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BIRTH CONTROL: CONTRACEPTIVES AVAILABLE WITHOUT A DOCTOR'S PRESCRIPTION
Condom. The most widely used contraceptive device in the United States, the condom is made of strong thin rubber, or of sheep's intestine. At its open end, which is about an inch and a half in diameter, there is a rubber ring. The closed end is usually plain, but it may have a pocket to provide space for ejaculated semen, thus lessening the possibility of its bursting. The condom usually measures seven and a half inches in length.
As a result of the U.S. Food and Drug Administration's placing condoms under its control, the product has been improved. The only drawback to its being totally effective is the possibility of breakage during use, or of its slipping off after ejaculation, with the result in either event that semen may be spilled into the vagina. The second eventuality can be avoided if there is adequate lubrication and if the condom is held onto while the penis is being withdrawn from the vagina after ejaculation. Condoms should always be inspected before use by blowing air into them, and it is advisable afterwards to fill them with water to be sure that no breakage has occurred. If a condom breaks in use, a contraceptive cream or jelly should be applied vaginally immediately. If none is available, a water douche should be used, since water is highly spermatoxic.
The efficiency in design and manufacture of the present-day rubber condom dates from about 1920, although the discovery of vulcanized rubber in the 1840s made possible the production of the condom on a large scale over a hundred years ago. Condoms made of linen or silk were used by the Italians and Chinese before the 17th century, principally as a prophylactic measure against venereal disease8" rather than as a contraceptive device.
Prior to the development of the vulcanization process, the French and English used sheep gut or the amniotic membrane of newborn lambs375 to fashion fairly satisfactory condoms. In recent years, manufacturers are again producing gut condoms, which, while more expensive than rubber condoms, appear to be as safe as the rubber ones, and which are aesthetically preferable because they interfere less with body warmth and other pleasurable sensations experienced during coitus.
With the exception of withdrawal (discussed in following paragraphs), the condom is probably the most frequently employed birth prevention technique, although it is used more in nonmarital than in marital coitus. About 750,000,000 condoms are produced each year in the United States. They are cheap, available in most pharmacies, simple to use, and easily disposable.
Some men object to the condom because it somewhat dulls pleasurable sensations. Also, its use may interfere with the natural progress of mounting sexual tension because sexual play must be interrupted in order to put it on. The pregnancy rate of the condom can be judged to be about 10 or 11, since estimates in individual studies range from 6 to 19. The condom is certainly the best method, after total abstinence, of preventing the spread of venereal diseases.
Chemical methods. The most effective of the chemical methods of preventing conception are creams, jellies, and vaginal foams.
They are used for two reasons: they serve to block the entrance to the uterus, and they contain an ingredient that is toxic to sperm. They must be introduced about five to fifteen minutes before ejaculation occurs, and if intercourse is repeated, more cream or jelly must be used.
Another chemical method involves the use of a vaginal suppository, a small solid cone that melts at about 95 F. It is toxic to sperm, but the disadvantage in its use is that it must be inserted at least fifteen minutes before ejaculation if it is to be effective. Suppositories usually have one of three basescocoa butter, glycerin gelatin, or soap. Pregnancy rates vary from 5 to 27.
Vaginal tablets have the same drawbacks as suppositories. Moisture is needed to dissolve them and it may not be present in sufficient quantity. The tablets, moreover, are very unstable in damp climates. They are given a pregnancy rate of 8 to 27.
Douche. The theory behind douching as a contraceptive measure is that semen can be flushed from the vagina before it has a chance to enter the mouth of the womb. Actually, however, sperm move so quickly that the douche often fails to reach them. Although water makes a satisfactory douching solution, strong soapsuds, three tablespoonfuls of vinegar, or a teaspoonful of alum per quart of water is probably better. Douching is not medically approved as an effective method of birth control, since it has the unsatisfactory pregnancy rate of 36. It serves better to cleanse the vagina than to prevent pregnancy.
Other contraceptives. A sponge and foam combination is a contraceptive that is inexpensive but relatively ineffectual. The sponge is dipped in water and squeezed; the contraceptive ingredient is then added and worked into a foam. The sponge, which is inserted deep into the vagina before intercourse, will remain effective for several hours. Another sponge can be added to the first one if intercourse is repeated. The sponge must remain in place for six hours following the last act of coitus. No douche is necessary.
Another contraceptive means is a tampon containing a spermatoxic chemical, which is inserted into the vagina as close to the cervix as possible. The chemical is a contraceptive jelly that begins a foaming action upon contact with sperm. This method and the one described in the preceding paragraph have the poor pregnancy rate of 27 to 42.
A recent innovation in contraception consists of foam preparations that are inserted into the vagina by. way of an aerosol spray can. These products contain effective spermicidal powders; they are easy to apply and have a pregnancy rate of from 3 to 10.
As part of their extensive research on human sexual response, Masters and Johnson investigated the effectiveness of eight commercial contraceptive products;170 none of the methods testedtwo creams and one each of a vaginal jelly, a liquid, a gel, a tablet, a foam, and a suppositorywas given perfect scores in the various tests performed. Each of the women taking part in the tests had her cervix capped, used the contraceptive according to the manufacturer's instructions, and engaged in artificial coition by means of a plastic penis until she had an orgasm. At this point, fertile semen was introduced into the vagina, and samples of vaginal content were taken from various parts of the vagina, the first sample being taken within one to five seconds after semen injection, followed by samples taken after fifteen seconds, thirty seconds, sixty seconds, two minutes, and five minutes. In another series of artificial coitions, which involved the same contraceptives and which was similarly conducted to the point of orgasm, the same sampling procedure was instigated one hour after injection of semen, then three and five hours later.
Findings of the study were that the diaphragm failed in a large percentage of the cases investigated (8 of 30) because of vaginal and uterine enlargement during the sexual response cycle, and because the reinsertion of the penis after the initial insertion and withdrawal tended to dislodge the diaphragm from its snug and properly fitted position. There was evidence, furthermore, that even a highly spermatocidal chemical may not be effective if the substance containing it does not dissolve or spread properly within the vagina. A chemical may be very effective in a suitable foam, but ineffective in a jelly, cream, or foaming tablet.
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Men's Health Erectile Dysfunction
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Pharmacy Information
BIRTH CONTROL: CONTRACEPTIVES AVAILABLE ONLY WITH A DOCTOR'S PRESCRIPTION
1. A diaphragm is a thin rubber dome-shaped cup stretched over a collapsible metal ring, designed to cover the mouth of the womb (the cervix). Properly fitted and used with a contraceptive cream or jelly, the diaphragm seals off the cervix and prevents sperm from entering the womb. The cream or jelly is toxic to sperm, and provides lubrication as well. This device in no manner interferes with the conduct or pleasure of intercourse.
The diaphragm can be obtained only by prescription from a physician, and must be fitted by him the first time. Because of individual differences in women, a diaphragm of the correct size and shape is of vital importance, both for the wearer's comfort and for its effectiveness as a contraceptive. After the initial examination and insertion of the diaphragm, the physician will instruct his patient how to insert it properly herself, and how to remove it. A virgin cannot be fitted with a diaphragm until the hymen is broken. Physicians are therefore reluctant to prescribe a diaphragm for any woman until after her honeymoon.
A diaphragm may be inserted several hours before or immediately preceding coitus. It must not be removed until four to six hours after intercourse, and it may be left in place for as long as twenty-four hours. Douching (discussed more fully hereafter) is unnecessary, since the natural processes of a healthy woman keep her vaginal tract clean. If she prefers to douche, however, she must wait at least six hours following coitus in order for the spermicide cream or jelly, or the naturally acid condition of the vagina, to destroy the sperm. Diaphragms are considered by many to be inconvenient, uncomfortable, and rather difficult to use. For other couples, the advance preparation implies a loss of spontaneity that detracts from sexual pleasure.
With the use of this device and a contraceptive jelly, the pregnancy rate varies from 4 to 10.
A cervical cap is a small deep cup usually made of plastic that fits snugly just over the cervix. Because the cervix lies so deep within the vagina, and because it is essential that the cap fit snugly, it must be fitted by a physician. Women can be trained to insert the cap, but many seem unable to learn the technique. This method of contraception is, therefore, not often used in the United States, although it is in fairly common use in Europe. Once the cap is fitted properly, the penis is not likely to dislodge it. It cannot be felt by the wearer, and it can be worn the entire time between menstrual periods. Caps made of rubber can be worn only about twenty-four hours. The cervical cap used with contraceptive cream or jelly is considered to have about the same pregnancy rate as the diaphragm used with contraceptive cream or jelly. Because the cervical cap is left in place between menstrual periods, some of the disadvantages of the diaphragm are eliminated.
Oral contraceptives (birth control pills, popularly called "the pill"). It was demonstrated in 1937 that the administration of the ovarian hormone progesterone would inhibit ovulation in rabbits. Since that time endocrinologists, biologists, chemists, and physicians using this and other information, and working together and separately, have developed a method of contraception for human beings that is apparently superior to any method previously employed.1 In 1954, an oral contraceptive in the form of a pill was used in laboratory studies, then two years later in Puerto Rico and Haiti in well-controlled studies to determine its safety and effectiveness. The experiments were tremendously successful. Since that time, pharmaceutical houses have been working overtime to supply the public with the pills, and to produce even better oral contraceptives.
The birth control pill is a combination of synthetic hormones (progesterone and estrogen) that, when taken in adequate doses, prevents ovulation by mimicking the body's natural hormones produced during pregnancy. If no ovum is released, pregnancy obviously cannot occur. The pill actually does several things to prevent or to make pregnancy extremely unlikely to occur. First, pituitary gonadotropin production is inhibited, which interferes with the growth and development of the ovarian follicles. In addition, the uterine mucosa is affected in such a manner as to make implantation more difficult and early spontaneous abortion more likely if an egg were to be fertilized. The mucous plug of the cervix is thickened and made more formidable by the hormonal agents, thereby helping to prevent sperm from entering the uterus.
Counting from the first day of her monthly menstrual period, a woman starts taking the pills on the fifth day. She must swallow one pill daily, and preferably at the same hour, for twenty days. Menstruation will start two to five days after the last pill is taken, although in about 3% of the cases, it fails altogether to commence. In this latter event, a physician usually advises his patient to commence a new round of twenty pills seven days after the last pill was taken, or he will offer alternative suggestions.
If one pill is missed, there is a chance of pregnancy, but it is rather remote. If taken as prescribed, however, contraceptive pills are virtually 100% effectiveand their success is unequalled by any other means of contraception.
During the early months of taking contraceptive pills, women seem to experience little reduction in sexual desire. The knowledge of being well protected against an unwanted conception often removes anxiety from both husband and wife, thereby increasing sexual desire in both partners. Authorities have warned women, however, to expect some loss of sex drive after protracted use of the pills because of their interference with normal hormonal production.3'5 Masters and Johnson report that a reduction in women's sex drive occurs after their taking the pills for eighteen to thirty-six months, and they suggest that other contraceptive methods be substituted for the pill from time to time, according to the advice of the individual woman's physician, in order that the original hormonal balance can be restored.217 The pill is also used to treat certain discomforts and disorders of the menstrual cycle, such as irregularity, too copious flow of blood, and discomfort before or during menstruation.
As contraceptive pills have been used, studied, modified, and improved upon since their initial introduction, the negative side effects have largely been removed. Occasional discomfort or unpleasantness may still be experienced by some women who take them, especially in the first months. The most common symptoms reported are mild gastrointestinal disturbance, nausea and a bloated feeling, increase in weight, and spotting and irregular bleeding. Other occasional negative side effects are persistent menstrual-like cramping and painful swelling of the breasts.
A considerable amount of research is being done on a pill for men that will induce temporary sterility. To date, however, there are unfortunate side effects when men use a pill of this nature, in that sex drive is reduced and the intake of alcohol produces abnormal reactions. Much further experimentation, therefore, in this aspect of contraception is indicated.
This means of contraception, as has been pointed out, is considered 100% successful when used as directed. Even when a woman occasionally misses taking one, the pill still has the excellent pregnancy rate of 3 to 7, equaling the best mechanical device. A birth control pill designed to prevent implantation of the fertilized egg is presently being studied. This pill, if taken just after sexual intercourse, would act for the next few days to prevent implantation of the fertilized egg. Vaccines to immunize people against fertility for several months are also being investigated.
A pharmaceutical house has recently produced an effective oral contraceptive for dogs. The pill, administered each day for thirty days before the female's estrus period, suppresses that period without affecting the animal's capacity for producing healthy litters in the future.318
4. Intrauterine contraceptive devices (IUCDs) are small plastic or metal devicesplastic being preferred over metal because of its flexibility and the greater chance of its not being rejected by the subject's body tissueof various sizes and shapes. They are designed to fit into the womb, and in some way they act as an irritant to prevent implantation of the fertilized ovum in the uterine wall. Technically, this method is more correctly called contraimplantation than contraception.
The device must be selected and fitted in the uterus by a physician. It remains permanently in place until the user wishes to become pregnant, at which time the doctor will remove it. After the birth of a child, it may be repositioned in the uterus until another pregnancy is desired. The device in no way affects the health of any children borne by the woman or her ability to conceive.
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Men's Health Erectile Dysfunction
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