Saturday, December 27, 2014

The Sociology and Science of Methods of Temporary Birth Control

by Dr. Margaret Aranda
Full, expanded version can be seen on Hormones Matter
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Women Helping Women!


******** If you want to have sex and use oral contraceptives, DON'T SMOKE! *******


So you are all big and grown-up now, and you have a boyfriend who makes your heart race every time he walks into the room. You've talked with him and you have both decided to have sex; but first, you asked him/her the following, because you are smart and you want to live a long life: 

1. How many sexual partners have you had? Sociology may tell you that he is a) still a virgin; 2) has had over 200 sexual partners; or 3) under 10.

2. Have any of them came back to him to tell him they had syphilis or any sexual disease? Sociology usually dictates that people like to be liars and not be truly honest with past partners. Or, sociology could say that a person who caught a sexual disease is perfectly happy to tell you, so that it hurts you and is just spiteful. Scientifically, MDs can determine the truth.

3. When was the last time he was tested for HIV? For chlamydia? And you?
     You both need to be checked via blood samples. This is straight Science.

4. You need to tell him the number of sex partners you have had, whether any partners later told you that they were infected with a disease, AND whether you took the proper medications for the prescribed length of time.
You owe this to Society so that diseases are not further spread.

5. Because of your concern over sexual diseases, you must tell your "almost new" partner that you would like him to use a condom until all the blood tests are back and you can both re-evaluate the situation. Nothing personal, it's just straight science. You are just being smart.(In the meantime, you may want to get a copper IUD placed, or talk to him about what contraceptive to use, since he is the reason you are using it. If he does not want to be part of this discussion, that's a RED FLAG that you won't be able to share your problems or life's problems with him as a caring partner. 

6. You never have sex with random people, or one-night stands with a guy that you just met that day. N-E-V-E-R. That is straight Sociology AND straight Science. And we care about you. So don't do it.

7. I think your sweet face would look uhm..different... with Hepatitis A cold sores around your mouth when it's sunny and you are stressed; let alone what your outer vagina and labia would look like with Herpes sores; or what your rectum would look like with Genital Warts from Herpes Papilloma Virus that someone else gave you when you had one night in your whole life that you went out on a drinking binge. Really. You need to have more self-esteem than that! You're so young! You're so beautiful! We're not going to let you throw yourself to the keep your wits about you, stop the horniness from escalating, and saying, "NO" is a great contraceptive without side effects. Pair up. Don't even walk to your car alone, my dear. 
You are just too precious.


1. ORAL CONTRACEPTIVES: The woman stays on a rigid regimen (i.e., same time, every day) needed to "work" at preventing pregnancy. Serious side effects: if you are obese and smoke, puts you at danger of a pulmonary embolus and immediate death.  The blood settles in your lower legs or pelvis, dislodges when you sneeze, goes to your heart and then to your lungs, and you can't breathe through a blood clot in your lungs. You die unless they crack your chest opened, put you on bypass, and get the clot out. You just can't breathe.

2. PROGESTIN-ONLY PILL: Like the regular Pill, it is taken at the same time every day. it does not contain estrogen; it only contains progestin. Ask your doctor, but the manufacturer thinks it is ok to use while breastfeeding. Your doctor will decide when to start, depending on how much breastmilk your baby is taking. Side Effects: can occur with allergy to progestins, aspirin, tartrazine, Tegretol, phenobarbital, phenytoin, and rifampin. Tell your MD if you have ever had: breast lumps or cancer, vaginal bleeding between periods, liver disease, diabetes. SERIOUS Side Effects: Smoking cigarettes increases the chance of heart attacks and strokes. DO NOT SMOKE if you take this med. Headache, dizziness, breast pain, bleeding for a long time, menstrual periods that just stop, and severe pain in the stomach.

3. THE NuvaRing: Higher likelihood of pregnancy, because the Ring sometimes slips, and offers no protection against sexual diseases. Serious side effects: (i.e., of the NuvaRing) include stroke, heart attack, or blood clots. The manufacturer advises NOT to use it if you are over age 35 and smoke cigarettes, because you have a higher risk of blood clots that can be fatal. It's not for women with high blood pressure on meds. It's not for women with diabetes and end-organ damage of the kidneys, eyes, blood vessel, or neuropathy. It is not for women with vaginal bleeding, liver disease, certain migraines. The Most Common Side Effects: vaginal irritation, headaches, migraines, increased weight, discharge or discomfort from the vagina, pain, discomfort, or tenderness from the breasts, menstrual and/or abdominal pain, acne, mood swings, depression, and decreased sexual drive (i.e., What? Seems like the risks are not worth the benefits to me, but you go talk to your own doctor AND get a second opinion). This list just seems to go on and on.

(In my book, Archives of the Vagina: A Journey through Time, I espouse chastity until marriage. Here is a great example of how messed up a young woman's body can get when she tries to protect herself from getting pregnant; but go ahead and read on ~ there's more. Personally, you'd better put a ring on my finger and be committed to me before I ruin my body or brain for you, and/or separate myself from my relationship with Christ).

4. The IUD, or Intrauterine Device: Over 99% effective, and it stays in. No protection from sexual diseases. Some babies have been born with a T-shaped indentation on their forehead, the back of the head, or other places. More on the copper IUD later. And always use it with SPERMICIDE.

6. THE PATCH: This method of contraceptive delivers hormones through the skin, and measures 5 x 5 cm. It contains the same mixture of hormones as the combined pill, and works the same way (i.e., by preventing ovulation). When used correctly, lasts for one week and is 99% effective. It's 3 weeks on, then 1 week off. May alleviate painful or heavy bleeding periods. Side Effects: It may increase blood pressure, leading to headaches or migraines. May lead to blood clots if you are over 35 years of age, smoke, and are overweight. NOT to be used if you are pregnant, breastfeeding, or taking medicines like antibiotics, St. John's Wort, epilepsy meds, Tuberculosis meds, or HIV meds. Talk to your doctor. HEALTH BENEFITS: The patch may protect against ovarian cancer, uterine cancer, and colon cancer. 

6. THE PROGESTIN-ONLY INJECTION: Must be taken on schedule, same time/day each month. If no mistakes made with injection timing, pregnancy rate is 1%.  But since we are human and we must expect variability, the expected pregnancy rate is 3%, or 3 in 100 women. It stops the release of eggs from the ovaries. This injection lasts 2-3 months (e.g., DMPA = 3 mo; NET-EN = 2 mo), and is safe after 6 weeks of birth to use while breastfeeding. Stopping it may take a longer time to get your period back. Does not protect against HIV. Contraindications: Breastfeeding a baby less than 6 weeks old; uncontrolled high blood pressure; rare diseases you discuss with your doctor; seizure medicines or rifampin for tuberculosis. Tell your doctor before you get a prescription. Side Effects: Variable periods, or no periods; headaches, migraines, dizziness, and gain weight.  HEALTH BENEFITS: Helps prevent cancer of the uterus lining; helps prevent uterine fibroids; may protect against pelvic inflammatory disease (PID); can prevent iron deficiency anemia from blood loss; reduces pain and irregular bleeding from uterine fibroids. 

7. DIAPHRAGM WITH SPERMICIDE: The diaphragm is shaped like a dome, covering the cervix so the spermies don't get in the uterus. It has a flexible ring around it so you can grab onto it with your fingers. Meant to be used with SPERMICIDE, together you have a sperm barrier and a sperm killer. You put it in no more than 2 hrs before sex (squatting helps), and take it out at least 6 hrs after having sex. More sex? Add more SPERMICIDE each time.
Success rate is 84 - 94 % effective, and the failure rate goes up if you and your partner have sex over 3x/week. Your size is determined by your doctor. RISKS: It is not proven to reduct the risk of HIV or AIDS.

8. CERVICAL CAP WITH SPERMICIDE: Not a good choice for women who have already had a vaginal delivery. The cervical cap is a soft latex or silicone cup with a rim, that sits around the cevix and like the diaphragm, it is fitted by size via a doctor visit. FemCap is one name of a cervical cap. You coat the inside of the cap with SPERMICIDE, and then put in the cap through your vagina, to cover the cervix. It has to stay in for at least 48 hrs to make sure it kills any spermies. Success rate is 17 - 23% effective, so better not use this method unless it is okay if you get pregnant (because you might). No need to put in more SPERMICIDE if you have sex again. RISKS: Some women may have latex allergy and anaphylaxis, requiring emergency medical treatment. Rarely, it may cause toxic shock syndrome. 

9. MALE CONDOM: AKA a "rubber," (and who can't laugh at that?), it is a thin membrane made of latex, plastic, or animal (?really? Yes.) membrane that is rolled over an erect penis. You can't really "get it on," literally, if the penis is soft. So for our elder gentlemen, they may need a little 'help' with getting the penis 'hard' first, before the condom is rolled on. The condom is supposed to get caught in a little bag-like thing at the end of the condom, preventing spermies from entering the vagina at all. SUGGESTION: Use vaginal spermicide at the same time. They come in different sizes, shapes, colors, flavors, thickness, and lubrication. Also, studies show that if a condom is placed 'in a hurry,' it is more likely to rip or tear. So, take your time. And Ladies, always protect yourself.

10. FEMALE CONDOM: The female condom protects against pregnancy by forming a barrier, and may not work 'as well' as the male condom in preventing sexual infections. The condom goes inside the vagina and at each end, there is a ring. The inner ring is closed, and sits at the cervix; the outer ring is opened and sits at the outer vulva of the vagina. The FEMALE CONDOM is 72 - 85% effective in practical use, but if used properly every single time, female condoms are 95% effective. 

11. COPPER IUD: The copper IUD is a T-shaped plastic rod that remains in the uterus, releasing copper. Copper acts as a spermicide, being over 99% effective. The copper IUD lasts 10-12 years and can be used during breastfeeding. Upon insertion, you may have heavy periods or cramps. SERIOUS RISKS: UPON placement include: fever, chills, belly pain. If you have a home pregnancy test positive, or have symptoms of pregnancy, call your doctor immediately.

12. PROGESTIN-ONLY IUD: Also known as Mirena, it is a progestin-only IUD that can remain in place for up to 5 years. It prevents sperm from reaching or fertilizing an egg. It releases levonorgestrel into the uterus, thickening mucous secretions and thereby preventing pregnancy. It is estrogen-free.
USES: Besides uses for contraception, it may help treat heavy periods. 

Progestin-only contraceptives are suggested to be used by Lopez, et al, from analyzing the Cochrane Database System Review on a June 24, 2014 publication that was retrospective, yet looking for a relationship between progestin use and bone fractures. Archives of the Vagina: A Journey through Time devotes a Chapter to Fractures, as I have witnessed all too many elderly women laying on my OR table for falling and sustaining a fracture. We must, as a country, dispel the notion that older women need to end up in a nursing home because they can't go home with no one to care for them after their hip fracture. 

For patients with Lupus, Cravioto studied various methods of contraception in 162 patients. Their findings showed that with counseling and proper training, oral contraceptives and IUDs were proper methods for women with lupus. The Progestin-only Pill was found to be inferior in this population.

The moral of the story? Yes, you may be old enough to have "your freedom" and make your own choices and do "whatever you want." But...and never forget this...Each Choice has its own Consequences.

You make your bed, you lay in it. You have sorrow and you want forgiveness, go to your parents. You will find that your mother has been praying for you every single day. Now go.

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Dr. Margaret Aranda's Books:

No More Tears en Espanol
Face Book Page: Stepping from the Edge
Little Missy Two-Shoes Likes to go to School
From Menarche to Menopause: A Journey through Time

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10. Lopez, et al.  2014 Jun 24;6:CD006033. doi:       10.1002/14651858.CD006033.pub5.

11.10. Cravioto, et al. Side effects unrelated to disease activity and acceptability of highly effective contraceptive methods in women with systemic lupus erythematosus: a randomized, clinical trial.  2014 Aug;90(2):147-53. doi: 10.1016/j.contraception.2014.04.001. Epub 2014 Apr 13.

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