and after as an extra safety measure.

Using this “calendar” method is not an accurate means of determining fertile days; it is simply an estimate. Although ovulation usually does occur at approximately the same time each month for many women, there is the chance that it might occur at any time before or after. If you have a strictly regular menstrual cycle which never varies, you have a better chance of using the rhythm method - but you are still taking a chance.

Advantages:

1. This is an accepted method of birth control for some religious groups.

2. There is no interruption of love play to apply contraceptives.

3. There is no cost.

4. There is no health hazard.

Disadvantages:

1. This is not a reliable means of birth control because ovulation can occur off schedule, or sperm may remain in the cervix longer than expected.

2. Since there are specified “safe days” for having intercourse, the spontaneity of sexual relations is affected.

The Basal Body Temperature Method

This method is used to calculate “safe” and fertile periods. It is based on the fact that before ovulation, a woman's body temperature drops slightly and then rises considerably twenty-four to seventy-two hours afterward. By keeping a chart of her body temperature highs and lows for a few months, a woman can determine her periods of ovulation - provided that her body temperature is not affected by illness, irregular sleeping habits, and other possible factors.

A special Basal Temperature Thermometer is necessary for accurate readings. You must follow directions carefully for most effective evaluation of “safe” periods. This method, if used carefully, may be the most effective way to practice the rhythm method.

The Billings Method

Just before ovulation occurs, cervical secretions become egg-white or clear - compared to the yellowish mucus usually present at other times of the month. Learning to recognize the differences in mucus discharge can aid in determining fertile and “safe” days. Effectiveness of this method is better if “safe” days are limited to those known to occur after ovulation.

Vaginal Tablets And Suppositories

A tablet or suppository is inserted into the vagina prior to intercourse. Body heat will cause it to dissolve and the spermicidal content is intended to kill sperm cells. However, these agents are less effective than creams or jellies and much less effective than foam because the spermicide does not spread evenly throughout the vagina.

Douching

This is an ineffective method. By the very act of flushing out the seminal fluid from the vagina after intercourse, you may actually be spraying some upward into the cervical canal.

Withdrawal

Withdrawing the penis during intercourse prior to ejaculation is not an effective means of birth control. First of all, there is a chance that the pre-ejaculatory fluid - even a few drops - may contain enough sperm to cause pregnancy. Secondly, even if pregnancy does not occur this way, any seminal fluid released from the penis and in contact with the vaginal lips can result in pregnancy.

Withdrawal takes away much of the joy of sexual intercourse for both partners. Both are concentrating on withdrawing “in time” instead of relaxing and enjoying themselves. If used habitually over a long period of time, this method can lead to premature ejaculation.

Female Sterilization

This is a surgical procedure and a permanent form of birth control. It is used when it is absolutely certain that no more children are desired because it is most probably irreversible.

For a woman to be sterilized, she is usually given general anesthesia and her Fallopian tubes are then cut and tied off or cauterized, preventing an egg and sperm cell from ever meeting. This is done either through the abdomen or the vagina, and requires a hospital stay. Sexual hormones and egg cells continue to be produced. The only difference sterilization makes is that the egg released by the ovary is prevented from meeting sperm because its path is cut off. Sexual drive is not affected - unless there are contributory emotional factors.

Traditional sterilization - called “tubal ligation” involves an abdominal (or sometimes vaginal) incision through which the doctor cuts out a piece of each Fallopian tube and ties off the ends.

Another technique is known as laparoscopy, by which a very small incision is made into the abdomen at the navel, through which a tiny tube with a light and mirror is inserted. A second small incision is made at the pubic hairline, through which another instrument is inserted in order to cauterize the Fallopian tubes.

The hospital stay for the traditional abdominal incision technique involves four to five days because it is considered major surgery. For the vaginal incision technique or laparoscopy, only one or two days in the hospital are required and in some cases you can go home the same day. Sterilization fees vary, but they are high, as is the cost of most surgical procedures.

Sterilization can be done while you are still in the hospital after having a baby. However, many women do not choose to have it performed at this time because it is too final a step to take immediately after giving birth, when the baby's condition is not always stable. On the other hand, some women do have it done while still in the hospital because it is more convenient and costs less than if they had to return another time.

Advantages:

1. Sterilization provides permanent free-from-worry birth control.

2. There are no known or suspected long-term health hazards.

Disadvantages:

1. It is costly and requires a hospital stay.

2. There are some risks from anesthesia and other complications, as in any surgical procedure.

3. There may be psychological reactions to the procedure which may affect the woman's sexuality.

4. It should be considered irreversible.

Male Sterilization

This is called a “vasectomy” and is usually done in the doctor's office or in a special clinic. Using a local anesthetic, the doctor, through an incision in the scrotal skin removes a piece from each vas deferens (the tubes which carry sperm from the testicles to the penis) and ties off the ends. The procedure takes about a half-hour.

A vasectomy does not affect ejaculation. Sperm is only a small part of the seminal fluid. Sexual hormones and sperm continue to be produced. The only difference that vasectomy makes is that sperm is prevented from reaching the penis and being expelled with ejaculate. Sexual drive is not affected - unless there are contributing emotional factors.

Advantages:

1. Vasectomy is less expensive than female sterilization because it is a simpler and faster procedure.

2. There is no hospitalization.

3. There are no known or suspected health hazards.

Disadvantages:

1. There may be psychological reactions to the procedure which can affect the man's sexuality.

2. It should be considered irreversible.

Abortion

Unfortunately, some people rely on abortion as a means of birth control. Abortion is the termination of pregnancy by removing the fetus and placenta from the uterus. It is considered unwise to use repeated abortions as a means of birth control because after several abortions there is a higher risk of miscarriage during a future wanted pregnancy.

Warnings

1. Never rely on breastfeeding as a means of contraception. Although ovulation may be inhibited by breastfeeding, it also may not!

2. Never use the same diaphragm which was used before your last pregnancy - until your physician examines you and prescribes the correct size needed. For adequate protection, you may need a different size after each pregnancy and after a gain or loss of ten pounds.

3. Never take anyone else's birth control pills. The hormone content was prescribed for her! Your system may require different dosages or the pill may be life-threatening to you.

4. Never lie to your doctor about previous or current physical conditions or family medical history and tendencies - in order to have the pill prescribed. You may be flirting with serious illness and death.

5. Never try to remove your own IUD. You may be flirting with serious illness and death.

6. Never try to insert anything into your cervical canal to induce abortion. You are risking serious illness and death.

Your doctor will probably advise that you cannot resume sexual relations until after your postpartum checkup - usually six weeks after delivery, although some doctors will approve intercourse after a two-week checkup

Because the fitting of a diaphragm or insertion of an IUD is usually postponed until several weeks after delivery, because spermicidal agents may cause irritation, because rhythm is unreliable during the early postpartum period, because the pill should not be used while breastfeeding, and because sterilization is too final a procedure for young parents, you may have only one choice - the condom - if you do not wish to conceive!

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