Posted in contraception, Genitals: A User's Guide, Uncategorized

Put a Ring On (?/In) It!

Last week I was interviewed for Cosmopolitan about ‘femidoms’ or internal condoms. These are one of a handful of contraceptives that often get talked about in sex ed classes, but appear to be less commonly in use.

Another type of contraception that this can be said about is the vaginal ring.

It gets its name from it’s shape – it’s a ‘ring’ made from a soft rubber like materials, about 5 cm across. It is inserted in to the vagina by the user and once inserted sits just below the cervix.

It’s another type of hormonal contraceptive – which means it protects against pregnancy by affecting the womb, ovaries and the fertility cycle.

It contains the same hormones as the combined pill – oestrogen and progesterone. Because of this, it works in a very similar way:

  1. Stops the ovaries from releasing an egg.
  2. Helps make the lining of the womb stay thin, rather than building up (a thick womb lining is needed for a fertilised egg to implant in and grow).
  3. Helps create a thick ‘plug’ of mucus in the cervix – the entrance to the womb. This helps stop sperm from entering the womb from the vagina in the first place and coming in to contact with an egg.

Also like the combined pill, the vaginal ring is used for three weeks and then not for one week – usually with a ‘withdrawal bleed’ in this week off. The main difference is that whilst the pill is delivered to your system by swallowing a pill, the vagina ring releases these hormones in to your system slowly over time.

After the week off, a new one is inserted. This is done by the user – so no need to attend a clinic or other appointment to get it fitted by a health professional, like with other contraceptive methods such as the coil.

From speaking to friends about their personal and professional experiences it seems like the vaginal ring isn’t something that is as easy to get hold of as other forms of contraception, at least in the UK!

Pros and cons

Because it doesn’t form a barrier between the vagina and the penis, it doesn’t protect against STIs. The vaginal ring is a form of contraception (helps reduce the risk of pregnancy) but not protection (doesn’t help reduce the likelihood of passing on infections through sex).

Some people may find it difficult to use – it involves being quite comfortable with your anatomy, slightly more so than a tampon.

On the other hand – it works very well. If used correctly, the vaginal ring is more than 99% effective. For comparison, this is more effective than condoms (98% effective). It only needs removing and replacing every four weeks – unlike the pill, which you need to think about every day.

For further details see:

NHS Contraception advice 

 

Posted in contraception, Genitals: A User's Guide

Learning for Pleasure

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I joined the lovely voluntary organisation Sexplain (‘Bringing sexual and relationship education into the 21st Century’) as a volunteer facilitator based on two things.  The first was an array of terrible personal experiences of Sex Ed over two decades ago during my time at school.  The second was professional surprise at how little people (particularly those with vulvas!) appeared to know about the intimate parts of their own bodies when I started working on a Gynaecology ward.

One of the things that I found a little unrelenting about my own school SRE learning experiences was how much the emphasis around sex was ‘not getting pregnant’.  It’s all very well to encourage and teach healthy sexual practices.  However, I feel the message went beyond this.   In my classroom, romantic intimacy amounted to sex and sex meant penetrative, penis-in-vagina sex only.  Pleasure, consent and masturbation were not on the curriculum.  Sex was problematic, dangerous, risky – never ‘fun’ or ‘fulfilling’.  The ultimate hazard was pregnancy and STIs.  Nothing good could come out of sex but if for some reason you found yourself having it, the ultimate consideration was to NOT GET PREGNANT.

It turns out that this world view prepared us badly for adult reality.  We learnt how effective a condom was versus a diaphragm, but not how to procure or negotiate the use of either.   We learnt that STIs cause discharge from orifices that we had only a crude understanding of.

Another classroom illusion that was challenged, by both my personal life and professional experience, was that there is a ‘perfect’ choice of contraception for each person.  For many, contraception can be a compromise, a ‘best match’, or a pragmatic move.  It can take in to account what you feel able to negotiate with a sexual partner.  Or what you can afford or have the time and resources to obtain.  Or choosing something you feel is a bit shoddy, but doesn’t leave you with the terrible side-effects of some methods.

I created ‘contraception top trumps’ because I wanted to look at contraception not as a set of absolutely rational, clear-cut decisions (you fulfil criteria x so you should use y) but as a work in progress.  You can learn about and develop an approach to contraception, depending on what is important to you… and unfortunately there’s an element of luck to the whole thing.

I’ve published a printable pdf of contraception top trumps – I would advise printing four pages to an A4 sheet for large print cards and eight for more portable ones!

The link above is for a smartened up and downloadable version of the top trumps game I published earlier this year here on this blog. One of the lovely things about doing this was the interesting and open conversations this prompted with friends.  For example -the one person who confessed she’d had a blazing row with her GP about removing the hormonal implant because she couldn’t cope with the emotional changes that came once it was fitted and had been told simply to ‘persevere’. Or the friend informed that they couldn’t have the copper coil fitted because ‘she hadn’t had children’.  Or the disbelieving faces that meet you when you look at failure rates of condoms, many peoples’ go-to!   Please download, play, share and learn these with whoever you can and start  your own conversations.

REFERENCES:

All statistics on effectiveness and general information are taken from the NHS contraception guide.

My estimate of 20% effectiveness from ‘a wing and a prayer’ was based on a statistic I saw that said 80% of couples having sex regularly would conceive within one year. So it’s probably a bit low for one single instance of sex.  However, I can’t for the life of me find that and the current online NHS advice on infertility suggests that 84% of such couples would conceive within a year, suggesting a figure of 16%.  Either way, it’s not a great method and is incredibly less reliable than actively doing something.  I just wanted to show that it was not guaranteed that you would get pregnant every time you had sex, even once, which is definitely the impression that I got from Miss Hargreaves in Year 9…

Posted in contraception, reproductive rights

Contraception Top Trumps!

Here’s a round-up of contraception methods, envisaged as the childhood game ‘top trumps’. If you feel I’ve left important pros/ cons or pieces of information out, please tweet me @SquiSquaSque !

I’ll try to update daily with a new card everyday for the next fortnight or so.

Hoping and praying: *for various reasons (lack of knowledge or planning, inability to negotiate) sometimes people do! ** This is an estimate based on the statistic that 80%trying to get pregnant do so within a year.

Fallopian Tube Sterilisation: either clips can be put on to block the Fallopian tubes, or they can be surgically dissectedclosed off. I’ve seen this performed a few times at elective Caesarian section, on request. It isn’t very common in the UK where contraception is widely available. I’ve been told by an Obstetrician that in his home country (a developing nation) it is much more popular for financial and cultural reasons.

Progesterone Pill: a.k.a the mini pill. Take it continuously, so no need to remember when to stop and rest as with the combined pill. As with all progesterone based hormonal methods, this stops your ovaries from ovulating (releasing eggs) and also helps to create a mucus plug in the cervix.

Contraceptive Patch: Works in a similar way to nicotine patches- sticks on to the skin and delivers a substance to your blood stream. I’m not convinced that they are very readily available as I’ve only ever seen them on Sex Ed leaflets.

Mirena: Progesterone based, fitted in to the womb.

Progesterone Depo: A twist on a classic- this injection delivers the hormone progesterone subcutaneously, where it slowly releases in to your body. This suppresses ovulation and thickens cervical mucus. Usually given every 8 weeks. A new preparation is available that is given every 13 weeks and can be self-administered at home. A terrible idea for anyone afraid of needles.

The Combined Pill: Tablet containing the hormones oestrogen and progesterone. This helps to stop ovulation (release of an egg for fertilisation). It is taken for 21 days, with a gap of a week, during which a ‘withdrawal bleed’ takes place. In the UK GP services seem fairly well placed to deliver fairly easy access to the pill, at least compared to other forms of contraception (I’m a bit bitter- I’m currently in the midst of a six week wait to get my contraceptive implant sorted). The main difficulty seems to be remembering to take it. Some people have lifestyles and personalities that are more amenable to this than others.

The Diaphragm:  Fits over the cervix, acting as a barrier to sperm.  Unlike true ‘barrier’ methods like the condom and femidom however, sperm is allowed to enter the vagina, so this method does not offer protection against STIs.   There seems to be some belief that only people who have already given birth can have them.  This isn’t true, but anecdotally I’ve heard from friends that some health care professionals can be reluctant to giving nulliparous people some methods (such as this and the copper coil).  So there may be some truth in this!

Natural Fertility Awareness: I’ve never seriously considered this as an option. It relies on a lot of organisation and not having sex some of the time. However, the real reason is that I didn’t think it was actually any good. My gut reaction is not to believe this ludicrously high effectiveness rate* but that may just be a hangover from sex Ed indoctrination. This figure is quoted from NHS choices who probably have less of an axe to grind than my old PRSE teacher.

Femidoms: work in a similar way to condoms, in that they are made of latex and work as a barrier. They sit in the vagina however, rather than over a penis. For some reason, they never seem to have become as commonplace as condoms, therefore seem much less widely available.

The implant: roughly the size of a match. This sits in your upper arm for up to three years, slowly releasing progesterone to suppress ovulation and thicken mucus at the cervix (entrance to the womb in The vagina). Needs to be fitted by someone with training, e.g. nurse or doctor at a GP or sexual health clinic. Waiting for this can make it a bit trickier to get one inserted, but once it’s in place you’re good to go for three years. Has a very low failure rate and fertility returns very quickly once removed.

The Copper Coil: inserted in to the uterus through the vagina, using a special device. The copper helps thicken the mucus at the cervix (entrance to the womb) to stop sperm from entering. It can also help stop a fertilised egg from implanting into the womb. Because of this theoretically it can be fitted a number of days after sex and act as emergency contraception. However, it needs to be fitted by a professional and this often takes time to arrange. For this reason it doesn’t often seem to be used in this manner, at least not in the UK.

Condoms: Widely available in good (and bad) shops everywhere, as well as some loo vending machines. Generally very cheap (I’ve seen packets for sale in Pound shops). Therefore financial limit to access is fairly small, if still present. However there are some schemes in the UK to get free condoms to particular groups. Red-faced teens in chemists up and down the country show that there’s also a social barrier to obtaining them too. Non-contraceptive uses: good for preventing diseases in penile penetrative sex (e.g. penis to anus).

*Lower efficacy rates been reported (e.g 82%). Lower effectiveness is generally linked to inexperience in using them.

References:

BPAS, accessed Friday 23rd February 2018 at {https://www.bpas.org/more-services-information/contraception/for-men/}

NHS choices, accessed Friday 23rd February 2018 at {https://www.nhs.uk/conditions/contraception/}