Tag Archives: efficacy

Contraception Then and Now

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When it comes to contraception, one thing is for sure: We’ve come a long way! And while the future might have even better things in store, like reversible male birth control, superior condoms, or remote-controlled implants, a look into the past reveals that modern contraceptors have a bevy of fantastic options to choose from. Unlike couples who had to forgo contraception or obtain birth control from the black market, nowadays Americans wishing to prevent or postpone pregnancy can select from a variety of legal, effective, and increasingly accessible family-planning methods.

While the history of birth control is fascinating, today’s contraception is the very best.

Let’s look at some old-fashioned birth-control methods and see how they stack up to their modern-day counterparts.

Linen and Guts vs. Latex and Polyurethane Condoms

Most people think of female condoms as new inventions, but the first condom recorded in history was made out of a goat’s bladder and inserted into the vagina — way back in 3000 BC. Ancient civilizations, from the Romans to the Egyptians to the Japanese, made penile sheaths and caps with a variety of materials, including linen, leather, lubricated silk paper, intestines, and tortoise shells. Linen and intestines remained popular through the Renaissance era.

A condom, with user manual, 1813. Photo: Matthias Kabel

Charles Goodyear might be most famous for tires, but his discoveries in vulcanizing rubber also led to the development of rubber condoms in the mid-1800s. Unfortunately, the Comstock Act of 1873 outlawed the manufacture and sale of contraception, and condoms were driven into a shadow economy. In the 1880s, New Yorkers might have been lucky to find black-market condoms made from surplus animal intestines, which were manufactured by Julius Schmid, a German immigrant who otherwise specialized in sausage casings — before his business was shut down by the New York Society for the Suppression of Vice. Condoms weren’t legal in the United States until the Crane ruling of 1918, just in time for the 1920 invention of latex, a form of rubber that was much stronger and more elastic — and with a shelf life of five years vs. rubber’s three months. By the 1920s, Schmid was once again on top of the condom game, peddling brands like Sheik, Ramses, and Sphinx.

Condoms made out of intestines are still on the market, sold as lambskin or “natural” condoms. However, they are not recommended for STD protection: Just as intestines need to allow nutrients to enter the body from digesting food, so too are viruses able to pass through condoms made from intestines. (Sperm, on the other hand, are thought to be too big.) These days, latex is the gold-standard material for condoms, while polyurethane can be used by people with latex allergies. Condoms constructed with these modern materials protect users from unintended pregnancy as well as many sexually transmitted infections, such as HIV and chlamydia. Continue reading →

“Instrument of Torture”: The Dalkon Shield Disaster

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This Dalkon Shield is archived at the Dittrick Medical History Center and Museum at Case Western Reserve University. Photo: Jamie Chung

This Dalkon Shield is archived at Case Western Reserve University. Photo: Jamie Chung

These days, IUDs, or intrauterine devices, have stellar reputations as highly effective contraceptives. Along with implants, IUDs can be more effective than permanent sterilization, and their safety record is fantastic. We also have powerful regulations in place to keep dangerous medical devices off the market, and the FTC can keep manufacturers from making false claims in advertising.

But a previous generation of birth-control users might associate IUDs with dangerous pelvic infections and miscarriages. That’s because a single device, called the Dalkon Shield, almost single-handedly destroyed an entire generation’s trust in IUDs. At the time of its debut, there were dozens of IUDs on the market — but the Dalkon Shield unfairly tainted the reputation of all of them. With no FDA or FTC regulations reining in untested devices or false advertising, women in the late 1960s and early 1970s didn’t enjoy the protections that we take for granted today. And it was actually the Dalkon Shield’s string, which was made with a material and by a method that hasn’t been used in IUDs before or since, that made it dangerous.

Today, IUDs are the most popular form of contraception among physicians wishing to avoid pregnancy.

We’ve known about IUDs for more than a century, and have made them out of ebony, ivory, glass, gold, pewter, wood, wool, and even diamond-studded platinum. These days, IUDs release hormones or spermicidal copper ions, but these older devices were simply objects inserted into the uterus that acted as irritants, possibly enlisting the immune system to kill sperm. They were not as effective as modern-day IUDs.

The Dalkon Shield was invented in 1968, was made primarily of plastic, and had “feet” — four or five on each side — to prevent expulsion. In 1970, after being marketed independently, it was sold to family-owned pharmaceutical giant A.H. Robins Company, of Robitussin fame. It was manufactured in the same factory where ChapStick was produced, and retailed for $4.35.

Dr. Hugh J. Davis, the Dalkon Shield’s primary inventor, claimed that users of his device had a 1.1 percent pregnancy rate — but that number was based on a small, methodologically flawed study conducted over eight months. In fact, the Dalkon Shield had a 5.5 percent failure rate over the course of a year. The fact that the Shield didn’t provide high protection against pregnancy was a huge problem, but its design also dramatically increased risk for pregnancy complications. Of the tens of thousands of users who became pregnant while wearing the Dalkon Shield, 60 percent of them had miscarriages. Continue reading →

Let’s Talk Contraception: What Contraception Does Your Doctor Choose?

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IUD in hand croppedHave you ever wondered what birth control method your health provider has chosen to use for her contraceptive? Though it is usually not relevant or ethical for your provider to disclose something so personal, you might find it helpful and reassuring to know this information when you are deciding which contraceptive is a good choice for you.

Thanks to the Affordable Care Act, you might not have to worry about footing the bill for an IUD or implant yourself.

New research by Planned Parenthood has some answers to this question. In a recent study published in Contraception, the official journal of the Association of Reproductive Health Professionals and the Society of Family Planning, Planned Parenthood researchers found that women’s health care providers are three-and-a-half times more likely to choose long-acting reversible contraceptives (LARCs) such as IUDs (intrauterine devices) and implants as their contraceptive of choice. Forty-two percent of providers use LARCs, compared to just 12 percent of women in the general population. The birth control pill is used far less often, by only 16 percent of providers surveyed. Earlier studies have also shown these differences, but the Planned Parenthood study shows an increasing trend of women health care providers choosing LARCs.

The Centers for Disease Control and Prevention also conducts surveys and studies to look at contraceptive usage across the general population. Their surveys have shown an upward trend in LARC use — a five-fold increase in the last 10 years. Most of the women using these methods are 25 to 34 years old. But women in general use LARCs far less often than the percentage of health care providers reporting they use LARCs in the Planned Parenthood study. Continue reading →

Let’s Talk Contraception: How Effective Is My Birth Control?

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According to the Guttmacher Institute, 62 percent of women of child-bearing age (roughly 15 to 44 years of age) currently use a contraceptive method. Most contraceptive users are married and on average would like to have two children. This means that a woman might be using a contraceptive method for more than 30 years.

Studies have calculated that if a sexually active woman is not using any contraceptive method, over the course of a year she has an 85 percent chance of becoming pregnant. Using contraceptives greatly decreases this chance, but there are still some possibilities that her contraceptive method could fail to prevent pregnancy.

To maximize your contraception’s effectiveness, use it as correctly and consistently as possible.

When choosing a contraceptive method, you might want to use the safest and most reliable method available. How likely is it that your choice could fail? With the many types of birth control at your disposal, how do you know which is most effective? And why, with even the most effective contraception around, do women still have unintended pregnancies?

If we rank birth control methods according to most effective to the least effective, how do they compare? How is effectiveness measured?  Continue reading →

STD Awareness: The Next Generation of Gardasil Is Coming!

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noisemakersIt’s January, which means it’s time to festoon our surroundings with streamers, throw around the confetti, break out the noisemakers, and shout Happy Cervical Health Awareness Month!

And, in 2015, we have something huge to celebrate: Last month, the Food and Drug Administration (FDA) approved Gardasil 9, the next-generation HPV vaccine, which provides broader protection than the current version. Next month, the new and improved vaccine will start to be shipped to health care providers, and the Advisory Committee on Immunization Practices is expected to give the Centers for Disease Control and Prevention the green light to recommend the vaccine, after which insurance plans and the Vaccines for Children program should start covering it.

The newest version of Gardasil protects against the seven strains of human papillomavirus that together cause 90 percent of cervical cancers.

Why is this news so exciting for people who care about cervical health? Because, while the current version of Gardasil, which debuted in 2006, protects recipients from the two HPV strains that cause 70 percent of cervical cancers, Gardasil 9 will protect against seven strains of HPV that collectively cause 90 percent of cervical cancers. On top of that, both versions of Gardasil protect against the two HPV strains that are together responsible for 90 percent of genital warts.

Gardasil 9 has been shown to be highly effective in clinical studies, and it is safe to use, which means Gardasil just became an even more potent weapon against cancers caused by HPV. Not only that, but vaccination against HPV will also reduce the frequency of precancerous lesions, which are cellular abnormalities that can be treated before progressing into full-fledged cancer. Less pre-cancer means less time, money, and anxiety spent dealing with followup procedures after an abnormal Pap test, for example. Continue reading →

Contraception in the Zombie Apocalypse

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The zombie hoard approaches. Photo: Caio Schiavo

The zombie horde approaches. Photo: Caio Schiavo

If you’ve watched a zombie movie with your friends, you’ve probably talked about what kinds of weapons you’d be packing in case of a zombie apocalypse. The Centers for Disease Control and Prevention even has a list of supplies you’ll need for a zombie preparedness kit, which includes smart choices like water, duct tape, and bleach. (I would add toilet paper to that list. How you’ll miss it when you’re on the run!) But how many of you have discussed birth control?

You’ve probably picked out which weapons to use during the zombie apocalypse. But have you chosen a birth control method?

Even if your greatest dream is to have a baby, you must admit that the zombie apocalypse is the worst time to be pregnant, give birth, and raise a child. Fleeing and hand-to-hand combat can be a drag while pregnant, and childbirth can kill you, especially without access to trained personnel or hygienic supplies. And if you do manage to birth a baby into this cruel new world, diapers can distract from more pressing duties, and the infant’s cries can attract undead attention.

When you’re in hardcore fight-or-flight mode, taking a pill at the same time every day might be difficult, and besides, a supply of pills can take up valuable backpack real estate. Plus, even if you find an abandoned pharmacy to raid, birth control pills and condoms come with expiration dates and can be affected by high temperatures. The same goes for contraceptive patches and rings. For these reasons, you need a contraceptive method that’s well suited to the zombie apocalypse. Besides abstinence, what are your options? Continue reading →

Let’s Talk Contraception: Is Spermicide Effective?

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According to the Guttmacher Institute, 0.5 percent of all contraceptive users surveyed in 2010 relied on spermicides as their contraceptive. Although not used often, they are a part of the contraceptive choices sexually active people have to prevent pregnancy. How effective are they, however?

The only available spermicide in the United States is nonoxynol-9. It is available in many products, such as a foam, cream, gel, suppository, or dissolvable film. Nonoxynol-9 is also the main ingredient in the Today contraceptive sponge.

Some spermicides increase risk of HIV transmission.

As a contraceptive by itself, it is not very effective at preventing pregnancy. Throughout the course of one year, and with proper use at every sexual act, 18 women out of 100 will become pregnant using spermicides alone. If used less than perfectly, that number rises to 29 out of every 100 women becoming pregnant. When used with a condom, however, the effectiveness is greatly increased. And spermicides are regularly used in combination with diaphragms and cervical caps. Continue reading →