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Five Things to Know About the Morning-After Pill on Its 20th Anniversary

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Medication portion of PREVEN Emergency Contraceptive Kit. Photo: Smithsonian Institution

In 1993, the New York Times Magazine posited that the morning-after pill might be “the best-kept contraceptive secret in America.” Even many doctors had no idea there was a fallback contraceptive that could be used shortly after unprotected sex or cases of rape.

In many ways, the morning-after pill had been right in front of U.S. doctors for decades. In terms of chemical composition, it was not much different from standard birth control, using the same main ingredients — synthetic hormones — in higher doses. Moreover, many of their colleagues in Europe and Asia had already been prescribing morning-after pills for years.

In 1998, years of research and advocacy led to the first FDA-approved morning-after pill.

Here, however, the secret was still largely intact. A 1994 study by the Kaiser Family Foundation revealed that two-thirds of American women had never heard of the morning-after pill or other forms of emergency contraception (EC). Less than 1 percent had ever used them.

There was an information shortfall in large part because there was no contraceptive that was approved by the U.S. Food and Drug Administration (FDA) specifically for emergency use. Some providers worked around that absence by using the chemically similar estrogen and progestin medications that were approved for regular birth control. By upping the dosage, they created a suitable morning-after pill on their own. But drug makers couldn’t label or market those birth-control pills for emergency, post-coital use, since they weren’t FDA-approved for that purpose. It also spelled problems for federally funded clinics. Federal dollars couldn’t pay for an off-label medication hack, a makeshift morning-after pill that wasn’t officially approved. Continue reading →

STD Awareness: Is Chlamydia Bad?

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chlamydiaPerhaps your sexual partner has informed you that they have been diagnosed with chlamydia, and you need to get tested, too. Maybe you’ve been notified by the health department that you might have been exposed to chlamydia. And it’s possible that you barely know what chlamydia even is, let alone how much you should be worried about it.

Chlamydia is one of the most common sexually transmitted diseases (STDs) out there, especially among young people. It can be spread by oral, vaginal, and anal sex, particularly when condoms or dental dams were not used correctly or at all. It is often a “silent” infection, meaning that most people with chlamydia don’t experience symptoms — you can’t assume you don’t have it because you feel fine, and you can’t assume your partner doesn’t have it because they look fine. If you’re sexually active, the best way to protect yourself is to know your partner’s STD status and to practice safer sex.

Chlamydia increases risk for HIV, leads to fertility and pregnancy problems, and might increase cancer risk.

The good news about chlamydia is that it’s easy to cure — but first, you need to know you have it! And that’s why it’s important for sexually active people to receive regular STD screening. Left untreated, chlamydia can increase risk of acquiring HIV, can hurt fertility in both males and females, can be harmful during pregnancy, and might even increase risk for a certain type of cancer. So why let it wreak havoc on your body when you could just get tested and take a quick round of antibiotics?

To find out just how seriously you should take chlamydia, let’s answer a few common questions about it.

Can Chlamydia Increase HIV Risk?

Chlamydia does not cause HIV. Chlamydia is caused by a type of bacteria, while HIV is a virus that causes a fatal disease called AIDS. However, many STDs, including chlamydia, can increase risk for an HIV infection, meaning that someone with an untreated chlamydia infection is more likely to be infected with HIV if exposed to the virus. Continue reading →

STD Awareness: Gonorrhea, Women, and the Pre-Antibiotic Era

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Penicillin, the first cure for gonorrhea, was developed for mass production in the 1940s.

Penicillin, the first reliable cure for gonorrhea, was mass produced in the 1940s.

It’s Women’s History Month, a time to reflect on the achievements of women worldwide — like Margaret Sanger, Rosalind Franklin, and Florence Nightingale, or contemporary heroes like Wangari Maathai. But it may also be a time to examine some of the sadder aspects of womanhood, including the increased burden gonorrhea imposes on women. While gonorrhea is no picnic for anyone, it wreaks the most havoc in female reproductive tracts. In fact, before antibiotics, gonorrhea was a leading cause of infertility — one 19th century physician attributed 90 percent of female infertility to gonorrhea. Not only that, but the effects of gonorrhea could seriously reduce a woman’s overall quality of life.

With gonorrhea becoming more resistant to antibiotics, the CDC warns of a return to the pre-antibiotic era.

Gonorrhea is described by written records dating back hundreds of years B.C. Ancient Greeks treated it with cold baths, massage, “cooling” foods, and vinegar. In the Middle Ages, Persians might have recommended sleeping in a cool bed with a metal plate over the groin. A bit to the west, Arabs tried to cure gonorrhea with injections of vinegar into the urethra. Kings of medieval England might have had their gonorrhea treated with injections of breast milk, almond milk, sugar, and violet oil.

Although gonorrhea is as ancient an STD as they come, because women rarely have symptoms while men usually do, for much of history it was mostly discussed in terms of men. The name gonorrhea itself derives from the ancient Greek words for “seed flow” — gonorrhea was thought to be characterized by the leakage of semen from the penis. This confusion inspired many misguided notions throughout the millennia, such as the idea that almost all women carried gonorrhea and transmitted it to their unwitting male partners. Continue reading →

Mythbusting: Does Emergency Contraception Cause Abortion?

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[T]he Centers for Disease Control and Prevention reported recently that one in nine sexually active women, or 5.8 million women, has used emergency contraceptive pills, such as Plan B. Emergency contraception is a woman’s back-up method to prevent an unwanted pregnancy, and women report using it when they feel their contraceptive method has failed, such as a broken condom, or they do not use a regular contraceptive like birth control pills.

The latest scientific evidence shows that Plan B works mainly by delaying ovulation — not by affecting a fertilized egg.

Some conservative politicians have been stating publicly that emergency contraceptive pills (ECPs), such as Plan B, cause abortions. They may believe that life begins at conception (fertilization of the egg by the sperm) and argue that ECPs disrupt a fertilized egg’s ability to implant in the uterus, which they consider equivalent to abortion. The American Congress of Obstetricians and Gynecologists and experts from the Food and Drug Administration and the National Institutes of Health consider a pregnancy to be established when a fertilized egg settles itself on the wall of the uterus — implantation. A woman is most likely to become pregnant when she ovulates, which is usually about two weeks before her next period. Sperm can live for up to three days. So, if an egg is fertilized, there are still possibly six to 12 days before the implantation may take place.

When ECPs were first developed and information about them was submitted to the FDA for market approval, the drug manufacturers included mention of every possible mechanism on how the pill might work to prevent pregnancy. This included wording about preventing or delaying ovulation, making the sperm or egg less able to meet, and possibly preventing implantation. However, the latest scientific evidence has shown that ECPs such as Plan B mainly work by delaying ovulation — Plan B does not affect implantation and has no effect on existing pregnancies. Several prominent researchers have stated that if in fact Plan B disrupted implantation, it would be 100 percent effective at preventing a pregnancy, and that is not the case. Continue reading →

Over 90 Percent of What Planned Parenthood Does, Part 15: Fertility Awareness Education

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Welcome to the latest installment of “Over 90 Percent of What Planned Parenthood Does,” a series on Planned Parenthood Advocates of Arizona’s blog that highlights Planned Parenthood’s diverse array of services — the ones Jon Kyl never knew about.

Fertility awareness is not the same as the rhythm method.

Let’s start there.

It’s a common misconception that is, at best, a massive oversimplification that misconstrues the concept and may lead people to dismiss or deride fertility awareness out of hand. In reality, a lot of people could benefit from a more thorough understanding of fertility, as many sexually active couples spend a lot of their lives trying to control it — whether to avoid or achieve pregnancy. Planned Parenthood health centers provide education in fertility awareness-based methods (FAMs) for a variety of purposes.

If fertility awareness is not just the rhythm method, what is fertility awareness?

For someone having menstrual cycles, fertility awareness involves monitoring cycle signs and symptoms — predominantly cervical fluid and basal body temperature, though these are often supported or “cross referenced” by tracking other signs as well — in order to determine when a person is approaching ovulation and/or to confirm when ovulation has already taken place.

How does that even work?

Fertility awareness-based methods rely on a few underlying assumptions about fertility and the likelihood of conception:

  1. For pregnancy to happen, there must be both sperm and an ovum (egg) present.
  2. Ovulation — the release of an egg from the ovary into the fallopian tube — occurs once per menstrual cycle.
  3. Sperm can survive inside someone with a uterus for approximately five to six days. (Note: The actual number a given person or couple will want to use for this assumption can vary a bit depending on whether their main goal is to achieve or avoid pregnancy.)
  4. The ovum itself is viable in the fallopian tube for approximately one to two days. After that, it begins to disintegrate, and fertilization is not possible during that cycle. (Again, different couples may use different assumptions depending on their goals.) Continue reading →

STD Awareness: “Can STDs Lead to Infertility?”

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Being diagnosed with a sexually transmitted disease (STD) can be upsetting. Some take it as evidence that they’ve been cheated on; others wonder if they can ever have sex again. Some people who have long dreamed of having children might worry about what impact, if any, their STD could have on future fertility. The bad news is that certain STDs can make it difficult or impossible to have children. But the good news is that STDs are avoidable — and regular STD screening can ensure that infections are caught and treated before they have time to do damage.

It’s common for STDs not to have symptoms, and infections can cause tissue damage — unbeknownst to you!

Fertility can be impacted in several ways. The ability to become pregnant and bear children can be affected by a condition called pelvic inflammatory disease, which is usually caused by untreated gonorrhea or chlamydia infections. If you have a cervix, an infection with a high-risk strain of HPV can require invasive treatment, which in some cases might affect the ability to carry a pregnancy. If you have a penis, an untreated STD might lead to epididymitis, which in extreme cases can cause infertility.

Pelvic Inflammatory Disease (PID)

Many sexually transmitted infections are localized; for example, the bacteria that cause gonorrhea usually just hang out on the cervix. But untreated infections can spread on their own, and bacteria can also hitch a ride on sperm or the upward flow of a douche, which can take them into the cervix, through the uterus, down the fallopian tubes, and to the ovaries. At any of these locations, microbes can stake claim on your reproductive real estate, establishing colonies deep in your reproductive system. As these colonies grow, the bacterial infections become more widespread, and can cause scarring and other tissue damage. To keep these interlopers from getting through the front door, sexually active people can use barrier methods, such as latex condoms — especially with spermicides. There’s no need to host an open house for sexually transmitted bacteria in your uterus. Continue reading →