December 1, 2012

Birth control options.. Post 1

Posted by maithili at 7:25 PM
       A few days back a survey form was forwarded to all darlings via mail and through facebook. As mentioned in that form, the responses to the questions regarding contraceptives were piled and I requested Dr Roshan Radhakrishnan to write a post for Darlings of Venus on the same. I m thankful for the great work he has done and made it possible to put up this post on World Aids Day. I want this post to reach as many women as possible and I therefore request all Darlings to please share this post with your friends. It might do a lot of people good. A document form of the post will be mailed for those who wish to save it for further reference or forward it through mail.Kindly share your email ids on comment or facebook page so that we can mail you. Handing over to the man himself!

     Let’s talk about (safe) sex, baby !

Talk about any controversial subject and instantly, people will add on their cultural, religious and other opinions to it and just drag the discussion away from the original topic. Sex for any reason other than procreation or giving your parents a bunch of grandkids tends to come under that heading sadly even today in so many educated homes. 
It is actually a normal part of a relationship between two people - the culmination of love/lust or maybe even the start of it. However, because of all the taboos associated with just the topic, the one thing that gets totally sidelined is perhaps the most key ingredient in the sexual relationship: The choice of when/whether to have a child and how to prevent getting pregnant till you are ready. 

Unlike a few generations ago, you are now blessed with a lot of options for this, be it physical, pharmaceutical or surgical. However, the biggest barrier to using them tends to still be in the mind. During my postings in obstetrics & gynaecology and even later as an anaesthetist, I have watched doctors struggle over the last decade to get the public and patients to adopt contraceptive measures. Even as they allow their own economic and health issues to be further burdened, they refuse to consider stopping even after 6-8 children. 
The reasons stated against using them are aplenty and even bizarre at times : I want a boy/ I want a girl / I want a sister for my son/ I want a brother to look after the sister who will look after her younger brother/ No one else in my family uses protection / It's against my religion / How to tell him to use a condom / My mother told me not to use anything. 

Sigh. As I said, having children is an important decision in any couple's life. Have them for the right reasons... not because mommy told you to do so or because a condom broke. 
 Now, we all know how and where babies come from, thanks in no small part to our parents and Cartoon Network : storks deliver them when mommy and daddy love each other. While these storks tend to be really busy in our beloved nation, sometimes we would just prefer that the storks took their own sweet time and circled around the block before they visited us. I came across a couple of text books while I was studying medicine that had weird theories about how children were created and how in their 'medical mythologies', people could delay the stork's arrival.   

Before we discuss these techniques, repeat after me : Sex. Vagina. Boobies. Penis. Sperm. Hugh Jackman.
Okay, these are words that may come up during this post so it's important you don't feel embarrassed by them ( Ok. Boobies won't be coming... I just didn't want them to feel left out. )   

Now,  Maithili had sent some of you surveys which you had filled out regarding this topic. It gave me a good starting point on what needed to be taught here. Since the topic is quite vast, I'll give you the main highlights that will help you decide what form of contraception best suits your needs.

Post 1 will deal with :
  1. Calendar method.
  2. Withdrawal method.
  3. Emergency contraceptive pills.
  4. Condom - Male
  5. Condom - Female
Post 2 will deal with :
  1. IUDs
  2. Oral contraceptive pills
  3. Foams, jellies, spermicides
  4. Injectable contraceptive
  5. Male/Female sterilization
Above all else, consult your gynecologist. They are there to provide the best advice to you. They are your doctors and you have no need to feel embarrassed while discussing options for birth control with them. 

1. Rhythm method :
  • Involves you and your partner having sex on days when you are least likely to be fertile.
  • Based on your regular menstrual cycles. 
  • Evolved from Knaus Onigo method to present standard days method.
  • Standard Days method :
    • Day 1-7 of menstrual cycle ( Day 1 - start of your period ) : safe for sex.
    • Day 8-19 : Thou is fertile. No unprotected sex.
    • Day 20 to end of cycle : You may have unprotected sex.
  • Well, this is commonly taught in developing countries ( India included ) where you don't have many alternatives for contraception. It has a average-decent success rate ( 88-95% ) but you can see flaws just while reading the chart.
    • It is not necessary for everyone to have the same fixed cycle every month.
    • The difference in luteal phase after ovulation differs from person to person and based on various factors including use of birth control pills, stress, breast feeding etc. So assuming 20 as the day to 'pop the champagne' may be good for some of you but for others, you may still be in the fertile phase.
    • Not all bleeding is due to menstruation, which is the assumption and hence, starting point in this cycle.
    • Most importantly by this method, the way I see it, if you don't use another form of contraception ( for whatever reason ), you've basically cut down your sex life to Day 20- end of cycle.  Ya, that's one horny bull you've got waiting for you at Day 19 and three-quarters.
2. Withdrawal method / Coitus interruptus
  • Probably the world's most common 'method of contraception', seeing as it's free of pills, packets or prescriptions. So there's no risk of side effects to hormonal pills and latex rashes etc.
  • A very simple yet effective technique, involving the guy removing his penis from the vagina before ejaculation. By itself, it has a success rate varying from 76-96% based on many studies. This number increases greatly if you combine it with other means like wearing a condom.
  • Risk is quite obvious : the guy knowing when his dynamite's gonna blow and having the self control to stop himself long enough to detonate elsewhere. This involves a certain amount of trust between partners as well. 
  • Common question : What about the pre-ejaculate ( aka Cowper's fluid aka the clear viscous stuff that comes out from the penis when your guy is moving from 1st gear to 2nd gear and beyond ) ? Well, the composition is like semen but studies have yet to conclusively determine the viability of what little sperm there is.   
  • More importantly, this will not prevent STDs.

3. Morning after pill / Emergency contraceptive pill
  • Contrary to popular belief, more often than not, you don't get preggies the moment you have sex. Or the same hour... or even the same day usually. Just like men, sperm too do not stop to ask for directions while they go hunting for the fallopian tubes ( their FINAL DESTINATION ) Hence, there is an actual window period between having unprotected sex and fertilisation of the ova.
  • The pills usually contain higher doses of the same hormones used in OCPs ( progestin only/ progestin+estrogen ). They may act by delaying ovulation or preventing fertilisation or preventing a fertilised egg from implanting in the uterus. 
  • Meant only for those 'emergency' times - unprotected sex, a broken condom. You cannot substitute these pills for your regular ocps - higher doses , remember ? If the 'moments of unexpected passion' are bound to be unexpected and spontaneous, consider starting another form of birth control.
  • Most come with packet directions suggesting use upto 72 hours after sex. If there are two pills, the second one is ideally taken 12 hours after the first ( Again. Follow the instructions in the packet ).
  • Side effects : generally mild and short lasting - nausea, vomiting, headache, fatigue, abdominal pain. If you vomit within two hours of taking the pill, you may need to consider consulting a gynecologist regarding whether to restart the dose again. 
  • Will not protect you from sexually transmitted diseases.
4. Condom - Male
  • The super-elastic latex scabbard for your mate's sword. Comes in various colours, flavours, 'modifications' ( ribbed / dotted - we need all the help we can get to find the g-spot ladies, bear with us. ) and even with anesthetic gels to make him last longer. 
  • One of the most easily available, inexpensive and popular contraceptive methods available.
  • Single use. Seriously. 
  • All condom packets come with instructions. Apply the rolled up condom onto the tip of the erect penis and unroll it onto the penis. That tip at the top isn't a snout - it collects the semen once he comes ( otherwise the semen would be forced out of the condom due to pressure. )
  • Does not need the addition of another lubricant - oils make them break or slip off. If at all you do feel the need to use, use a water based lubricant rather than an oil-based one.  
  • There's no need to 'pre-test' : these aren't Christmas lights that you need to test them before you use them. If you're just inquisitive or planning on having fun, then sure fill it up with water to your's hearts content - we've done that for a friends birthday at the hostel instead of balloons. Prepare to be shocked at how large they can get. 
  • Protects you from sexually transmitted diseases. 
  • After ejaculation, he still has to remove his penis and the condom en mass and then safely dispose of said condom once its away from the vagina. Removing the penis and leaving the condom there leaves the risk of the sperm still falling back into the vagina.
  • Double bagging : a condom over a condom. The jury is out on this one - early claims stated that the two rubbers rubbing each other may cause friction and a tear but other studies say it's beneficial. 
  • Risk of pregnancy or STD relates mostly to tear in the condom, which isn't really common. 
  • The guy may complain of diminished pleasure wearing it. The onus of showing his Highness how 'relative' a term diminished pleasure is when he's got the girl of his dreams in bed with him - that's up to you !      
5. Condom - Female
  • The lesser known one - were you even aware you had condoms ?
  • The sheath ( made of polyurethane / nitrile / latex ) has two rings at either end - the outer ring remains outside the vagina and may even cover the labia. The inner ring... goes in.
  • While not fully endorsed, various studies have discussed washing, drying and re-using of the female condom.
  • Protection from STDs.
  • Lubrication rules : no oil based lubes but you will need (water based) lubrication for the guy.
  • Don't use both a male and female condom simultaneously - friction may cause them to break, remember ? 
  • To remove - twist the outer ring gently and then pull the condom out.
  • Advantages : nitrile is safe for guys with latex allergy, can be worn hours before the sexual encounter and doesn't require immediate removal either.
  • Disadvantages : 2-3 times as expensive ( if used once only ), used to be some weird sounds with polyurethane versions when you get down to business, the exposed outer ring can be a turn-off.  

That's it for Class 1. The rest will be discussed in Class 2. Till then, play safe and have fun.

P.S. I lied. Hugh Jackman isn't appearing in this blog post.


Arch on December 1, 2012 at 9:12 PM said...

Doc, Thanks so much for this post! I have always been interested in learning as much as I can on this topic, and no other site I have read has discussed it this clear. Thank you, and looking forward to the next posts.

AJNABI on December 2, 2012 at 12:45 AM said...

Nyc and knowledgble post thanks

Anita Jeyan on December 2, 2012 at 11:31 AM said...

I almost laughed aloud reading the 'asking for directions' part and the FINAL DESTINATION. Very informative. I wish this post gets as much publicity as it deserves.

Nisha on December 2, 2012 at 2:13 PM said...

Brilliant post. Very Informative and keeps you interested. Doc did the right thing by not leaving out boobies!!

Wings of Harmony on December 2, 2012 at 6:42 PM said...

I wish this was the way we were taught about "the sex education" at school. :| Apart from being informative, this was hilarious too. (Hugh Jackman! He shouldn't really come under the protection this ;)) Thank you SO much Doc! Shared it on Twitter! :D

Dr Roshan Radhakrishnan on December 2, 2012 at 9:10 PM said...

Arch, glad you are inquisitive. It's a topic that everyone should really take the trouble to find out, since in general, sex education is a very taboo topic in our society.

Thank you Ajnabi.

Anita, glad you liked it... Publicity is upto you gals :D

Nisha, them boobies deserve all the respect in the world ( well, in bed, atleast ) !!

Mystical Skeptical Me, first off - awesome name ! Did you gals have sex ed - cause we never did as far as I remember. I'm still partly convinced in the 'Stork delivering' theory... and I'm a doctor ! And yes, I see how redundant putting Hugh Jackman in a 'safe sex' class is - my bad ! :D

Varsha on December 2, 2012 at 9:19 PM said...

Great, witty and informative! No one could have written it better. Who would believe you are not a gynecologist! Awesome hats off Doc

Rachna on December 3, 2012 at 9:44 AM said...

Roshan a nice post, really. I guess we are squeamish to even talk about these topics and have loads of reasons for not using contraception. Yes, it does help to speak to the gynaecs about it. And, these days the internet offers a lot of opportunity to get information and then clarify doubts with a doctor.

Vinita Apte on December 3, 2012 at 1:03 PM said...

Wonderful post yet again Roshan :)

Shilpa Garg on December 3, 2012 at 5:02 PM said...

A witty and informative post on a topic that is so taboo... awesome post, Roshan!

Dr Roshan Radhakrishnan on December 3, 2012 at 6:36 PM said...

Thanks Varsha. Lots of gynaecs could have done better - just maybe with less boobies and Hugh Jackman in their post :)

Rachna, sadly people remain squeamish in this topic even with their gynecologists... the net gives information, no doubt but not many have access to the net even today sadly.

Thanks Vinita :)

Shilpa, thats the point - it should not be taboo.. not in a nation bursting at the seams with population rise !

Smita on December 3, 2012 at 8:07 PM said... was an informative plus hillarious post :P Loved the mixing of words with humor !!!

Hugh Jackman shud have appeared na ;)

Okay, honestly, I gained less knowlwdge, (need a practical I guss LOL ) but surely got to know much for starters :)
Thanks for the post :)

Wings of Harmony on December 3, 2012 at 8:25 PM said...

Thanks Doc!! :D

Dr Roshan Radhakrishnan on December 3, 2012 at 8:46 PM said...

Smita, dont worry - when the time comes, you will find you have the knowledge within you :D This is pretty much meant as a starter course so that women are aware of all their options. People tend to avoid this topic always so just laying out 'the merchandise'.. as I said, the best guide is always your gynecologist


Spaceman Spiff on December 3, 2012 at 9:52 PM said...

That I see this post exactly a week before my wedding must be just sheer coincidence, right? Not that sex has anything to do with marriage.. but still. :D

Soumya on December 5, 2012 at 12:18 PM said...

Thank you so much Doc.

Hugh Jackman not appearing is such a disappointment. I thought he'll appear as a sperm donor :D

Very informative post, I'll save it for my children :)

Arcane on December 5, 2012 at 4:35 PM said...

Wow I come to your blog and end up seeing so many post and which one do I comment on, well this one!

Quite an informative post and well people in India dunno why they still feel shy of talking all this to their gynaecs or even their better half, if you can have sex why not discuss and try to have safe sex!

Sadly, my school also din have any sex-ed class but got some good information here, not that I haven't read about it before but this was like a step by step manual :D

And btw, going by the comments it seems you are a doc if not gynaec, whats your specialization ??

Dr Roshan Radhakrishnan on December 5, 2012 at 5:19 PM said...

Spaceman, :D what better post to get you started !! All the best and have a blast :D

Soumya, so sorry.. he backed out at the last minute... better luck next post :D

Arcane, in general, the patients who visit the hospitals tend not to even discuss with their husbands... they just go with the flow. It becomes the gynecs headache to try and teach the couple options while shes busy delivering !!
And, I'm at the other end of the operative table usually - an anaesthesiologist.

Bhavana on December 5, 2012 at 10:22 PM said...

Great post! And having watched some of the workers teach sex workers and drug addicts on safe sex, may I add some insights here? First of all, many men do not like the use of condom--ahem, they like it "raw." Women have to develop the art of saying, "if you want it raw, we have to kiss some other day." IT is a difficult thing, believe me, to say. Next, there are ways to please a man into enjoying a condom. Women need to learn the art of putting on a condom seductively so that protection itself becomes an erotic possibility!
Female condoms are nice but expensive. But when you know you may be having sex, you can walk into the washroom, wear it and step out. It gives a sense of control But yes, danged expensive. And I dont know where one can buy it in India :(
Regarding emergency pills--if you have major mood swings or depressive disorder, the hormones can be very intense on you. Watch out! You may need to stay in touch with your consellor during the days that follow.
Regarding withdrawal method--ahem, there are cases when late fertilization also occurs--the time when you think it is safe..the egg is weak but pregnancy is known to happen!

Dr Roshan Radhakrishnan on December 6, 2012 at 9:26 AM said...

The art of putting on a condom seductively is indeed something that can help maintain the mood.
As for female condoms, while I believe they are available, I too have no idea where.
And the last thing you describe is the rhythm method - and ya, I dont see it as very accurate at all,simply because it takes for granted that everyone has fixed rigid cycles, which is just not true.

Eyes-speak on December 6, 2012 at 1:12 PM said...

Quite informative...
Would be of a great help to many of us for sure...:)

Dr Roshan Radhakrishnan on December 7, 2012 at 5:57 PM said...

glad to know Eyes-speak :)

SuKupedia ™ :) :) on December 8, 2012 at 8:06 PM said...

I just hope all the methods mentioned here work..and does not dupe.. like you.. you promised Hugh Jackman O_O

On a serious note.. a very educative post.. really liked the way you have written it.. :) :)

Dr Roshan Radhakrishnan on December 9, 2012 at 12:14 PM said...

Would you settle for that wolf guy from the 'Twilight' series :)
And as for them working, well, most of the methods come with a statistical range of around 94-99% ( except that withdrawal method for obvious reasons :D )

Keirthana on December 11, 2012 at 9:15 PM said...

A very clear and educative post helping to know the things that we ought to know. Thanks to Dr. Roshan for doing this and thanks to Maithili for coming up with this attempt :)

Dr Roshan Radhakrishnan on December 12, 2012 at 8:03 PM said...

Welcome Keirthana... always glad to help... stick around... there will be a second post..

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