This column receives many queries about contraception, even if the latest article has nothing to do with sex.
Is this because, despite our exploding population, our push for family planning and our desire to propagate the one child norm, sex education is not yet an integral part of the school curriculum?
Our teenagers have inaccurate, incorrect and inadequate information about sex from folklore, peers, pornography and the internet.
Contraception is not really a licentious 20th century notion. Nobody ever wanted to reproduce every time they had sex. Egyptian women inserted vaginal tablets made from mildly acidic substances, the French used a hair from a horse's mane and sometimes honey or oil was poured into the vagina soon after intercourse to prevent conception. The Chinese used the first female condoms, a cervical blocking cap made of oiled paper. The first male condoms were made of animal intestine and were used in the 17th century.
These methods were unpleasant and inefficient, so the science of contraception evolved to produce the more reliable methods that we have today.
Women can prevent pregnancy by abstinence (not having sex at all). Timed intercourse is more popular than abstinence and is considered "natural.". The "safe period" when unprotected intercourse is least likely to result in a pregnancy is carefully calculated. Ovulation (release of the egg) occurs in women on the fourteenth day BEFORE the first day of the next period and that is the period of maximum fertility. Avoiding intercourse five days before and after this date decreases the chances of an unwanted pregnancy. This method can be combined with "coitus interruptus", when ejaculation is controlled and takes place outside the vagina.
Women do not function like machines. Menstrual cycles can suddenly lengthen or shorten, making this an unreliable method. Its efficiency can be increased by watching the consistency of the cervical mucous. This changes from clear and transparent to sticky and opaque in the safe period. The body temperature also rises by 0.50 C during ovulation and this can be measured daily with a thermometer. All these methods require an understanding and compliant male partner. They are more successful in planning pregnancy than preventing it.
Oral contraceptive pills (OCPs) taken by women are safe, popular and reliable provided they are taken as prescribed, at the same time every day. They are combinations of synthetic estrogens and progesterones and are taken for 21 days at a stretch. Then there is a "pill free" interval of 7 days, during which menstruation occurs. Some companies provide a 28 day pack, in which the last 7 tablets are placebos. If a pill is forgotten two should be taken the next day. If there has been two or more pill free days contraception is not assured. The actual formulation of the various hormones in the pills marketed vary. The pill best suited to that particular individual can be prescribed. Pills are contraindicated in those with complicated diabetes, thrombo-embolism, sickle cell disease, cancer of any reproductive organ and undiagnosed vaginal bleeding.
Progesterone only pills are also available and can be used in women in whom estrogens are contraindicated. They are taken continuously with no pill free interval.
India has also developed a contraceptive tablet called centchroman which belongs to the SERM (Selective Estrogen Receptor Molecule) group of medications.
OCPs are very safe, can be taken for years, do not increase the risk of cancer or decrease with the chances of a subsequent pregnancy.
Long acting progesterone injections like medroxyprogesterone acetate or norethisterone acetate, can be given every 12 and 8 weeks respectively instead for women who cannot remember to take their tablets.
Alternatively, an IUD (intrauterine device) can be inserted and left in situ to prevent pregnancy for around 3 years.
Condoms, both male and female, if properly used from the beginning to the end of intercourse protect against both pregnancy and STD. Their efficacy is increased if they are combined with a spermicidal cream.
Accidents can occur and people may have sex first and remember contraception afterwards. The government has licensed the use of "emergency contraceptive morning after pills." They are effective if taken within 72 hours.
Abortion is legal in India and medical methods with mifepristone and misoprost can be used up to 49 days.
If the pregnancy is more advanced surgical methods like a suction or dilatation curettage are needed.
Permanent contraception can be achieved by surgical sterilization, a tubectomy in women and vasectomy in men.
Pregnancy can occur if contraception is not used during lactation, with irregular cycles or even if there has been prompt douching.
Responsibility for safe sex, rests with both partners. However, unfortunately it is the women who displays the obvious outward results of an unprotected sexual encounter.
Would men be more careful if they were the ones becoming pregnant?
Dr. Gita Mathai
The writer is a paediatrician with a family practice at Vellore.
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